70: Long-term improvements in physical activity levels and physical functioning after midurethral sling for female stress urinary incontinence

Abstract

To estimate the long-term effect of the midurethral sling on leisure physical activity (PA) levels and physical functioning (PF) in women 5 or more years after surgery for stress urinary incontinence (SUI). We conducted a long-term follow-up study of a previously published prospective, observational study of women undergoing outpatient midurethral sling for SUI from 2009 to 2011. For the primary study, and this follow-up study, women completed validated questionnaires for incontinence, leisure PA, and PF at baseline and postoperatively. The questionnaires included the UDI-6, International Physical Activity Questionnaire (IPAQ), Pelvic Floor Distress Inventory-20 (PFDI-20), Body Image Scale (BIS), and the NIH Patient-Reported Outcomes Measurement Information System measure for physical functioning (PROMIS-PF). Women were categorized as having sedentary, insufficient, or sufficient leisure PA levels by metabolic equivalents (MET-min/week on the IPAQ). They were also categorized as having low, moderate, or high overall PA levels using IPAQ scoring rules. For this follow-up study, all patients who consented to participating in future studies at the time of enrollment in the initial study were contacted via telephone to complete questionnaires through mail or e-mail. PA and PF levels were compared pre-operatively and at 5 or more years follow-up. Paired T-tests, signed-rank tests, and linear regression were used to estimate the effect of improvements in urinary symptoms on PA levels and PF scores at long-term follow-up. Of the 85 women enrolled in the primary study, 48 consented to being contacted for future studies. Of these, 28 completed surveys through mail or e-mail (58% response rate) and the long-term follow-up range was 5 to 7.5 years. The baseline mean age of the 28 participants was 51 years (SD 8), 64.3% had comorbidities, mean baseline UDI score was 50.3 points (SD 22.4). At baseline, no patients were categorized as having low overall PA, 26.9% were categorized as moderate, and 73.1% were categorized as high. 26.9% were categorized as having sedentary baseline leisure PA levels, 15.3% as insufficient, and 57.7% as sufficient. At long-term follow-up, 57.1% of women with low baseline leisure PA levels improved to moderate or high levels and 50.0% of women with moderate leisure PA improved to high leisure PA levels (P = 0.6). For overall PA levels, 7.7% improved their overall level of PA, while 53.8% maintained the same level of overall PA (P > 0.05). PROMIS-PF scores improved significantly between baseline and long-term follow up (mean 44.8 vs 52.9, P < 0.0001). When comparing 6 month post-operative results to long-term follow-up, BMI remained stable (29.78 vs 29.23), as did PFDI (11.98 vs 14.06), and BIS (4 vs 3) scores (all P > 0.05). On multiple linear regression, each 11- point improvement in UDI was associated with a mean improvement of 1.32 points in PF scores (P = 0.04), adjusting for age, comorbidity and baseline PA level at long-term follow up. Midurethral sling procedures for SUI are associated with long-term improvements in PA levels and PF.