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Aktaş D, Koçaşlı S, Baykara ZG. The Effect of Pelvic Floor Muscle Exercises on Bowel Evacuation and Quality of Life in Following Intestinal Ostomy Closure: Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2024; 51:221-234. [PMID: 38820220 DOI: 10.1097/won.0000000000001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
PURPOSE This purpose of this study was to evaluate the effect of pelvic floor muscle exercises (PFMEs) on bowel evacuation problems and health-related quality of life (HRQOL) following ostomy closure. DESIGN Randomized controlled trial. SUBJECTS AND SETTING Forty individuals following ostomy closure consented to participate in the study; 6 participants (15%) did not complete the trial (2 died and 2 required a second ostomy) yielding a study sample of 34. Participants were randomly allocated to an Exercise Group (EG, n = 17) and Control Group (CG, n = 17). The mean age of the EG was 55.7 (SD 12.6) years, whereas the mean age of the CG was 62.0 (SD 12.1) years. The study setting was the surgery clinic of 4 hospitals in Ankara, Turkey. Data were collected between December 2018 and May 2020. METHODS The study intervention, PFME training by a clinician, was administered to participants in the EG; CG participants received no information regarding PFME. Data were collected during face-to-face interviews on the day before discharge and by phone at the first, second, third, and sixth months after surgery. A questionnaire was used for data collection that queried a demographic and pertinent clinical questions, along with the Assessment Form for Bowel Evacuation Habits and Psychosocial Problems, Wexner Scale, and the Short Form (SF-36) Health-related Quality of Life Scale. Descriptive statistics and Mann-Whitney U test, t-test, Pearson-χ2 test, Fisher's Exact test, Friedman test, and Cochran-Q test statistical analysis according to normal distribution were used in data evaluation. RESULTS The number of defecations in the EG was statistically significantly lower than the CG at the second, third, and sixth months (P = .002, P = .002, P = .001, respectively). In addition, the number of individuals experiencing night defecation was statistically significantly less in the EG compared to the CG at the second-, third-, and sixth-month follow-ups (P = .001, P = .001, P = .028, respectively). HRQOL scores were also significantly higher in the EG. CONCLUSION Pelvic floor exercises applied after ostomy closure are effective in reducing bowel evacuation and increasing quality of life. Given these findings, PFMEs are recommended for patients after ostomy closure.
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Affiliation(s)
- Dilek Aktaş
- Dilek Aktaş , PhD, Faculty of Health Sciences, Department of Nursing School of Nursing, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Sema Koçaşlı, PhD, Faculty of Health Sciences, Department of Nursing, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Zehra Göçmen Baykara, PhD, Faculty of Nursing, Fundamentals of Nursing Department, Gazi University, Ankara, Turkey
| | - Sema Koçaşlı
- Dilek Aktaş , PhD, Faculty of Health Sciences, Department of Nursing School of Nursing, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Sema Koçaşlı, PhD, Faculty of Health Sciences, Department of Nursing, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Zehra Göçmen Baykara, PhD, Faculty of Nursing, Fundamentals of Nursing Department, Gazi University, Ankara, Turkey
| | - Zehra Göçmen Baykara
- Dilek Aktaş , PhD, Faculty of Health Sciences, Department of Nursing School of Nursing, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Sema Koçaşlı, PhD, Faculty of Health Sciences, Department of Nursing, Ankara Yıldırım Beyazıt University, Ankara, Turkey
- Zehra Göçmen Baykara, PhD, Faculty of Nursing, Fundamentals of Nursing Department, Gazi University, Ankara, Turkey
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Koifman E, Armoni M, Gorelik Y, Harbi A, Streltsin Y, Duek SD, Brun R, Mazor Y. Long term persistence and risk factors for anorectal symptoms following low anterior resection for rectal cancer. BMC Gastroenterol 2024; 24:31. [PMID: 38216868 PMCID: PMC10787434 DOI: 10.1186/s12876-023-03112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Rectal cancer is commonly treated by chemoradiation therapy, followed by the low anterior resection anal sphincter-preserving surgery, with a temporary protecting ileostomy. After reversal of the stoma a condition known as low anterior resection syndrome (LARS) can occur characterized by a combination of symptoms such as urgent bowel movements, lack of control over bowel movements, and difficulty fully emptying the bowels. These symptoms have a significant negative impact on the quality of life for individuals who have survived the cancer. Currently, there is limited available data regarding the presence, risk factors, and effects of treatment for these symptoms during long-term follow-up. AIMS To evaluate long term outcomes of low anterior resection surgery and its correlation to baseline anorectal manometry (ARM) parameters and physiotherapy with anorectal biofeedback (BF) treatment. METHODS One hundred fifteen patients (74 males, age 63 ± 11) who underwent low anterior resection surgery for rectal cancer were included in the study. Following surgery, patients were managed by surgical and oncologic team, with more symptomatic LARS patients referred for further evaluation and treatment by gastroenterologists. At follow up, patients were contacted and offered participation in a long term follow up by answering symptom severity and quality of life (QOL) questionnaires. RESULTS 80 (70%) patients agreed to participate in the long term follow up study (median 4 years from stoma reversal, range 1-8). Mean time from surgery to stoma closure was 6 ± 4 months. At long term follow up, mean LARS score was 30 (SD 11), with 55 (69%) patients classified as major LARS (score > 30). Presence of major LARS was associated with longer time from surgery to stoma reversal (6.8 vs. 4.8 months; p = 0.03) and with adjuvant chemotherapy (38% vs. 8%; p = 0.01). Patients initially referred for ARM and BF were more likely to suffer from major LARS at long term follow up (64% vs. 16%, p < 0.001). In the subgroup of patients who underwent perioperative ARM (n = 36), higher maximal squeeze pressure, higher maximal incremental squeeze pressure and higher rectal pressure on push were all associated with better long-term outcomes of QOL parameters (p < 0.05 for all). 21(54%) of patients referred to ARM were treated with BF, but long term outcomes for these patients were not different from those who did not perform BF. CONCLUSIONS A significant number of patients continue to experience severe symptoms and a decline in their quality of life even 4 years after undergoing low anterior resection surgery. Prolonged time until stoma reversal and adjuvant chemotherapy emerged as the primary risk factors for a negative prognosis. It is important to note that referring patients for anorectal physiology testing alone tended to predict poorer long-term outcomes, indicating the presence of selection bias. However, certain measurable manometric parameters could potentially aid in identifying patients who are at a higher risk of experiencing unfavorable functional outcomes. There is a critical need to enhance current treatment options for this patient group.
