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Effect of a multimodal supervised therapeutic exercise program on quality of life, pain, and lumbopelvic impairments in women with endometriosis unresponsive to conventional therapy: a randomized controlled trial
Artacho-Cordon F, Del Mar Salinas-Asensio M, Galiano-Castillo N, Ocon-Hernandez O, Peinado FM, Mundo-Lopez A, Lozano-Lozano M, Alvarez-Salvago F, Arroyo-Morales M, Fernandez-Lao C, Cantarero-Villanueva I
Archives of Physical Medicine and Rehabilitation 2023 Nov;104(11):1785-1795
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To evaluate the effectiveness of 'Physio-EndEA', a multimodal nine-week supervised exercise intervention, on quality of life, pain, and lumbopelvic impairments in women with endometriosis unresponsive to conventional therapy. DESIGN: Parallel-group randomized controlled trial. Outcomes were measured at baseline, post-intervention, and at one year. SETTING: Two public University Hospitals. PARTICIPANTS: This trial included 31 women with endometriosis randomly allocated to 'Physio-EndEA' group (n = 16) or control group (n = 15). Four participants dropped out of the study for causes unrelated to the intervention. INTERVENTIONS: The 'Physio-EndEA' program consisted of a one-week lumbopelvic stabilization learning phase followed by an eight-week phase of stretching, aerobic and resistance exercises focused on the lumbopelvic area. It was sequentially instructed and supervised by a trained physiotherapist (with volume and intensity progression) and adapted daily to the potential of each participant. Control group received the usual treatment stipulated by their gynecologist. MAIN OUTCOME MEASURES: The primary outcome was quality of life. Secondary outcomes were pain intensity, pressure pain thresholds, pain-related catastrophic thoughts, abdominal and back strength, lumbopelvic stability, and muscle architecture. RESULTS: Adherence rate was 90.6% and mean (+/- standard deviation) satisfaction was 9.44 +/- 0.73 out of 10. No remarkable health problems were reported during the trial. In comparison to controls, the quality of life was improved post-intervention and at one year in the Physio-EndEA group with large effect sizes (d > 0.80). This group also evidenced: a reduced intensity of dyspareunia, catastrophic thoughts; an increase in pelvic, lumbar, and distal pressure pain thresholds; increases in abdominal and back strength and lumbopelvic stability; and increased thickness of transversus abdominis (right side) and width of lumbar multifidus (left side). CONCLUSION: A nine-week program of multimodal supervised therapeutic exercise is a feasible and effective intervention to improve QoL in women with endometriosis. This program also offers benefits in terms of pain/sensitization, and lumbopelvic impairments.

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