High-quality pelvic health physiotherapy for vaginal mesh-associated complications: a modified e-Delphi consensus study

Introduction: Transvaginal mesh implants have been widely used to treat stress urinary incontinence and pelvic organ prolapse but have been associated with significant complications in some women. Specialist multidisciplinary Mesh Centres have been established to provide expert diagnosis and management. Pelvic health physiotherapy (PHPT) is recommended as part of this provision; however, to date no published interventional studies have directly evaluated PHPT in this population, and there is no consensus to guide high-quality PHPT service delivery. This study aimed to establish expert consensus on the components of high-quality PHPT for women with vaginal mesh-associated complications. Methods: A three-round modified e-Delphi study was conducted with specialist physiotherapists who were members of the Pelvic, Obstetric and Gynaecological Physiotherapy Mesh Centres Committee. Participants rated proposed quality indicators using a five-point Likert scale and provided free-text feedback. Response rates, agreement levels, and consensus stability were assessed. Consensus was predefined as > 75% agreement and stability as < 10% variation between the final two rounds. Results: Thirteen expert physiotherapists completed all three Delphi rounds. Forty quality indicators achieved stable consensus across five domains: (i) holistic care, (ii) integrated care, (iii) surgical care pathways, (iv) non-surgical care pathways, and (v) PHPT treatment modalities. Conclusion: This study establishes the first expert consensus defining high-quality PHPT services for women with vaginal mesh-associated complications. The resulting quality indicators provide a structured framework to inform commissioning, service design, and clinical practice. In the absence of direct interventional evidence, further research is required to evaluate their implementation and impact on patient-centred outcomes.