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Affiliation(s)
- E Koifman
- Rambam Health Care Campus, Department of Gastroenterology, Haifa, Israel.
| | - M Armoni
- Rambam Health Care Campus, Department of Gastroenterology, Haifa, Israel
| | - Y Gorelik
- Rambam Health Care Campus, Department of Gastroenterology, Haifa, Israel
| | - A Harbi
- Rambam Health Care Campus, Department of General Surgery, Haifa, Israel
| | - Y Streltsin
- Rambam Health Care Campus, Department of Gastroenterology, Haifa, Israel
| | - S D Duek
- Rambam Health Care Campus, Department of General Surgery, Haifa, Israel
| | - R Brun
- Rambam Health Care Campus, Department of Gastroenterology, Haifa, Israel
| | - Y Mazor
- Rambam Health Care Campus, Department of Gastroenterology, Haifa, Israel
- Department of Medical Neurobiology, The Hebrew University of Jerusalem, Jerusalem, Israel
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Management of Low Anterior Resection Syndrome (LARS) Following Resection for Rectal Cancer. Cancers (Basel) 2023; 15:cancers15030778. [PMID: 36765736 PMCID: PMC9913853 DOI: 10.3390/cancers15030778] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION A total of 60-80% of patients undergoing rectal resection (mostly as a treatment for rectal cancer) suffer from a variety of partly severe functional problems despite preservation of the anal sphincter. These patients are summarized under the term low anterior resection syndrome (LARS). Preoperative radiotherapy, vascular dissection and surgical excision of the low rectum and mesorectum lead, alone or all together, to a significant impairment of colonic and (neo-) rectal motility. This results in a variety of symptoms (multiple defecation episodes, recurrent episodes of urge, clustering, incontinence, etc.) which are associated with severe impairment of quality of life (QOL). METHODS This narrative review summarizes the present state of knowledge regarding the pathophysiology of LARS as well as the evidence for the available treatment options to control the symptoms resulting from this condition. RESULTS A review of the literature (Medline, Pubmed) reveals a variety of treatment options available to control symptoms of LARS. Medical therapy, with or without dietary modification, shows only a modest effect. Pelvic floor rehabilitation consisting of muscle exercise techniques as well as biofeedback training has been associated with improvement in LARS scores and incontinence, albeit with limited scientific evidence. Transanal irrigation (TAI) has gained interest as a treatment modality for patients with LARS due to an increasing number of promising data from recently published studies. Despite this promising observation, open questions about still-unclear issues of TAI remain under debate. Neuromodulation has been applied in LARS only in a few studies with small numbers of patients and partly conflicting results. CONCLUSION LARS is a frequent problem after sphincter-preserving rectal surgery and leads to a marked impairment of QOL. Due to the large number of patients suffering from this condition, mandatory identification, as well as treatment of affected patients, must be considered during surgical as well as oncological follow-up. The use of a standardized treatment algorithm will lead to sufficient control of symptoms and a high probability of a marked improvement in QOL.
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Asnong A, D’Hoore A, Van Kampen M, Wolthuis A, Van Molhem Y, Van Geluwe B, Devoogdt N, De Groef A, Guler Caamano Fajardo I, Geraerts I. The Role of Pelvic Floor Muscle Training on Low Anterior Resection Syndrome: A Multicenter Randomized Controlled Trial. Ann Surg 2022; 276:761-768. [PMID: 35894434 PMCID: PMC9534049 DOI: 10.1097/sla.0000000000005632] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Total mesorectal excision (TME) for rectal cancer (RC) often results in significant bowel symptoms, commonly known as low anterior resection syndrome (LARS). Although pelvic floor muscle training (PFMT) is recommended in noncancer populations for treating bowel symptoms, this has been scarcely investigated in RC patients. The objective was to investigate PFMT effectiveness on LARS in patients after TME for RC. METHODS A multicenter, single-blind prospective randomized controlled trial comparing PFMT (intervention; n=50) versus no PFMT (control; n=54) 1 month following TME/stoma closure was performed. The primary endpoint was the proportion of participants with an improvement in the LARS category at 4 months. Secondary outcomes were: continuous LARS scores, ColoRectal Functioning Outcome scores, Numeric Rating Scale scores, stool diary items, and Short Form 12 scores; all assessed at 1, 4, 6, and 12 months. RESULTS The proportion of participants with an improvement in LARS category was statistically higher after PFMT compared with controls at 4 months (38.3% vs 19.6%; P =0.0415) and 6 months (47.8% vs 21.3%; P =0.0091), but no longer at 12 months (40.0% vs 34.9%; P =0.3897). Following secondary outcomes were significantly lower at 4 months: LARS scores (continuous, P =0.0496), ColoRectal Functioning Outcome scores ( P =0.0369) and frequency of bowel movements ( P =0.0277), solid stool leakage (day, P =0.0241; night, P =0.0496) and the number of clusters ( P =0.0369), derived from the stool diary. No significant differences were found for the Numeric Rating Scale/quality of life scores. CONCLUSIONS PFMT for bowel symptoms after TME resulted in lower proportions and faster recovery of bowel symptoms up to 6 months after surgery/stoma closure, justifying PFMT as an early, first-line treatment option for bowel symptoms after RC.
