Optimism in Women Undergoing Abdominal Sacrocolpopexy for Pelvic Organ Prolapse

Received 24 October 2007; received in revised form 18 February 2008; accepted 20 February 2008. published online 13 May 2008.

Background

Although studies suggest that optimism can predict health outcomes, the relationship has not been tested in women with pelvic organ prolapse (POP). This study sought to explore the relationship between optimism, prolapse severity, and symptoms before operation; and examine whether optimism predicts postsurgical functional status, treatment satisfaction, and treatment success.

Study Design

Data from the randomized Colpopexy and Urinary Reduction Efforts (CARE) study, in which stress continent women undergoing sacrocolpopexy to repair stage II to IV POP completed a baseline assessment of optimism and validated symptom and quality-of-life measures at baseline and 24 months. Relationships between optimism and demographics, clinical status, and functional and quality-of-life outcomes were assessed.

Results

Of 322 Colpopexy and Urinary Reduction Efforts study participants, 305 (94.7%) completed 24-month followup interviews. At baseline, there were no notable differences in optimism with respect to POP stage or history of earlier operations for prolapse or urinary incontinence. At baseline, women with greater optimism reported markedly better physical and mental functioning (p ≤ 0.001) and less symptom distress (p ≤ 0.01). Two years after operation, the difference in symptom experience across the three optimism categories narrowed; all women reported improved health status, fewer symptoms, and less impact on daily activities. Satisfaction with treatment and perception of treatment success were not associated with optimism.

Conclusions

In women planning operation for POP, optimism is related to pelvic symptom severity, but is not associated with satisfaction with treatment or treatment success. Abdominal sacrocolpopexy resulted in substantial improvements in quality of life and functional outcomes that were not notably influenced by optimism.

Abbreviations and Acronyms: CARE, Colpopexy and Urinary Reduction Efforts, LOT-R, Life Orientation Test-revised, PFDI, Pelvic Floor Disorders Inventory, PFIQ, Pelvic Floor Impact Questionnaire, POP, pelvic organ prolapse, QOL, quality of life

a Department of Wellness, Health Promotion, and Injury Prevention, School of Health Sciences, Oakland University, Rochester, MI

b Department of Health Behavior and Health Education, School of Public Health, The University of Michigan, Ann Arbor, MI

c Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, IL

d Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH

e Department of Geriatric Medicine, University of Alabama, Birmingham, AL

f Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada

g Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT

h Department of Obstetrics, Gynecology, and Women's Health, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, PA.

Correspondence address: Patricia A Wren, PhD, MPH, Department of Wellness, Health Promotion, and Injury Prevention, School of Health Sciences, Oakland University, 2200 N Squirrel Rd, Rochester, MI 48309.

Disclosure Information: Nothing to disclose.

Supported by grants from the National Institute of Child Health and Human Development (U01 HD41249, U10 HD41268, U10 HD41248, U10 HD41250, U10 HD41261, U10 HD41263, U10 HD41269, and U10 HD41267).

PII: S1072-7515(08)00220-2

doi:10.1016/j.jamcollsurg.2008.02.019

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