Long-term effects and costs of pelvic floor muscle training for prolapse: trial follow-up record-linkage study

Abstract

Introduction: Pelvic organ prolapse affects around 40% of women aged over 50 years. A multicentre parallel group randomised trial (the Pelvic Organ Prolapse PhysiotherapY (POPPY) trial) demonstrated pelvic floor muscle training (PFMT) was effective in reducing prolapse symptoms compared to no treatment. However, insight into the long-term impact of PFMT on health outcomes and health service utilisation is scarce. Methods: This study utilised linkage of Scottish administrative health records to follow-up POPPY trial participants resident in Scotland over 11 years. Mixed effects logistic regression determined the likelihood of receiving further prolapse treatment for those in the PFMT and control group. Analyses were adjusted for age group, prolapse stage, baseline symptom severity and attitude towards surgery. A cost assessment estimated longitudinal costs to the UK National Health Service (in Scotland) of accessing further prolapse treatment for each trial group. Results: 293 women, aged 25 to 79 years, were followed-up. 141 women (48.1%) had received further prolapse treatment: 65 (of 149; 43.6%) in the PFMT group compared with 76 (of 144; 52.8%) in the control group. PFMT was associated with a reduction in the odds of any prolapse treatment during follow-up (AOR 0.61 95% CI 0.37 to 0.99). Total cost of secondary care was 154,544 (GBP) PFMT group and 172,549 (GBP) control group. Conclusions: While PFMT did not lead to significant differences in total costs for further prolapse treatment over a post-intervention period of more than 10 years, it reduced the overall long-term risk of requiring hospital-based treatment for pelvic floor disorders.