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Affiliation(s)
- Anne Asnong
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
| | - André D’Hoore
- Department of Abdominal Surgery, University Hospitals Gasthuisberg Leuven and KU Leuven—University of Leuven, Leuven, Belgium
| | - Marijke Van Kampen
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Gasthuisberg Leuven and KU Leuven—University of Leuven, Leuven, Belgium
| | - Yves Van Molhem
- Department of Abdominal Surgery, OLV Hospitals, Aalst/Asse/Ninove, Belgium
| | - Bart Van Geluwe
- Department of Abdominal Surgery, AZ Groeninge, Kortrijk, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
- Center for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, University of Antwerp, Antwerp, Belgium
- International Research Group Pain in Motion, Brussels, Belgium
| | - Ipek Guler Caamano Fajardo
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU Leuven and Hasselt University, Leuven, Belgium
| | - Inge Geraerts
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Leuven, Belgium
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Zhou XD, Wei HG, Ai FL. Biofeedback therapy combined with Baduanjin on quality of life and gastrointestinal hormone level in patients with colorectal cancer. World J Gastrointest Oncol 2022; 14:1187-1198. [PMID: 35949217 PMCID: PMC9244983 DOI: 10.4251/wjgo.v14.i6.1187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/15/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With the change in people’s lifestyles, the incidence of colorectal cancer (CRC) is increasing. It is essential to study the efficacy of various treatment methods for CRC patients to prevent and treat CRC.
AIM To investigate the efficacy of biofeedback therapy combined with Baduanjin in improving the quality of life and gastrointestinal hormone levels of patients with CRC.
METHODS A total of 120 patients with CRC who were admitted to our hospital from June 2020 to June 2021 were included in the study. They were randomly divided into four groups (n = 30): the control group (group A), the biofeedback therapy intervention group (group B), the Baduanjin exercise intervention group (group C), and the combination group (group D). Patients in group A adopted the standard nursing mode and necessary health education. Patients in group B were treated with biofeedback therapy based on routine nursing care. Patients in group C were given Baduanjin intervention for 12 wk based on conventional drug treatment and care. Patients in group D were treated with biofeedback therapy and Baduanjin exercise. In this study, patients’ quality of life, gastrointestinal hormone levels, and clinical efficacy in the four groups were observed at baseline and 12 wk after intervention. Meanwhile, the correlation between gastrointestinal hormone levels and various functional areas of quality of life was analyzed. By comparing the observed indicators of patients in the four groups, the efficacy of biofeedback therapy combined with Baduanjin in improving the quality of life and gastrointestinal hormone levels of patients with CRC was explored.
RESULTS At baseline, there were no significant differences in quality of life, gastrointestinal hormone levels, or clinical efficacy among the four groups (P > 0.05). Twelve weeks after the intervention, the combination group’s quality of life, gastrointestinal hormone levels, and clinical effectiveness were better than those of the three other groups.
CONCLUSION On the basis of routine nursing care, patients with CRC combined with biofeedback therapy and Baduanjin exercise can improve the quality of life of patients with CRC and the efficacy of gastrointestinal hormone levels.
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Affiliation(s)
- Xiao-Ding Zhou
- Graduate Work Department, Shenyang Sport University, Shenyang 110102, Liaoning Province, China
| | - Hong-Gang Wei
- Wushu and Dance Academy, Shenyang Sport University, Shenyang 110115, Liaoning Province, China
| | - Fu-Lu Ai
- Department of General Surgery, Liaoning Tumor Hospital, Shenyang 110042, Liaoning Province, China
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Fermin ASR, Friston K, Yamawaki S. An insula hierarchical network architecture for active interoceptive inference. ROYAL SOCIETY OPEN SCIENCE 2022; 9:220226. [PMID: 35774133 PMCID: PMC9240682 DOI: 10.1098/rsos.220226] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/09/2022] [Indexed: 05/05/2023]
Abstract
In the brain, the insular cortex receives a vast amount of interoceptive information, ascending through deep brain structures, from multiple visceral organs. The unique hierarchical and modular architecture of the insula suggests specialization for processing interoceptive afferents. Yet, the biological significance of the insula's neuroanatomical architecture, in relation to deep brain structures, remains obscure. In this opinion piece, we propose the Insula Hierarchical Modular Adaptive Interoception Control (IMAC) model to suggest that insula modules (granular, dysgranular and agranular), forming parallel networks with the prefrontal cortex and striatum, are specialized to form higher order interoceptive representations. These interoceptive representations are recruited in a context-dependent manner to support habitual, model-based and exploratory control of visceral organs and physiological processes. We discuss how insula interoceptive representations may give rise to conscious feelings that best explain lower order deep brain interoceptive representations, and how the insula may serve to defend the body and mind against pathological depression.
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Affiliation(s)
- Alan S. R. Fermin
- Center for Brain, Mind and Kansei Sciences Research, Hiroshima University, Hiroshima, Japan
| | - Karl Friston
- The Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, England
| | - Shigeto Yamawaki
- Center for Brain, Mind and Kansei Sciences Research, Hiroshima University, Hiroshima, Japan
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Li H, Guo C, Gao J, Yao H. Effectiveness of Biofeedback Therapy in Patients with Bowel Dysfunction Following Rectal Cancer Surgery: A Systemic Review with Meta-Analysis. Ther Clin Risk Manag 2022; 18:71-93. [PMID: 35140468 PMCID: PMC8819167 DOI: 10.2147/tcrm.s344375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/21/2021] [Indexed: 01/30/2023] Open
Abstract
Objective To identify, systematically review and synthesize the evidence on the effectiveness of biofeedback therapy in patients with bowel dysfunction following rectal cancer surgery. Data Sources Four electronic databases (PubMed 1974–2021; Embase1980–2021; Cochrane databases and the trial registers) were systematically searched by reviewers from inception through March 2021. Study Selection Randomized controlled trials (RCTs), cohort studies, and case series studies were included for adults with bowel dysfunction following rectal cancer surgery. All participants received an intervention of biofeedback treatment. Any outcomes that can evaluate the patient’s bowel function were the primary research endpoint, while the quality of life was the second endpoint. The disagreements between the two reviewers were resolved after discussion and the third independent reviewer’s ruling. As a result, 12 of 185 studies met selection criteria and were included in the review. Data Extraction We designed an electronic data extraction form and data were extracted independently. The methodological quality of included studies was assessed using the Cochrane Risk of Bias, the MINORS scale, and the Institute of Health Economics scale. Data Synthesis Meta-analyses were conducted for case series only and narrative syntheses were completed. Key findings included significant improvements in bowel function as well as health-related quality of life after biofeedback therapy. (Wexner score: t=7, MD=3.33; 95% CI [2.48, 4.18]) and (Vaizey score: t=3, MD=2.46; 95% CI [1.98, 2.93]). Subgroup analysis of Wexner score: receiving electrical stimulation therapy (t=3, MD=2.36; 95% CI [1.51, 3.22]), not receiving electrical stimulation (t=4, MD=3.79;95% CI[2.66, 4.93]); not receiving adjuvant chemoradiotherapy (t=3, MD=2.42;95% CI[1.61, 3.24]), chemotherapy and radiotherapy (t=1, MD=4.10; 95% CI [2.90, 5.30]), radiotherapy and chemotherapy on parts of patients (t=2, MD=3.46;95% CI [1.41, 5.51]), chemotherapy (t=1, MD=4.81; 95% CI [3.38, 6.24]); performing ISR (t=2, MD=3.32;95% CI [0.37, 6.27]), performing AR (t=4, MD=3.08; 95% CI [2.12, 4.04]), performing PLRAS surgery (t=1, MD=4.10;95% CI[2.90, 5.30]). Conclusion Although biofeedback therapy may improve intestinal function and quality of life as well as anal function reflected by ARM after surgery, patient satisfaction is still unclear. Due to the scarcity of data, good-quality research is required to delve deeper. Clinical Trial Registration Number CRD42020192658.
