To describe how approaches to vaginal pessary interventions for pelvic organ prolapse (POP) are being reported in randomised controlled trials (RCTs).

This was a secondary analysis of data extracted from a systematic review with a unique component network meta-analysis (CNMA); the review was preregistered on PROSPERO (CRD42024595871). We searched the Cochrane Incontinence Specialised Register (including RCTs and quasi-RCTs from MEDLINE, CINAHL, Embase and CENTRAL, and clinical trial registries) from inception to 31 March 2023. The search strategies were applied to search each database and registry independently up to 24 April 2025. Further to this, iterative reference list and citation checking were undertaken. The eligibility criteria for this secondary analysis included RCTs and quasi-RCTs of women with POP assessing the effects of any vaginal pessary compared with no treatment, usual care, another non-surgical intervention, or surgery. 

Gold standard methods as outlined by the Cochrane Handbook were used to undertake study selection and data extraction (1). Information on how pessaries were described and delivered within eligible studies was extracted using the Template for Intervention Description and Replication (TIDieR) checklist (2). A descriptive analysis of frequencies was undertaken to determine how many TIDieR domains each of the included studies reported. This analysis was undertaken on every study arm that contained a vaginal pessary as a component of the intervention. Where vaginal pessaries were delivered alongside other non-surgical interventions, a sensitivity analysis determined whether removing these studies changed the conclusions.

Fourteen studies (across 43 reports) were included. Eight reported using support pessaries only, three used both support and space-filling pessaries, one used mainly support pessaries, one used both support and occlusive pessaries, and one did not report on the type of pessary used. Only one included study reported details relating to all of the TIDieR domains (Figure 1). 

All but one included study provided women with some form of advice or training on how to use a vaginal pessary, though details on the type and level of advice provided varied. Seven studies provided some details on the expertise of the intervention provider, but the level of description regarding their expertise varied. Only one study explicitly reported on aspects of pessary care such as timing of removal, cleaning and reinsertion of pessaries, as well as the amount of times women needed to visit a healthcare professional to help manage their pessary. Three of the 14 included studies did not report any details surrounding whether the intervention was personalised, such as personalisation of the pessary size, and 7 of 14 studies did not report any details on whether there were any modifications to the pessary intervention during the trial period. Finally, only 3 of 14 studies explicitly described how adherence to the intervention was planned to be measured, with 7 of 14 studies reporting on actual intervention adherence.

There was considerable variation in how TIDieR domains were reported. The level of detail on how vaginal pessary interventions were delivered also varied substantially. This makes it challenging for healthcare practitioners to be able to translate the findings of these studies when implementing vaginal pessary interventions in practice.

Currently, reporting of approaches to pessary interventions for POP within RCTs is insufficient to enable healthcare professionals to reproduce and transfer findings to clinical practice. Future studies should ensure that all TIDieR checklist domains are reported and easily accessible to enhance understanding of how pessary interventions for POP were delivered and to help reduce research waste.

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al, editor(s). Cochrane Handbook for Systematic Reviews of Interventions version 6.5 (updated August 2024). Cochrane, 2024. Available from www.cochrane.org/handbook.
Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, Lamb SE. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Bmj. 2014 Mar 7;348.