Expedited Versus Restrictive: Limitations on Activity Following Surgical Treatment of Prolapse

Specific aim 1: Determine if liberal (ad lib) resumption of postoperative activity levels is non-inferior to standard restrictions with regards to short-term anatomic and symptomatic outcome, as measured by maximum pelvic organ prolapse support loss ('SLmax') and the Pelvic Organ Prolapse Distress Inventory (POPDI) at 3 months. (Co-primary outcome)

Specific aim 2: Compare postoperative "Recovery Time" and physical function between women instructed to resume their activity levels ad lib versus women instructed to restrict activity levels. "Recovery Time," defined as the postoperative day at which the patient resumes 90% of her baseline activity levels will be objectively measured using the Actigraph accelerometer.8 ,9 Physical function will be measured with the 6-minute walk, chair stand tests, and through patient-reported outcome measures. (exploratory outcome)

Specific aim 3: Compare timing of return-to-work and health-related QOL in women instructed to resume activity levels and return to work ad lib versus restrict their activity levels (exploratory outcome)

Eligible participants will first be briefly explained regarding the research study. If interested, will then complete the informed consent process. She will first be asked to complete the International Physical Activity Short Form to confirm study eligibility. For study eligibility, participants must at least report a baseline of 725 MET-minutes per week of physical activity according to the IPAQ-SF, which is consistent with the lowest quartile of activity among elderly women. If she reports greater than 725 MET-minutes per week of physical activity, she will undergo the remainder of baseline assessments. If she reports less than 725 MET-minutes per week of physical activity, she will be explained that she does not meet the activity level criteria for completion of the study at this time. She will then be asked to complete a series of baseline questionnaires (demographics, past medical history, POPDI, AAS, PROMIS, PFDI, PFIQ). She will also undergo a baseline POPQ exam and tests of physical function, including the 6-minute walk test and chair stand test.

A sealed envelope will then be opened by the research coordinator (or study investigator) in front of the patient indicating the patient's study allocation. The packet will also include an accelerometer which the patient will be instructed to wear for a 7-day period preoperatively. However, to ensure that participants are not given an accelerometer too far in advance from her surgery (as at times surgery may be scheduled remotely from the initial decision to proceed with surgery which would potentially result in too many accelerometers being out of circulation), the envelope containing study allocation and accelerometers may alternatively be provided at the preoperative "Surgical Workup" visit once the surgery is scheduled and at a date no greater than 3 weeks from the planned surgery. If a participant will be undergoing surgery at an interval greater than 1 week from the initial receipt of the accelerometer, she will only be required to wear the accelerometer for 1 week prior to the surgery. Patients will be given an opportunity to ask any questions regarding postoperative activity instructions to research personnel or nurses at the time of study enrollment and at any point prior to her surgery. Patients will be notified, prior to providing consent, that her primary surgeon will remain blinded as to her treatment allocation until completion of her study participation.