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Trial registered on ANZCTR
Registration number
ACTRN12618000011280
Ethics application status
Approved
Date submitted
27/11/2017
Date registered
10/01/2018
Date last updated
27/11/2019
Date data sharing statement initially provided
19/12/2018
Type of registration
Prospectively registered
Titles & IDs
Public title
Can an informational flip chart on pelvic floor muscle training and lifestyle advice improve the quality of life for Nepali women with a pelvic organ prolapse? A randomised control trial
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Scientific title
Impact of an informational flip chart on conservative treatment strategies for Nepali women with a pelvic organ prolapse: a randomised control trial
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Secondary ID [1]
293322
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Pelvic organ prolapse
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Condition category
Condition code
Reproductive Health and Childbirth
304692
304692
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0
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Other reproductive health and childbirth disorders
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Public Health
304693
304693
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0
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Health promotion/education
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The intervention includes brief verbal instruction on how to perform pelvic floor muscle training and in-depth education using a flip chart. The brief verbal instruction will be administered by the gynaecologist and the flip chart will be administered by a public health worker. The flip chart was designed specifically for this study as a resource for health workers and is not intended for the participant to take home. The flip chart describes lifestyle factors that reduce pressure on the pelvic organs such as how to reduce constipation, manage a chronic cough, correct toilet habits, weight management advice and correct lifting techniques and also describes pelvic floor muscle training in detail . The participants will be instructed to perform daily pelvic floor muscle training and to document the exercises they perform on a log sheet. The pelvic floor muscle training prescription includes performing 10 strong squeezes on and off quickly and one 10 second hold with moderate squeeze pressure. These two exercises will be performed once per day and should only take a few minutes. The intervention will take place in an outpatient gynaecology clinic in Kathmandu and will be provided individually, face to face, once only and will take 15 minutes.
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Intervention code [1]
299579
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Rehabilitation
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Intervention code [2]
299773
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Treatment: Other
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Comparator / control treatment
The control group will receive usual care, which is brief (<5 minute) verbal instruction on how to perform pelvic floor muscle training. The brief verbal instruction will be administered by the gynaecologist. The participants will be instructed to perform the same pelvic floor muscle training prescription as the intervention group and to document the exercises they perform on a log sheet.
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Control group
Active
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Outcomes
Primary outcome [1]
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Change in mean score for the validated Prolapse-Quality of Life (P-QoL) questionnaire
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Assessment method [1]
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Timepoint [1]
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The P-QoL will be administered at 6 weeks, 12 weeks and 6 months after the intervention. The primary endpoint will be at 6 months.
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Secondary outcome [1]
340403
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Frequency of performing PFMT as recorded in a daily diary
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Assessment method [1]
340403
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Timepoint [1]
340403
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6 weeks, 12 weeks and 6 months after intervention
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Eligibility
Key inclusion criteria
Women attending POP screening camps at two urban hospitals in Kathmandu Valley with a symptomatic pelvic organ prolapse stage I-III (as measured using the Pelvic Organ Prolapse Quantification System - POP-Q) are eligible for this study
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Women who are pregnant, breastfeeding, have had gynaecological cancer, mental illness, have a stage IV POP and those who have been previously taught PFMT
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Study design
Purpose of the study
Educational / counselling / training
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Sealed opaque envelopes
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using a table created by computer software
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Assuming a difference of 20% in the PQoL scores between the intervention and the control arm at 6 months follow-up, with alpha set at 0.05, and beta at 80, we estimate that we require a sample size of 64 women in each arm. To allow for loss to follow-up we have inflated the sample by ~10% to 70 women in each arm.
