Surgical Versus Nonsurgical Treatment of Women With Pelvic Floor Dysfunction: Patient Centered Goals at 1 Year

Abstract

Objective-In women with pelvic floor dysfunction (PFD), we assessed the degree to which treatment (surgical vs. non-surgical) was associated with achievement of patient-centered goals, satisfaction with care, and quality of life. Study design-Prospective cohort. Between September 2003 and December 2004we recruited women during their first referral visit for PFD treatment at our outpatient Urogynecology Clinic. At the first visit, women enumerated up to five personal treatment goals, and "anchored" each goal by anticipating best and worst possible outcomes. At 12 month follow-up, women were asked to indicate their level of goal attainment (−2, worst outcome; +2, best outcome). At baseline and follow-up, women completed short forms of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) (range 0-100, high scores indicating greater impact or distress). Patients indicated level of treatment satisfaction on a 4 level ordinal scale.Results-Of the 127 study participants with complete data, 46 (36.2 %) were managed surgically and 81 (63.8%) non surgically. There were no major demographic differences between the two groups in terms of age, race, weight, prior PFD surgery, and vaginal parity. The surgical group was more likely to have received baseline diagnosis of pelvic organ prolapse (80 % vs 60 %, p = 0.0259), and be post-menopausal (89 % vs 72 %, p = 0.0261). There were no significant differences in the distribution of goal type (symptom relief, activity, self image, general health) by treatment status (p = 0.1074). Using logistic regression to adjust for age and baseline diagnosis, surgically managed patients at one year were significantly more likely to report complete primary goal attainment (odds ratio (OR) = 4.42; p = 0.0154) and complete treatment satisfaction (OR = 6.12; p = 0.0109). For all participants, one-year IIQ-7 and UDI-6 scores were significantly correlated with primary goal attainment scores.Correspondence: Kathie L. Hullfish, MD, Associate Professor, Department OB/GYN and Urology, PO Box 800726, UVA Health System, Charlottesville, VA 22908, O: 434-924-2103, Fax: 434-982-1841, Email: khullfish@virginia.edu. Condensation: self-described patient treatment goals are similar in surgical and non-surgical patients with pelvic floor dysfunction, but are more likely to be completely achieved in the surgical group one year later Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-In this non-randomized, prospective analysis, surgically managed patients with PFD had higher one-year self-described complete goal attainmen...

Goal attainment after treatment in patients with symptomatic pelvic organ prolapse

“…We found that both surgery and pessary patients with pelvic floor dysfunction stated that their most important treatment goal was to address prolapse symptoms. Similar to our findings, another study 10 that examined the qualitative aspect of patient goals and expectations found that nearly half of all women with pelvic floor dysfunction had concerns relating to symptoms caused by or exacerbated by their prolapse. A different study that evaluated goals and severity of prolapse 11 noted that relief of urinary symptoms was the most commonly stated goal regardless of prolapse stage.…”

“…13 And although there was a nonsignificant difference in overall goal attainment between pessary and surgery groups for POP, surgically managed patients overall had higher rates of satisfaction at 1 year compared with nonsurgically managed patients (P = .0109). 10 The surgical cohort was followed long-term and patients showed 68% goal attainment at 1.8 years. 3 In our current study, although both pessary and surgery groups demonstrated significant improvements in symptom distress, sexual function, and body image, we too found that among women treated for symptomatic prolapse, surgery patients reported higher goal attainment compared to the pessary group.…”

Should we use pessaries for pelvic organ prolapse?

“…21 In a nonrandomized prospective cohort study by Hullfish et al, patients centered goals were evaluated by using a Goal Attainment Scale (GAS); a 5-point scale, with -2 assigned to the worst outcome and +2 to the best outcome; between surgically treated and nonsurgical treatment in patients with pelvic floor dysfunction. 22 In this small study of 127 participants, there was a non-significant difference in overall patient goal attainment, but at 1 year surgically treated patients were 4 times more likely to report primary goal attainment than those treated with pessaries, medication, behavior modification programs and expectant management. Symptom relief and activity improvement were the two most commonly cited goals.…”

Outcomes and Pelvic Floor Interventions: Can We Predict?

“…In GAS, patients judge their own treatment outcomes based on pretreatment, self-identified goals that have been set or "anchored" by the worst and best possible perceived outcomes [31]. Attaining predetermined, patientspecified, or patient-stated goals has been associated with increased patient satisfaction after PFD treatment after 3 and 12 months' follow-up [32,33], as well as with choosing to undergo surgical versus nonsurgical treatment for PFDs [34]. PFD treatment goal attainment has also correlated independently with condition-specific QoL and satisfaction [31].…”