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Affiliation(s)
- Haoze Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing, 100050, People’s Republic of China
| | - Ce Guo
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing, 100050, People’s Republic of China
| | - Jiale Gao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing, 100050, People’s Republic of China
| | - Hongwei Yao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing, 100050, People’s Republic of China
- Correspondence: Hongwei Yao, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, People’s Republic of China, Email
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Oyama O, Park DH, Lee MK, Byeon JY, Lee EB, Chung JY, Jung HJ, Park J, Kim T, Jee SH, Kim NK, Jeon JY. Characteristics of Defecation Function Related Quality of Life According to Cancer Location in Colorectal Cancer Survivors. ASIAN ONCOLOGY NURSING 2022. [DOI: 10.5388/aon.2022.22.4.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Okimitsu Oyama
- BS, Department of Sports Industry, Yonsei University, Seoul, Korea
| | - Dong-Hyuk Park
- MS, Department of Sports Industry, Yonsei University, Seoul, Korea
| | - Mi-Kyung Lee
- Ph.D, Department of Sports Industry, Yonsei University · Frontier Research Institute of Convergence Sports Science, Yonsei University, Seoul, Korea
| | - Ji-yong Byeon
- Ph.D., Department of Sports Industry, Yonsei University, Seoul, Korea
| | - Eun Byeol Lee
- MS, Department of Sports Industry, Yonsei University, Seoul, Korea
| | - Jae-Youn Chung
- Ph.D., Department of Sports Industry, Yonsei University, Seoul, Korea
| | - Hye Jeong Jung
- MS, Department of Nursing, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jisu Park
- Prof., Cancer Prevention Center, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Taeil Kim
- Prof., Cancer Prevention Center, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Ha Jee
- Prof., Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Nam Kyu Kim
- Prof., Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Justin Y Jeon
- Prof., Department of Sports Industry, Yonsei University · Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Seoul, Korea
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Nafedzov IO, Chernyshov SV, Ponomarenko AA, Fomenko OY, Alekseev MV, Khomyakov EA, Belousova SV, Rybakov EG. Rehabilitation of patients with low anterior resection syndrome. KOLOPROKTOLOGIA 2021; 20:57-64. [DOI: 10.33878/2073-7556-2021-20-2-57-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
Abstract
Aim: to develop a conservative rehabilitation program for patients with severe symptoms of LARS.Patients and methods: since January 2019, 50 patients after low anterior resection were included in the study. The main group included 25 patients who underwent biofeedback therapy and tibial neuromodulation in 3–6 months after surgery. Functional results before and after treatment were evaluated by anorectal manometry. The control group included 25 patients, according to the Propensity score matching.Results: the median score on the LARS scale, in the main group was 41.0 ± 2.8 points, in the control — 38 ± 4. With sphincterometry, the median pressure at rest before treatment was 30.0 ± 7.8, with a voluntary contraction of 140.6 ± 56.0 mm Hg. After the conservative treatment, patients in the main group had significantly better results: the median score on the LARS scale decreased from 41 ± 2.8 to 17 ± 8 points (p < 0.0001), the median pressure after treatment increased from 30.0 ± 7.8 to 36.0 ± 8.0 (p = 0.004), with a voluntary contraction from 140.6 ± 56.0 to 157.5 ± 53.2 mmHg (p = 0.008). Comparing the results of the questionnaire of the main group with the control group after the stoma closure and after 12 months, it turned out that in the main group there was a significant decrease in the severity of LARS: 17.0 ± 8.0 scores vs. 35.0 ± 4.5 (p = 0.0003), which shows an improvement in the tone and contractility of the sphincter after conservative treatment.Conclusion: comprehensive biofeedback therapy and tibial neuromodulation improves the functional results of patients with severe LARS.
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Affiliation(s)
- I. O. Nafedzov
- Ryzhikh National Medical Research Center of Coloproctology
| | | | | | - O. Yu. Fomenko
- Ryzhikh National Medical Research Center of Coloproctology
| | - M. V. Alekseev
- Ryzhikh National Medical Research Center of Coloproctology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia
| | - E. A. Khomyakov
- Ryzhikh National Medical Research Center of Coloproctology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia
| | | | - E. G. Rybakov
- Ryzhikh National Medical Research Center of Coloproctology
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Khomyakov EA, Nafedzov IO, Fomenko OY, Alekseyev MV, Frolov SA, Tchernyshov SV, Rybakov EG. Risk factors for major low anterior resection syndrome: meta-analysis and systematic literature review. RUSSIAN OPEN MEDICAL JOURNAL 2021. [DOI: 10.15275/rusomj.2021.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction — Low anterior resection syndrome (LARS) is a socially significant problem that impedes social adaptation and contributes to deterioration of life quality in patients.
The objective of this study was to search for the category of patients most prone to major LARS, as well as to identify the factors determining the severity of this syndrome manifestations.
