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Evidence Review H: Lifestyle and Conservative Management Options for Pelvic Organ Prolapse

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Evidence Review H: Lifestyle and Conservative Management Options for Pelvic Organ Prolapse National Institute for Health and Care Excellence Final Urinary incontinence and pelvic organ prolapse in women: management [H] Evidence reviews for lifestyle and conservative management options for pelvic organ prolapse NICE guideline NG123 Evidence reviews April 2019 Final These evidence reviews were developed by the National Guideline Alliance hosted by the Royal College of Obstetricians and Gynaecologists FINAL Error! No text of specified style in document. Disclaimer The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties. NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn. Copyright © NICE 2019. All rights reserved. Subject to Notice of Rights. ISBN: 978-1-4731-3319-8 FINAL Contents Contents Lifestyle and conservative management options for women with pelvic organ prolapse ................................................................................................................ 8 Management of pelvic organ prolapse .............................................................................. 9 Lifestyle interventions ..................................................................................................... 9 Introduction ........................................................................................................... 9 Summary of the protocol ....................................................................................... 9 Methods and process .......................................................................................... 10 Clinical evidence ................................................................................................. 10 Summary of clinical studies included in the evidence review ............................... 10 Quality assessment of clinical studies included in the evidence review ............... 10 Economic evidence ............................................................................................. 10 Summary of studies included in the economic evidence review ........................... 10 Economic model .................................................................................................. 10 Clinical evidence statements ............................................................................... 11 Economic evidence statements ........................................................................... 11 The committee’s discussion of the evidence ........................................................ 11 References .......................................................................................................... 12 The effectiveness of topical oestrogen for managing pelvic organ prolapse with vaginal atrophy ........................................................................................................... 13 Review question ........................................................................................................... 13 Introduction ......................................................................................................... 13 Summary of the protocol ..................................................................................... 13 Methods and process .......................................................................................... 14 Clinical evidence ................................................................................................. 14 Summary of clinical studies included in the evidence review ............................... 14 Quality assessment of clinical studies included in the evidence review ............... 14 Economic evidence ............................................................................................. 14 Summary of studies included in the economic evidence review ........................... 14 Economic model .................................................................................................. 15 Clinical evidence statements ............................................................................... 15 Economic evidence statements ........................................................................... 15 The committee’s discussion of the evidence ........................................................ 15 References .......................................................................................................... 16 Effectiveness of conservative interventions in the management of pelvic organ prolapse ...................................................................................................................... 17 Review question ........................................................................................................... 17 Introduction ......................................................................................................... 17 Summary of the protocol ..................................................................................... 17 Methods and process .......................................................................................... 18 4 FINAL Contents Clinical evidence ................................................................................................. 18 Summary of clinical studies included in the evidence review ............................... 19 Quality assessment of clinical studies included in the evidence review ............... 27 Economic evidence ............................................................................................. 27 Summary of studies included in the economic evidence review ........................... 27 Economic model .................................................................................................. 30 Clinical evidence statements ............................................................................... 30 Economic evidence statements ........................................................................... 35 The committee’s discussion of the evidence ........................................................ 35 References .......................................................................................................... 38 Appendices ........................................................................................................................ 40 Appendix A – Review protocols .................................................................................... 40 Review protocol for review question: What lifestyle interventions are effective for managing pelvic organ prolapse (POP)? ............................................. 40 Review protocol for review question: What is the effectiveness of topical oestrogen for managing pelvic organ prolapse (POP) with vaginal atrophy? ................................................................................................... 44 Review protocol for review question: What are the most effective conservative management options (for example, pelvic floor exercises and pessaries) for pelvic organ prolapse (POP)? ............................................ 48 Appendix B – Literature search strategies .................................................................... 53 Literature search strategy for review question: What lifestyle interventions are effective for managing pelvic organ prolapse (POP)?............................... 53 Literature search strategies for review question 8.2: What is the effectiveness of topical oestrogen for managing pelvic organ prolapse (POP) with vaginal atrophy? ....................................................................................... 59 Literature search strategies for the review question: What are the most effective conservative management options (for example, pelvic floor exercises and pessaries) for pelvic organ prolapse (POP)? ..................... 61 Appendix C – Clinical evidence study selection ............................................................ 64 Clinical evidence study selection for review question: What lifestyle interventions are effective for managing pelvic organ prolapse (POP)? ... 64 Clinical evidence study selection chart for review question: What is the effectiveness of topical oestrogen for managing pelvic organ prolapse (POP) with vaginal atrophy?....................................................................
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