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The POSH-Ex Study: Study Protocol for a Randomized Controlled Trial of a 12-Week Online Physiotherapy Intervention
Nikolina Zaplatić Degač1,2, Ivana Živoder2, Špela Bogataj3,4
1Faculty of Health Sciences, University of Novo mesto, Na Loko 2, 8000 Novo Mesto, Slovenia.
Background/Objectives:
Postpartum sexual dysfunction is common and multifactorial, yet structured physiotherapy interventions specifically targeting sexual function after childbirth remain insufficiently investigated. This study aims to evaluate the effectiveness of Postpartum Sexual Health Exercise (POSH-Ex), a standardized, multimodal, physiotherapist-led online therapeutic exercise programme designed to improve postpartum sexual function. We hypothesise that participants allocated to POSH-Ex will have a higher mean FSFI total score at 12 weeks than participants receiving usual postpartum care, after adjustment for baseline FSFI score.
Methods:
This randomized controlled trial will include 84 women recruited at 10-12 weeks postpartum and randomly allocated (1:1) to the POSH-Ex intervention or control group. The intervention will consist of a 12-week progressive programme delivered twice weekly in 60-min sessions, integrating pelvic floor muscle training, breathing and relaxation exercises, trunk stabilization, functional strengthening, flexibility, and movement re-education, while the control group will receive usual postpartum care and continue their usual activities without a study-specific exercise intervention. Outcomes will be assessed at baseline and after 12 weeks. Sexual function, assessed using the Female Sexual Function Index (FSFI), is the primary outcome; physical activity (IPAQ-SF), fatigue (FAS), and depressive symptoms (EPDS) are secondary outcomes. The primary analysis will compare FSFI scores at 12 weeks between groups using analysis of covariance (ANCOVA) adjusted for baseline FSFI. The trial was prospectively registered at ClinicalTrials.gov (NCT07747285).
Conclusions:
The POSH-Ex trial is designed to determine whether a structured, multimodal, physiotherapist-led online therapeutic exercise programme improves postpartum sexual function compared with usual postpartum care. If effective, POSH-Ex may inform the development of structured physiotherapy approaches that recognise sexual health as an integral component of comprehensive postpartum care.