Material and Methods — Systematic review and meta-analysis were performed according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study selected publications that included the functional results of treatment of patients operated for rectal cancer. Functional impairments were assessed according to the international LARS Score. Statistical analysis was performed using the inverse-variance weighted average method (IVW) with calculation of the odds ratio logarithm and standard error of the mean.
Results — After a critical search and analysis of all literature sources, eight studies were found suitable for meta-analysis. In total, 1042 patients (796 men and 246 women) were included into statistical analysis, 409 of which (39.2%) had symptoms of major LARS. Chemotherapy was performed on 637 (62.5%) patients, while 568 subjects (55.5%) underwent radiation therapy, and anastomotic leaks were described in 89 (8.5%) people. According to the results of the meta-analysis, statistically significant factors were: preventative ostomy (OR=3.32, 95% CI 1.99-5.55, p<0.00001), chemotherapy (OR=1.98, 95% CI 1.23-3, 19, p=0.005), radiation therapy (OR=5.00, 95% CI 2.73-9.13, p <0.00001), anastomotic leaks (OR=2.93, 95% CI 2.30-3, 73, p<0.00001), anal verge distance from anastomosis site (OR=2.61, 95% CI 1.47-4.62, p=0.001).
Conclusion — The results of our meta-analysis allowed us identifying the group of rectal cancer patients most vulnerable to LARS. The risk of developing severe functional disorders is significantly higher in patients with low colorectal anastomosis, as well as in patients undergoing neoadjuvant radiation therapy.
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11
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Asnong A, D'Hoore A, Van Kampen M, Devoogdt N, De Groef A, Sterckx K, Lemkens H, Wolthuis A, Van Molhem Y, Van Geluwe B, Debrun L, Geraerts I. Randomised controlled trial to assess efficacy of pelvic floor muscle training on bowel symptoms after low anterior resection for rectal cancer: study protocol. BMJ Open 2021; 11:e041797. [PMID: 33483444 PMCID: PMC7831707 DOI: 10.1136/bmjopen-2020-041797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Radical surgery after a total mesorectal excision (TME) for rectal cancer often results in a significant decrease in the patient's quality of life, due to functional problems such as bowel, urinary and sexual dysfunction. The effect of pelvic floor muscle training (PFMT) on these symptoms has been scarcely investigated. We hypothesise that the proportion of successful patients will be significantly higher in the intervention group, receiving 12 weeks of PFMT, compared with the control group without treatment. The primary outcome of this trial is the severity of bowel symptoms, measured through the Low Anterior Resection Syndrome questionnaire, 4 months after TME or stoma closure. Secondary outcomes are related to other bowel and urinary symptoms, sexual function, physical activity and quality of life. METHODS AND ANALYSIS This research protocol describes a multicentre single blind prospective, randomised controlled trial. Since January 2017, patients treated for rectal cancer (n=120) are recruited after TME in three Belgian centres. One month following surgery or, in case of a temporary ileostomy, 1 month after stoma closure, patients are randomly assigned to the intervention group (n=60) or to the control group (n=60). The assessments concern the preoperative period and 1, 4, 6, 12 and 24 months postoperatively. ETHICS AND DISSEMINATION The study will be conducted in accordance with the Declaration of Helsinki. Ethics approval was granted by the local Ethical Committee of the University Hospitals Leuven (s59761) and positive advice from the others centres has been obtained. Dissemination of the results will be accomplished via guidelines and (non-)scientific literature for professionals as well as organisation of patient symposia. TRIAL REGISTRATION NUMBER NTR6383.
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Affiliation(s)
- Anne Asnong
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - André D'Hoore
- Department of Abdominal Surgery, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Vlaams-Brabant, Belgium
- Department of Oncology, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Marijke Van Kampen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Kim Sterckx
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Hilde Lemkens
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Vlaams-Brabant, Belgium
- Department of Oncology, KU Leuven, Leuven, Vlaams-Brabant, Belgium
| | - Yves Van Molhem
- Department of Abdominal Surgery, OLVZ, Aalst, Oost-Vlaanderen, Belgium
| | - Bart Van Geluwe
- Department of Abdominal Surgery, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Vlaams-Brabant, Belgium
- Department of Abdominal Surgery, AZ Groeninge - Campus Kennedylaan, Kortrijk, West-Vlaanderen, Belgium
| | - Lynn Debrun
- Department of Abdominal Surgery, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Leuven, Vlaams-Brabant, Belgium
| | - Inge Geraerts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Vlaams-Brabant, Belgium
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12
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Chan KYC, Suen M, Coulson S, Vardy JL. Efficacy of pelvic floor rehabilitation for bowel dysfunction after anterior resection for colorectal cancer: a systematic review. Support Care Cancer 2020; 29:1795-1809. [PMID: 33111180 DOI: 10.1007/s00520-020-05832-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/13/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Bowel dysfunction is common after anterior resection for colorectal cancer (CRC). Pelvic floor rehabilitation (PFR) may improve functional outcomes after surgery. This review aimed to evaluate the efficacy of PFR for patients with bowel symptoms after anterior resection. METHODS MEDLINE, CINHAL, PUBMED, EMBASE, Scopus, PsycINFO, Web of Science, PEDRO and Cochrane Library were searched from inception to June 2019. A final search was performed on 11 July 2020. Randomised controlled trials (RCTs), cohort studies, case-control studies and case series of bowel dysfunction after CRC surgery and PFR were eligible for review. Outcome measures were bowel function changes measured by patient-reported outcomes and manometric measurement. Risk of bias assessments using Methodological Index for Non-Randomized Studies (MINORS) tool and Newcastle Ottawa Scale (NOS) were conducted. RESULTS Eleven trials met eligibility criteria: four retrospective studies and seven prospective, non-randomised controlled studies. A total of 516 participants were included, of which 455 received PFR. Functional outcomes were measured by bowel functional outcome questionnaires, patient diary, anorectal manometry and three studies measured quality of life. Faecal incontinence was improved in seven studies, and bowel frequency also decreased in five studies. The mean MINORS score was 10 (8-13) out of 16 in non-comparative groups and 18 (16-22) out of 24 in comparative groups; the NOS was 4.2 (3-7) out of 9. The overall risk of bias was high in most studies. CONCLUSIONS PFR appears to be beneficial for improving bowel function after anterior resection for CRC. However, the studies included had methodological limitations, so further investigation on the effectiveness of PFR is warranted.