For statistical analysis, SPSS software will be used to compare the change in P-QoL scores between groups and identify any associations with the participant POP-Q stage, pelvic floor muscle strength, age, parity, occupation and body mass index
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
1/02/2018
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Actual
21/01/2018
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Date of last participant enrolment
Anticipated
1/04/2018
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Actual
4/12/2018
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Date of last data collection
Anticipated
18/06/2019
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Actual
4/06/2019
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Sample size
Target
140
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Accrual to date
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Final
140
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Recruitment outside Australia
Country [1]
9345
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Nepal
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State/province [1]
9345
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Kathmandu Valley
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Funding & Sponsors
Funding source category [1]
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Self funded/Unfunded
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Name [1]
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Delena Caagbay
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Address [1]
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The University of Sydney
Sydney NSW 2006
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Country [1]
297945
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Australia
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Funding source category [2]
298370
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University
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Name [2]
298370
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Dr Albert S McKern Research Scholarship
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Address [2]
298370
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Sydney Medical School
The University of Sydney
Sydney, NSW 2009
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Country [2]
298370
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Australia
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Primary sponsor type
Individual
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Name
Delena Caagbay
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Address
The University of Sydney
Sydney, NSW 2006
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Country
Australia
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Secondary sponsor category [1]
297008
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Individual
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Name [1]
297008
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Ganesh Dangal
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Address [1]
297008
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Kathmandu Model Hospital
Pradarsani Marg
GPO Box: 6064
Kathmandu
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Country [1]
297008
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Nepal
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Secondary sponsor category [2]
297036
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Individual
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Name [2]
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Kirsten Black
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Address [2]
297036
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The University of Sydney
Sydney NSW 2006
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Country [2]
297036
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Australia
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Secondary sponsor category [3]
297037
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Individual
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Name [3]
297037
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Camille Raynes-Greenow
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Address [3]
297037
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The University of Sydney
Sydney, NSW 2006
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Country [3]
297037
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
298990
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Institutional Review Committee (phect-Nepal)
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Ethics committee address [1]
298990
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Public Health Concern Trust GPO Box 6064 Pradarshani Marg Kathmandu
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Ethics committee country [1]
298990
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Nepal
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Date submitted for ethics approval [1]
298990
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03/10/2017
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Approval date [1]
298990
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30/10/2017
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Ethics approval number [1]
298990
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Summary
Brief summary
The aim of this study is to determine if an informational flip chart describing pelvic floor muscle training (PFMT) and lifestyle advice can improve the quality of life (QOL) for Nepali women who have a symptomatic pelvic organ prolapse (POP). In Nepal, there is a high prevalence of POP and many women have difficulties accessing treatment options. Pelvic floor muscle training has been shown to be an effective conservative treatment option for women with stage I-III POP. Many of the randomised control trials highlighting the efficacy of PFMT are based in developed countries with well-educated Caucasian women. Additionally, the protocols require participants to engage in multiple treatment sessions with a health professional. These study designs are not feasible for women living in rural regions of Nepal as often they have low literacy levels and face barriers in accessing health professionals. In these regions, local health workers are responsible for delivering maternal health information to women in the community. The current conservative approach for Nepali women with a POP involves brief (<5 minute) verbal instruction on PFMT without any additional lifestyle advice. Previous studies have shown that brief verbal instruction is often inadequate in teaching women about important lifestyle modifications and to correctly perform PFMT. In order to address these challenges, we developed a flip chart to assist local health workers in delivering in-depth education on PFMT and lifestyle advice for Nepali women who have a POP. We hypothesise that a flip chart with in-depth information on PFMT and lifestyle advice on how to manage a POP will result in greater improvement in the Prolapse-quality of life (P-QoL) score when compared to brief verbal education on PFMT. The study design is a randomised control trial with two arms, an intervention and a control arm. Participants include women from rural regions in Nepal attending POP screening camps at two urban hospitals in Kathmandu valley. Women with a stage I-III POP as assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system will be invited to participate in the study. The intervention arm will be shown a flip chart with in-depth information about PFMT and lifestyle advice in addition to usual care. The control arm will receive usual care, which includes brief (<5 minute) verbal PFMT instruction only. Women in both arms will be instructed to perform PFMT daily and to document the exercises they perform on a log sheet. A prolapse quality of life questionnaire (P-QoL) will be completed at baseline then again at six, 12 weeks and 6 months post-intervention. The results of this study will determine if an informational flip chart on PFMT and lifestyle advice may be a useful tool for local health workers to utilise when providing education to Nepali women who have a POP.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Mrs Delena Caagbay
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Address
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The University of Sydney
Sydney NSW 2006
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Country
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Australia
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Phone
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+61 2 9351 2222
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Fax
78914
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Email
78914
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[email protected]
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Contact person for public queries
Name
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Delena Caagbay
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Address
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The University of Sydney
Sydney NSW 2006
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Country
78915
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Australia
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Phone
78915
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+61 02 9351 2222
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Fax
78915
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Email
78915
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[email protected]
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Contact person for scientific queries
Name
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Delena Caagbay
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Address
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The University of Sydney
Sydney NSW 2006
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Country
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Australia
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Phone
78916
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+61 02 9351 2222
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Fax
78916
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Email
78916
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
Source
Title
Year of Publication
DOI
Embase
Impact of an informational flipchart on lifestyle advice for Nepali women with a pelvic organ prolapse: a randomized controlled trial.
2020
https://dx.doi.org/10.1007/s00192-020-04228-1
N.B. These documents automatically identified may not have been verified by the study sponsor.
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