Aplicação de instrumentos de resultados relatados pelos pacientes no tratamento não cirúrgico do prolapso de órgãos pélvicos: uma revisão de escopo

Li, Miao; Wang, Huan; Jia, Yuanli; Liu, Hangcheng; Li, Xixi

doi:10.1590/1980-220X-REEUSP-2025-0341en

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REVIEW • Rev. esc. enferm. USP 60 • 2026 • https://doi.org/10.1590/1980-220X-REEUSP-2025-0341en linkcopiar

Aplicação de instrumentos de resultados relatados pelos pacientes no tratamento não cirúrgico do prolapso de órgãos pélvicos: uma revisão de escopo

Autoria SCIMAGO INSTITUTIONS RANKINGS

Objetivo: Revisar o conteúdo, as características e o status atual da aplicação dos resultados relatados pelo paciente (PROs) para o tratamento não cirúrgico do prolapso de órgãos pélvicos (POP), fornecendo informações para pesquisas futuras.

Métodos: Em conformidade com a extensão das Diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses para revisões de escopo (PRISMA-ScR), uma busca sistemática no PubMed, Web of Science, Embase, CINAHL, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database e Chinese Biomedicine Literature Database (CBM-SinoMed) foi realizada. O período de pesquisa abrangeu o início de cada banco de dados até 16 de janeiro de 2025.

Resultados: Um total de 1548 estudos foram identificados, dos quais 19 foram incluídos na revisão. No contexto do POP não cirúrgico, os PROs foram usados principalmente para avaliar a eficácia clínica, a qualidade de vida e os sintomas. Em toda a literatura incluída, 29 instrumentos de PRO foram descritos, abrangendo aspectos como o estado fisiológico e psicológico dos pacientes, a satisfação com o tratamento e os objetivos do tratamento.

Conclusão: A aplicação de PROs no manejo não cirúrgico do POP permanece limitada. Esforços futuros devem expandir seu escopo, implementar a avaliação dinâmica em todas as fases do tratamento e utilizar a tecnologia digital para melhorar a conveniência e a eficiência da avaliação.

DESCRITORES
Prolapso de Órgãos Pélvicos; Tratamento Conservador; Medidas de Resultados Relatados pelo Paciente