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Affiliation(s)
- K Y C Chan
- Concord Cancer Centre, Concord Repatriation & General Hospital, Hospital Road, Sydney, NSW, 2139, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - M Suen
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Colorectal Surgery, Concord Repatriation & General Hospital, Concord, NSW, 2139, Australia
| | - S Coulson
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Janette L Vardy
- Concord Cancer Centre, Concord Repatriation & General Hospital, Hospital Road, Sydney, NSW, 2139, Australia.
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
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13
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Fomenko OY, Kashnikov VN, Alekseev MV, Veselov AV, Belousova SV, Aleshin DV, Morozov SV, Kozlov VA, Reutova AA, Rumiantsev AS, Nafedzov IO. [Rehabilitation program for patients with low anterior resection syndrome]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2020; 97:52-59. [PMID: 33054009 DOI: 10.17116/kurort20209705152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
UNLABELLED Surgical treatment of rectal cancer and sphincter-preserving low anterior resection results to evacuation disorders («low anterior resection syndrome» - LARS). There are no clinical recommendations for the treatment of patients with LARS as well as a rehabilitation program for them. OBJECTIVE To develop a rehabilitation program for patients with low anterior resection syndrome. MATERIAL AND METHODS The investigation was performed at 2 stages. During the first stage, 29 patients with LARS (17 (58.6%) men, mean age of the participants' 61.5±9.5 years), 12 (41.4%) women (mean age 61.2±7.8 years) were examined and received the course of conservative treatment with the use of biofeedback-therapy performed by the standard protocol. On the second stage, 17 patients (mean age 61.4±12.7 years) - 9 (52.9%) men, 8 (47.1%) women received biofeedback therapy in combination with tibial neuromodulation (TNM). Functional state of the rectum and the locking apparatus in all patients were evaluated by anorectal manometry: sphincterometry and studies of the reservoir function of the rectum before and after treatment. RESULTS The developed complex of rehabilitation measures led to improved treatment results for patients with rectal cancer by improving the quality of life after low anterior resection, reducing the manifestations of LARS (by 47.8%). Stable positive results of treatment were maintained in 36.4% of patients, positive dynamics from the treatment according to the LARS scale decreased slightly in 54.5%, deterioration of indicators in 3-6 months after conservative rehabilitation was registered in 9.1% of cases. At the first stage maximal squeeze pressure improvement was reached in the whole cohort (p=0.047), at the second stage these trend was seen only for women for the pressure values at rest (p=0.01) and during squeeze (p=0.025). The data obtained allowed us to recommend a repeat course of treatment to 63.6% of patients. The authors modified and optimized a special complex of physical therapy for the rehabilitation of patients both in a medical institution and at home. These exercises are aimed at improving the functional state of the pelvic floor muscles and sphincter apparatus. CONCLUSION Rehabilitation program for patients with low anterior resection syndrome should include: 1) biofeedback therapy to improve the holding function; 2) biofeedback therapy aimed at improving the reservoir function and sensitivity of the rectum to filling; 3) tibial neuromodulation. This program may help improving the contractility of the anal sphincter and reservoir function of the rectum, as well as the appearance of the urge to defecate.
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Affiliation(s)
- O Yu Fomenko
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - V N Kashnikov
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - M V Alekseev
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - A V Veselov
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - S V Belousova
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - D V Aleshin
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - S V Morozov
- Federal Research Center of Nutrition, Biotechnology and Food Safety, Moscow, Russia
| | - V A Kozlov
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
| | - A A Reutova
- State clinical hospital No. 67 named after L.A. Vorokhobov, Moscow, Russia
| | - A S Rumiantsev
- State clinical hospital No. 67 named after L.A. Vorokhobov, Moscow, Russia
| | - I O Nafedzov
- National Medical Research Centre for Coloproctology named after A.N Ryzhikh, Moscow, Russia
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14
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Bastiaenen VP, Hovdenak Jakobsen I, Labianca R, Martling A, Morton DG, Primrose JN, Tanis PJ, Laurberg S. Consensus and controversies regarding follow-up after treatment with curative intent of nonmetastatic colorectal cancer: a synopsis of guidelines used in countries represented in the European Society of Coloproctology. Colorectal Dis 2019; 21:392-416. [PMID: 30506553 DOI: 10.1111/codi.14503] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/07/2018] [Indexed: 02/08/2023]
Abstract
AIM It is common clinical practice to follow patients for a period of years after treatment with curative intent of nonmetastatic colorectal cancer, but follow-up strategies vary widely. The aim of this systematic review was to provide an overview of recommendations on this topic in guidelines from member countries of the European Society of Coloproctology, with supporting evidence. METHOD A systematic search of Medline, Embase and the guideline databases Trip database, BMJ Best Practice and Guidelines International Network was performed. Quality assessment included use of the AGREE-II tool. All topics with recommendations from included guidelines were identified and categorized. For each subtopic, a conclusion was made followed by the degree of consensus and the highest level of evidence. RESULTS Twenty-one guidelines were included. The majority recommended that structured follow-up should be offered, except for patients in whom treatment of recurrence would be inappropriate. It was generally agreed that clinical visits, measurement of carcinoembryoinc antigen and liver imaging should be part of follow-up, based on a high level of evidence, although the frequency is controversial. There was also consensus on imaging of the chest and pelvis in rectal cancer, as well as endoscopy, based on lower levels of evidence and with a level of intensity that was contradictory. CONCLUSION In available guidelines, multimodal follow-up after treatment with curative intent of colorectal cancer is widely recommended, but the exact content and intensity are highly controversial. International agreement on the optimal follow-up schedule is unlikely to be achieved on current evidence, and further research should refocus on individualized 'patient-driven' follow-up and new biomarkers.
