***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The primary aims of this trial are : 1 ) to compare surgical outcomes following sacrospinous ligament fixation to uterosacral vaginal vault suspension in women undergoing vaginal surgery for apical or uterine pelvic organ prolapse and stress urinary incontinence and 2 ) to examine the effects of a structured perioperative program consisting of behavioral techniques and pelvic floor muscle training compared to usual care . This trial is performed through the Pelvic Floor Disorders Network ( PFDN ) , which is funded by National Institute of Child Health and Human Development . Subjects will be enrolled from hospitals associated with seven PFDN clinical centers across the United States . A central ized biostatistical coordinating center will oversee data collection and analysis . Two approaches will be investigated simultaneously using a 2x2 r and omized factorial design : a surgical intervention ( sacrospinous ligament fixation versus uterosacral vaginal vault suspension ) and a perioperative behavioral intervention ( behavioral and pelvic floor muscle training versus usual care ) . Surgeons have st and ardized essential components of each surgical procedure and have met specific st and ards of expertise . Providers of the behavioral intervention have undergone st and ardized training . Anatomic , functional , and health-related quality of life outcomes will be assessed using vali date d measures by research ers blinded to all r and omization assignments . Cost-effectiveness analysis will be performed using prospect ively collected data on health care costs and re source utilization . The primary surgical endpoint is a composite outcome defined by anatomic recurrence , recurrence of bothersome vaginal prolapse symptoms and /or retreatment and will be assessed 2 years after the index surgery . Endpoints for the behavioral intervention include both short-term ( 6-month ) improvement in urinary symptoms and long-term ( 2-year ) improvement in anatomic outcomes and prolapse symptoms . This article describes the rationale and design of this r and omized trial , focusing on several key design features of potential interest to research ers in the field of female pelvic floor disorders and others conducting r and omized surgical trials Introduction and hypothesisThe purpose of this study is to determine whether a Pilates exercise program and a pelvic floor muscle-training ( PFMT ) program could provide similar improvements in pelvic muscle strength . Methods Sixty-two women with little or no pelvic floor dysfunction were r and omized to Pilates or PFMT . Each group had 24 biweekly 1-h sessions with either a physical therapist or Pilates instructor . Strength was measured via perineometry ( cmH2O ) . Two question naires — pelvic floor distress inventory ( PFDI-20 ) and pelvic floor impact question naire (PFIQ-7)—were also collected . Results At baseline , the Pilates and PFMT groups measured 14.9 ± 12.5 and 12.5 ± 10.4 cmH2O , respectively ( p = 0.41 ) . Both the Pilates and PFMT groups got stronger ( 6.2 ± 7.5 cmH2O , p = 0.0002 and 6.6 ± 7.4 cmH2O , p = 0.0002 , respectively ) , with no difference between groups p = 0.85 . PFIQ and PFDI scores improved from baseline but not between groups . Conclusions Further study is required to determine if Pilates can actually treat pelvic floor dysfunction OBJECTIVE The aim of this study was to investigate the effectiveness of pelvic floor muscle training in reversing pelvic organ prolapse and alleviating symptoms . STUDY DESIGN This assessor-blinded , parallel group , r and omized , controlled trial conducted at a university hospital and a physical therapy clinic r and omly assigned 109 women with prolapse stages I , II , and III to pelvic floor muscle training ( n = 59 ) or control ( n = 50 ) . Both groups received lifestyle advices and learned " the Knack . " In addition , pelvic floor muscle training comprised individual physical therapy sessions and home exercise .  Student t test , Mann-Whitney U test , odds ratio , and effect size were used to compare groups . RESULTS Eleven ( 19 % ) women in the pelvic floor muscle training group improved 1 Pelvic Organ Prolapse Quantification System stage vs 4 ( 8 % ) controls ( P = .035 ) . Compared with controls , the pelvic floor muscle training group elevated the bladder ( difference : 3.0 mm ; 95 % confidence interval , 1.5 - 4.4 ; P < .001 ) and rectum ( 5.5 mm ; 95 % confidence interval , 1.4 - 7.3 ; P = .022 ) and reduced frequency and bother of symptoms compared with controls . CONCLUSION Pelvic floor muscle training is without adverse effects and can be used as treatment for prolapse Objective To evaluate the mobility of the vesical neck during coughing and valsalva in healthy nulliparous volunteers and to test the reliability of the technique applied INTRODUCTION This assessor-blinded r and omized controlled trial investigated the effect of a pre- and post-operative physiotherapy-supervised pelvic floor muscle ( PFM ) training program in women undergoing surgery for prolapse or hysterectomy . METHODS Participants were assessed pre-operatively , and at 3 , 6 , and 12 months post-operatively by a blinded physiotherapy assessor . Following r and omization , participants were allocated to a control group ( CG ) which included " usual care " ( as provided by the surgeon and the hospital staff ) , or a treatment group ( TG ) which included one pre-operative and seven post-operative treatment sessions over 12 months . Primary outcomes were bladder and prolapse symptoms , measured by the Urogenital Distress Inventory ( UDI ) and the Incontinence Impact Question naire ( IIQ ) . RESULTS Fifty-one participants were r and omized . The 12-month post-operative findings showed there was no difference in the prevalence of the primary outcomes ( ORs 1.2 , 1.3 ) . There were no significant differences between groups on the change scores of the UDI ( mean : 44.1 [ 5.1 ] ; 54.0 [ 5.4 ] , P = 0.20 ) nor the IIQ ( median : 0.0 [ 9,14 ] ; 10.0 [ 5,19 ] , P = 0.09 ) . The repeated measures analyses also demonstrated no significant changes . CONCLUSION The program tested did not improve bladder or prolapse symptoms in this trial . Reasons may include the effectiveness of surgery alone , wide variance in data , small sample size , insufficient training by the TG , and PFM training by the usual care group Forty-seven women participated in a pilot study for a multi-centre r and omized controlled trial of the effectiveness of pelvic floor muscle training ( PFMT ) for women with prolapse . Women with symptomatic stage I or II prolapse [ measured by Pelvic Organ Prolapse Quantification ( POP-Q ) ] were r and omized to a 16-week physiotherapy intervention ( PFMT and lifestyle advice ; n = 23 ) or a control group receiving a lifestyle advice sheet ( n = 24 ) . Symptom severity and quality of life were measured via postal question naires . Blinded POP-Q was performed at baseline and follow-up . Intervention women had significantly greater improvement than controls in prolapse symptoms ( mean score decrease 3.5 versus 0.1 , p = 0.021 ) , were significantly more likely to have an improved prolapse stage ( 45 % versus 0 % , p = 0.038 ) and were significantly more likely to say their prolapse was better ( 63 % versus 24 % , p = 0.012 ) . The data support the feasibility of a substantive trial of PFMT for prolapse . A multi-centre trial is underway PURPOSE : Large rectoceles have been associated with symptoms of impaired rectal evacuation , often leading to rectocele repair . However , these symptoms , or the anatomic abnormality , may be caused , at least in part , by a primary disturbance of rectoanal coordination . This study aim ed to determine the efficacy of biofeedback therapy in such patients . METHODS : Thirty-two female patients ( median age , 52 years ) complaining of impaired rectal evacuation and with a rectocele greater than 2 cm at proctography were evaluated by structured question naire before , immediately after treatment , and at follow-up . Physiologic and proctographic findings were related to outcome . RESULTS : Immediate results were available in 32 patients and medium-term follow-up ( median , 10 ; range , 2–30 months ) in 25 patients . At follow-up 14 ( 56 percent ) patients felt a little and 4 ( 16 percent ) patients felt major improvement in symptoms , including 3 ( 12 percent ) with complete symptom relief . Immediately after biofeedback there was a modest reduction in need to strain ( from 72 to 50 percent ) , feeling of incomplete evacuation ( from 78 to 59 percent ) , need to assist defecation digitally ( from 84 to 63 percent ) , and need to use an evacuant ( from 47 to 28 percent ) , and this was maintained at follow-up . Bowel frequency was significantly normalized at follow-up ( P=0.02 ) . Pretreatment presence of symptoms of digitally assisting defecation , pelvic floor incoordination , and proctographic rectocele size and contrast trapping , did not predict outcome . CONCLUSIONS : Behavioral therapy , including biofeedback , leads to major symptom relief in a minority , and partial symptom relief in a majority , of patients with a feeling of impaired defecation and the presence of a large rectocele . Residual symptoms are common . Biofeedback may be a reasonable first-line treatment for such patients OBJECTIVE : To investigate morphological and functional changes after pelvic floor muscle training in women with pelvic organ prolapse . METHODS : This r and omized controlled trial was conducted at a university hospital and a physical therapy clinic . One hundred nine women with pelvic organ prolapse stages I , II , and III were r and omly allocated by a computer-generated r and om number system to pelvic floor muscle training ( n=59 ) or control ( n=50 ) . Both groups received lifestyle advice and learned to contract the pelvic floor muscles before and during increases in intraabdominal pressure . In addition the pelvic floor muscle training group did individual strength training with a physical therapist and daily home exercise for 6 months . Primary outcome measures were pelvic floor muscle ( pubovisceral muscle ) thickness , levator hiatus area , pubovisceral muscle length at rest and Valsalva , and resting position of bladder and rectum , measured by three-dimensional ultrasonography . RESULTS : Seventy-nine percent of women in the pelvic floor muscle training group adhered to at least 80 % of the training protocol . Compared with women in the control group , women in the pelvic floor muscle training group increased muscle thickness ( difference between groups : 1.9 mm , 95 % confidence interval [ CI ] 1.1–2.7 , P<.001 ) , decreased hiatal area ( 1.8 cm2 , 95 % CI 0.4–3.1 , P=.026 ) , shortened muscle length ( 6.1 mm , 95 % CI 1.5–10.7 , P=.007 ) , and elevated the position of the bladder ( 4.3 mm , 95 % CI 2.1–6.5 , P<.000 ) and rectum ( 6.7 mm , 95 % CI 2.2–11.8 , P=.007 ) . Additionally , they reduced the hiatal area and muscle length at maximum Valsalva indicating increased pelvic floor muscle stiffness . CONCLUSION : Supervised pelvic floor muscle training can increase muscle volume , close the levator hiatus , shorten muscle length , and elevate the resting position of the bladder and rectum . CLINICAL TRIAL REGISTRATION : www . clinical trials.gov , NCT00271297 . LEVEL OF EVIDENCE : 
    Output:
    
Pelvic floor muscle function findings differed between the trials : one found no difference between trial groups in muscle strength , whilst the other found a benefit for the PFMT group in terms of stronger muscles .
There is now some evidence available indicating a positive effect of PFMT for prolapse symptoms and severity .
The largest most rigorous trial to date suggests that six months of supervised PFMT has benefits in terms of anatomical and symptom improvement ( if symptomatic ) immediately post-intervention .