Author	Year	Country	Study design	Study population	Sample size	PROs content	PRO instruments	Application fields	Assessment form	Evaluation frequency	Assessment setting
Hagen et al.(¹⁶)	2016	UK, New Zealand	Multicenter randomized controlled trials	Women of any age with POP stage 1-3	412 (control group = 207/intervention group = 207)	Prolapse, sexual function, bladder and bowel symptoms, and quality of life	POP-SS PISQ4R SF-12 ICIQ-UI-SF ICIQ-B	Clinical effectiveness evaluation	Mailed paper questionnaires	Baseline, 1 and 2 years after randomization grouping	Gynecology clinics in participating centers
Hagen et al.(¹⁷)	2014	UK, New Zealand, Australia	Multicenter randomized controlled trials	Female with stage 1-3 prolapse	447 (control group = 22/intervention group = 225)	Prolapse, sexual function, bladder and bowel symptoms, and quality of life	POP-SS PISQ-IR SF-12 ICIQ-UI-SF ICIQ-B	Clinical effectiveness evaluation	Mail paper or phone	Baseline, 6 and 12 months after enrollment	Gynecology clinics in participating centers
Strohbehn et al.(¹⁸)	2024	United States	Prospective studies	Patients with POP-Q stage ≥2 prolapse	78	Prolapse, sexual function, bladder, bowel symptoms, pain, satisfaction	PFDI-20 PFIQ-7 PISQ-IR Global satisfaction VAS	Clinical effectiveness evaluation	Face-to-face paper or telephone	1 month at baseline and 3 months in the intervention period (visits 0, 1 and 3)	Urogynecology clinical trial site
Mao et al.(^l9)	2018	China	Prospective studies	Patient successfully wearing a supported ring uterine tray	142	Prolapse, bladder, bowel symptoms, body imagery	PFDI-20 PFIQ-7 PGI-C	Symptom assessment/Quality of life	Face-to-face paper or telephone	Median follow-up of 17 months (range 13-24 months), follow-up time points (months 3, 6, 12, and every 6 months thereafter)	Hospital outpatient clinics for obstetrics and gynecology
Bugge et al.(²⁰)	2024	Britain	Randomized controlled trial	Patients using uterine supports for at least two weeks	340 (control 169/intervention group 171)	Pelvic floor symptoms (prolapse, bladder, bowel), sexual function, quality of life, self-efficacy	PFIQ-7 PFDI-20 EQ-5D-5L GSES PISQ-IR PGI-I	Clinical effectiveness evaluation/Quality of life	Mailed paper, telephone, face-to-face, electronic links	Total 18 months, baseline, follow-up 6 months, 12 months, 18 months	Hospital maternity or clinic outpatient
Meriwether et al.(²¹)	2015	United States	Prospective studies	Patients with uterine supports in place	127	Sexual Function, Body Imagery	PISQ-IR mBIS	Quality of life	Face-to-face paper	Baseline, three months	Uterine tray management clinic
Ai et al.(²²)	2018	China	Prospective studies	Patients using uterine supports	102	Prolapse, Bowel, Bladder, Quality of Life, Depression	PFDI-20 PFIQ-7 PHQ-9	Symptom assessment/Quality of life	Face-to-face paper	Baseline, 3 months	Pelvic Floor Center Clinic
Ouch et al.(²³)	2018	Japan	Quasi-experi mental studies	Patients with stage 2 or 3 prolapse	27	Quality of life	P-QOL POP-specific QOL	Quality of life/Symptom assessment	Face-to-face paper or telephone	Baseline (pre-PFMT), at the end of 4-month PFMT, 2-year follow-up	Urological Surgery Department to or from home
Gorji et al.(²⁴)	2019	Iran	Randomized Controlled Trial	Women with POP-Q stage 2 or 3	40 (20 in the intervention group/20 in the control group)	Lower urinary tract symptoms, quality of life	ICIQ-FLUTS P-QOL	Clinical effectiveness evaluation	Unreported	Baseline, 4 weeks postintervention	Urology Clinic
Pizarro-Berdichevsky et al.(²⁵)	2016	Chile	Prospective studies	Patients with stage 2 and above	91	Quality of life, depression	PFDI-20 P-QOL PISQ-12 GHQ-12	Symptom assessment/Quality of life	Unreported	Baseline, after 12 months of follow-up	Urogynecology Clinic
Limbutara et al.(²⁶)	2023	Thailand	Randomized Controlled Trial	Women with POP-Q stage 2 or 3	40	Quality of life, sexual function, treatment goals	GAS VAS for Treatment Goal Achievement PISQ-IR P-QOL	Clinical effectiveness evaluation	Face-to-face paper	Baseline, 2 weeks, 6 weeks posttreatment	Urogynecology Clinic
Crowle and Harley(²⁷)	2020	Britain	Retrospective casecontrol study	Conservatively treated patients	23	Prolapse, bladder, bowel symptoms	PFDI-20	Clinical effectiveness evaluation	Face-to-face paper	Baseline, after last treatment (median treatment duration 3 months)	Private hospitals or physiotherapy clinics
Sweta et al.(²⁸)	2018	India	Randomized Controlled Trial	Patients with mild POP	50 (intervention group 25/control group 25)	Prolapse, bladder, bowel symptoms	PFDI-20 PFIQ-7	Clinical effectiveness evaluation	Face-to-face paper	Baseline, postintervention weeks 4, 8, and end of 12	unreported
Shobeiri and Santiago(²⁹)	2014	United States	Randomized Controlled Trial	Patients with stages 1 to 3 prolapse	447 (intervention group 225/control group 222)	Prolapse Symptoms	POP-SS	Clinical effectiveness evaluation	Unreported	At baseline, 6 and 12 months	unreported
Wiegersma et al.(³⁰)	2014	Netherlands	Randomized Controlled Trial	Stage 1 and 2 elderly patients	287 (intervention group 145/control group 142)	Perception of prolapse, bladder, bowel, sexual function, quality of life, symptomatic changes	PFDI-20 PFIQ-7 PISQ-12 SF-12 VAS for Treatment Effect Evaluation	Symptom assessment	Face-to-face paper/mail questionnaire	Baseline, 3 months postintervention	Unreported
Wiegersma et al.(³¹)	2014	Netherlands	Randomized Controlled Trial	Stage 2 and 3 elderly patients	447 (intervention group 226/control group 221)	Prolapse, bladder, bowel, sexual dysfunction, quality of life, symptom burden	PFDI-20 PFIQ-7 PISQ-12 SF-12 EQ-5D	Clinical effectiveness evaluation	Face-to-face paper/mail questionnaire	Baseline, 3 months, 12 months, 24 months after treatment	Unreported
Min et al.(³²)	2023	China	Randomized Controlled Trial	Patients with stages 1-3 prolapse	117 (control group 58/intervention group 59)	Prolapse, bladder, bowel, sexual function, quality of life, anxiety, depression, self-efficacy	PFDI-20 PISQ-12 SAS SDS QLQ-52 GSES	Clinical effectiveness evaluation	Face-to-face paper	Baseline, 3 months postintervention	Hospital outpatient clinics
Ziv and Erlich(³³)	2022	Israel	Quasi-experi mental study	Women with POP-Q stage 2-4 prolapse	52	Prolapse, bladder, bowel, quality of life	PFDI-20 PFIQ-7 POP symptoms alleviation score	Quality of life/Clinical effectiveness evaluation	Face-to-face paper or telephone	Baseline, 2 years after use	Clinic visits
Coelho et al.(³⁴)	2018	Brazil	Prospective studies	Patients with stage 3-4 prolapse	19	Vaginal symptoms, sexuality, quality of life	SF-36 ICIQ-VS	Quality of life/Symptom assessment	Face-to-face paper	Baseline, 6 months postuse	Gynecology clinic

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[1] PFDI-20: Pelvic Floor Distress Inventory-20; PFIQ-7: Pelvic Floor Impact Questionnaire-7; PISQ-IR: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire; ICIQ-UI-SF: ICIQ-Urinary Incontinence Short Form; ICIQ-FLUTS: International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms; ICIQ-B: International Consultation on Incontinence Questionnaires-Bladder; PISQ-12: Incontinence Sexual Function Questionnaire-12; ICIQ-VS: International Consultation on Incontinence Questionnaire-Vaginal Symptoms; POP-SS: Pelvic Organ Prolapse Symptom Score; POP symptoms alleviation score: the self-administered Pelvic Organ Prolapse Score; POPspecific QOL: self-administered Prolapse Symptom Report; P-QOL: Prolapse-quality of life questionnaire; SF-12: 12-ltem Short-Form Survey; QLQ-52: Quality of life-52; SF-36: MOS 36-ltem Short-Form Health Survey; EQ-5D-5L: EuroQol-5 Dimensions, five-level; EQ-5D: EuroQol-5D questionnaire; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; PHQ-9: Patient Health Questionnaire-9; GHQ-12: 12-item Goldberg Health Questionnaire; VAS: Visual Analogue Scale; mBIS: Modified female body image scale; CAS: Goal Attainment Scaling; PGI-I: Patient Global Impression of Improvement; PGI-C: Patient Global Impression of Change; GSES: General Self-efficacy Scale.