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Affiliation(s)
- V P Bastiaenen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - R Labianca
- Cancer Center, Ospedale Giovanni XXIII, Bergamo, Italy
| | - A Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - D G Morton
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - J N Primrose
- University Surgery, University of Southampton, Southampton, UK
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S Laurberg
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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15
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A meta-analysis of the prevalence of Low Anterior Resection Syndrome and systematic review of risk factors. Int J Surg 2018; 56:234-241. [PMID: 29936195 DOI: 10.1016/j.ijsu.2018.06.031] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/10/2018] [Accepted: 06/20/2018] [Indexed: 12/16/2022]
Abstract
AIM To summarize the reported prevalence and causative factors of Low Anterior Resection Syndrome (LARS) from studies using the LARS score. METHODS A systematic literature search was conducted using Pubmed, Ovid Medline and the Cochrane database. Searches were performed using a combination of MeSH (medical subject headings) terms and key terms. Studies that were included used the LARS score as their primary collection tool. Studies were excluded if initial surgery was not for malignancy, or if the majority of LARS scores were from patients less than 1 year post initial surgery or closure of diverting stoma. Eligible studies were assessed with a validated quality assessment tool prior to performing a meta-analysis with quality effects model. Meta-analysis was conducted with prevalence estimates that had been transformed using the double arcsine method. RESULTS Following the initial search and implementation of inclusion and exclusion criteria 11 studies were deemed suitable for meta-analysis. Meta-analysis found the estimated prevalence of major LARS was 41% (95% CI 34 -48). Where possible outlier studies were excluded, the prevalence was 42% (95%CI 35-48). Radiotherapy and tumour height were the most consistently assessed variables, both showing a consistent negative effect on bowel function. Defunctioning ileostomy was found to have a statically significant negative impact on bowel function in 4 of 11 studies. The majority of reported data has been produced by groups in Denmark and the United Kingdom with limited numbers provided by other locations. Available data is heterogenous with some variables having limited numbers, making meta-analysis of certain variables impossible. CONCLUSIONS There is significant prevalence of Low Anterior Resection Syndrome following oncological rectal resection. A low anastomotic height or history of radiotherapy are major risk factors.
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16
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Ridolfi TJ, Berger N, Ludwig KA. Low Anterior Resection Syndrome: Current Management and Future Directions. Clin Colon Rectal Surg 2016; 29:239-45. [PMID: 27582649 DOI: 10.1055/s-0036-1584500] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Outcomes for rectal cancer surgery have improved significantly over the past 20 years with increasing rates of survival and recurrence, specifically local recurrence. These gains have been realized during a period of time in which there has been an increasing emphasis on sphincter preservation. As we have become increasingly aggressive in avoiding resection of the anus, we have begun accepting bowel dysfunction as a normal outcome. Low anterior resection syndrome, defined as a constellation of symptoms including incontinence, frequency, urgency, or feelings of incomplete emptying, has a significant impact on quality of life and results in many patients opting for a permanent colostomy to avoid these symptoms. In this article, we will highlight the most recent clinical and basic science research on this topic and discuss areas of future investigation.
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Affiliation(s)
- Timothy J Ridolfi
- Department of Surgery, Division of Colorectal Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nicholas Berger
- Department of Surgery, Division of Colorectal Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kirk A Ludwig
- Department of Surgery, Division of Colorectal Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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17
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Kwoun HJ, Shin YH. Impact of Bowel Function, Anxiety and Depression on Quality of Life in Patients with Sphincter-preserving Resection for Rectal Cancer. J Korean Acad Nurs 2015; 45:733-41. [DOI: 10.4040/jkan.2015.45.5.733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 03/05/2015] [Accepted: 07/06/2015] [Indexed: 11/09/2022]
Affiliation(s)
| | - Yun Hee Shin
- Department of Nursing, Wonju College of Medicine, Yonsei University, Wonju, Korea
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18
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Lin KY, Granger CL, Denehy L, Frawley HC. Pelvic floor muscle training for bowel dysfunction following colorectal cancer surgery: A systematic review. Neurourol Urodyn 2014; 34:703-12. [PMID: 25156929 DOI: 10.1002/nau.22654] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/16/2014] [Indexed: 12/11/2022]
Abstract
AIMS To identify, evaluate and synthesize the evidence examining the effectiveness of pelvic floor muscle training (PFMT) on bowel dysfunction in patients who have undergone colorectal cancer surgery. METHODS Eight electronic databases (MEDLINE 1950-2014; CINAHL 1982-2014; EMBASE 1980-2014; Scopus 1823-2014; PsycINFO 1806-2014; Web of Science 1970-2014; Cochrane Library 2014; PEDro 1999-2014) were systematically searched in March 2014. Reference lists of identified articles were cross referenced and hand searched. Randomized controlled trials, cohort studies and case series were included if they investigated the effects of conservative treatments, including PFMT on bowel function in patients with colorectal cancer following surgery. Two reviewers independently assessed the risk of bias of studies using the Newcastle-Ottawa Scale (NOS). RESULTS Six prospective non-randomized studies and two retrospective studies were included. The mean (SD) NOS risk of bias score was 4.9 (1.2) out of 9; studies were limited by a lack of non-exposed cohort, lack of independent blinded assessment, heterogeneous treatment protocols, and lack of long-term follow-up. The majority of studies reported significant improvements in stool frequency, incontinence episodes, severity of fecal incontinence, and health-related quality of life (HRQoL) after PFMT. Meta-analysis was not possible due to lack of randomized controlled trials. CONCLUSIONS Pelvic floor muscle training for patients following surgery for colorectal cancer appears to be associated with improvements in bowel function and HRQoL. Results from non-randomized studies are promising but randomized controlled trials with sufficient power are needed to confirm the effectiveness of PFMT in this population.
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Affiliation(s)
- Kuan-Yin Lin
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Catherine L Granger
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, Australia
| | - Linda Denehy
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Helena C Frawley
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia.,Allied Health Research, Cabrini Health, Melbourne, Australia
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19
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Visser WS, Te Riele WW, Boerma D, van Ramshorst B, van Westreenen HL. Pelvic floor rehabilitation to improve functional outcome after a low anterior resection: a systematic review. Ann Coloproctol 2014; 30:109-14. [PMID: 24999460 PMCID: PMC4079807 DOI: 10.3393/ac.2014.30.3.109] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 05/21/2014] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Impaired functional outcome is common after a low anterior resection (LAR). Pelvic floor rehabilitation (PFR) might improve functional outcome after a LAR. The aim of this systematic review is to evaluate the effectiveness of PFR in improving functional outcome. METHODS PubMed, Embase, and the Cochrane Library were searched using the terms fecal incontinence, colorectal neoplasm/surgery, LAR, rectal cancer, anterior resection syndrome, bowel habit, pelvic floor, training, therapy, physical therapy, rehabilitation and biofeedback. Of the 125 identified records, 5 articles were included. RESULTS The 5 included studies reported on 321 patients, of which 286 patients (89%) underwent pelvic floor training. Three studies included patients with anterior resection syndrome after a LAR while the remaining studies included a series of patients after a LAR. Functional outcome was mostly assessed by using the Wexner incontinence scale. Quality of life was assessed in one study, and in three studies, rectal manometry was performed. After PFR, the functional outcome was improved in four studies, as was the quality of life. CONCLUSION This systematic review demonstrated that PFR is useful for improving the functional outcome after a LAR. The data are extracted from studies of limited quality, but the available evidence points to the effectiveness of the procedure.
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Affiliation(s)
| | - Wouter W Te Riele
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Djamila Boerma
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Bert van Ramshorst
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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20
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Munro J, Adams R, Campbell A, Campbell S, Donaldson C, Godwin J, Haw S, Kidd L, Lane C, Leslie SJ, Mason H, Mutrie N, O'Carroll R, Taylor C, Treweek S, Watson A, Hubbard G. CRIB--the use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer: a pilot randomised controlled trial (RCT) with embedded feasibility study. BMJ Open 2014; 4:e004684. [PMID: 24549168 PMCID: PMC3931997 DOI: 10.1136/bmjopen-2013-004684] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/23/2014] [Accepted: 01/24/2014] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Patients with colorectal cancer report ongoing physical and psychological impairments and a high proportion of these patients are overweight, insufficiently active and high-risk drinkers, putting them at risk of poor recovery and risk of recurrence and comorbidities. A challenge is implementing sustainable and effective rehabilitation as part of routine care for this group. METHODS AND ANALYSIS A two-arm pilot randomised controlled trial (RCT) with embedded feasibility study undertaken as a phased programme of work. The intervention involves an existing cardiac rehabilitation programme for cardiac patients accepting colorectal cancer patient referrals. The intervention consists of supervised exercise sessions run by a cardiac physiotherapist and information sessions. Phase 1 will involve one research site enrolling 12 patients to assess intervention and study design processes. Semistructured interviews with patients with colorectal cancer and cardiac patients and clinicians will be used to gather data on acceptability of the intervention and study procedures. Phase 2 will involve three sites enrolling 66 patients with colorectal cancer randomised to control or intervention groups. Outcome measures will be taken preintervention and postintervention, for phases 1 and 2. The primary outcome is accelerometer measured physical activity; secondary outcomes are self-report physical activity, quality of life, anxiety, depression, symptoms including fatigue. The following variables will also be examined to determine if these factors influence adherence and outcomes: self-efficacy, risk perception and treatments. ETHICS AND DISSEMINATION Full ethical approval was granted by NRES Committees-North of Scotland (13/NS/0004; IRAS project ID: 121757) on 22 February 2013. The proposed work is novel in that it aims to test the feasibility and acceptability of using an evidence-based and theory driven existing cardiac rehabilitation service with patients with colorectal cancer. Should this model of rehabilitation prove to be clinically and cost effective we aim to conduct a randomised controlled trial of this intervention to measure effectiveness. TRIAL REGISTRATION REFERENCE ISRCTN63510637; UKCRN id 14092.
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Affiliation(s)
- Julie Munro
- School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK
| | - Richard Adams
- Cardiff University, School of Medicine, Velindre Hospital, Cardiff, UK
| | - Anna Campbell
- Institute of Sport and Exercise, University of Dundee, UK
| | | | - Cam Donaldson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jon Godwin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sally Haw
- School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK
| | - Lisa Kidd
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Helen Mason
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Nanette Mutrie
- Moray House School of Education, The University of Edinburgh, Edinburgh, UK
| | - Ronan O'Carroll
- School of Natural Sciences, University of Stirling, Stirling, UK
| | - Cara Taylor
- NHS Tayside, Level 10, Ninewells Hospital, Dundee, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK
| | | | - Gill Hubbard
- School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK
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Chasen MR, Feldstain A, Gravelle D, Macdonald N, Pereira J. An interprofessional palliative care oncology rehabilitation program: effects on function and predictors of program completion. ACTA ACUST UNITED AC 2013; 20:301-9. [PMID: 24311945 DOI: 10.3747/co.20.1607] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND After treatment, patients with active cancer face a considerable burden from the effects of both the disease and its treatment. The Palliative Rehabilitation Program (prp) is designed to ameliorate disease effects and to improve the patient's functioning. The present study evaluated predictors of program completion and changes in functioning, symptoms, and well-being after the program. METHODS The program received referrals for 173 patients who had finished anticancer therapy. Of those 173 patients, 116 with advanced cancer were eligible and enrolled in the 8-week interprofessional prp; 67 completed it. Measures of physical, nutritional, social, and psychological functioning were evaluated at entry to the program and at completion. RESULTS Participants experienced significant improvements in physical performance (p < 0.000), nutrition (p = 0.001), symptom severity (p = 0.005 to 0.001), symptom interference with functioning (p = 0.003 to 0.001), fatigue (p = 0.001), and physical endurance, mobility, and balance or function (p = 0.001 to 0.001). Reasons that participants did not complete the prp were disease progression, geographic inaccessibility, being too well (program not challenging enough), death, and personal or unknown reasons. A normal level of C-reactive protein (<10 mg/L, p = 0.029) was a predictor of program completion. CONCLUSIONS Patients living with advanced cancers who underwent the interprofessional prp experienced significant improvement in functioning across several domains. Program completion can be predicted by a normal level of C-reactive protein.
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Affiliation(s)
- M R Chasen
- Department of Palliative Medicine, Bruyère Continuing Care, