262 - Exploring women’s experiences with endometriosis-associated pelvic pain following participation in pelvic floor muscle exercises or pelvic floor muscle relaxation combined with mindfulness intervention programme: a qualitative study

Hypothesis / aims of study Pelvic floor muscle (PFM) exercise is commonly prescribed to women with endometriosis-associated pelvic pain (EAPP). [1] However, women’s experiences with this intervention are unknown. The aim of this study was to explore the experiences of women with EAPP regarding PFM exercise, providing insights for interpreting the findings of a randomised controlled trial involving women who participated in an intervention programme that included PFM exercises and mindfulness. Study design, materials and methods This was a qualitative study nested within a pilot randomised controlled trial. Semi-structured interviews, guided by the Theoretical Framework of Acceptability, were performed with participants with EAPP who participated in an 8-week intervention programme. The framework conceptualises acceptability through seven key constructs: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. [2] The intervention programme included either PFM contraction-plus-relaxation (PFMC+R) or PFM relaxation-only (PFMR), and both groups also received mindfulness training. Purposive sampling was used to recruit participants from the trial for this qualitative study. In order to achieve maximum variation sampling, participants with different intensities of general pelvic pain and different adherence levels were sampled. Individual interviews were conducted via videoconference (Zoom™) one to two weeks after the last intervention session. A research team member who was not involved in delivering the intervention conducted the interviews to reduce the likelihood of positive response bias. Interview data were recorded and transcribed verbatim. Direct content analysis was conducted using a combination of deductive and inductive processes. Results A total of 16 participants (PFMC+R=9; PFMR=7) with a mean age of 30 (SD=4.23) were interviewed. Participants in both groups reported positive experiences in terms of the intervention components, delivery mode, exercise progression and perceived beneficial effects on their EAPP symptoms (Table 1). Factors that facilitated engagement with the intervention in both groups included a well-explained programme, tailoring of PFM exercises based on their abilities and pain level, and varying mindfulness recordings. Participants in both groups also identified barriers that hindered their abilities to perform PFM exercises and mindfulness, such as severe pelvic pain and fatigue. Additionally, participants in both groups described strategies to overcome these barriers, such as shortening mindfulness practice, and reducing the number of exercise repetitions during painful days. Some differences in participants’ experiences were observed between groups. For example, more participants in the PFMC+R group perceived that the intervention helped them to better cope with pain, reduce their dyspareunia, and improve their PFM strength. There were also more participants from this group that would recommend the intervention for other women with EAPP. Interpretation of results Although participants from both groups reported positive experiences and perceptions about the intervention, the PFMC+R protocol might be more acceptable and beneficial than the PFMR protocol. Findings from this study also highlight the importance of tailoring PFM exercises to individuals’ pain levels, fatigue, and physical capabilities. Concluding message Understanding participants' experiences and perceptions of the PFM exercises and mindfulness interventions is crucial for evaluating the feasibility and potential implementability of an intervention, as these factors influence engagement, adherence, and overall effectiveness. This qualitative study identified factors that facilitated engagement with the intervention programme, barriers that hindered participant’s abilities to undertake PFM exercises and mindfulness, and strategies to overcome these barriers. However, it is important to acknowledge that the relatively small sample size represents a limitation, as the participants may not be fully representative of the broader study population. Despite this, findings from this study could provide insights into how pelvic floor physiotherapy and mindfulness interventions for women with EAPP can be enhanced in clinical practice and future research. Clinicians and researchers should consider these factors and address challenges that limit the ability of women with EAPP to engage in this intervention programme. Download: Download high-res image (143KB) Download: Download full-size image Figure 1 . Table 1: Themes and subthemes Funding No Clinical Trial No Subjects Human Ethics Committee Monash Health Human Research Ethics Committee (HREC/88754/MonH-2022-330436) Helsinki Yes Informed Consent Yes

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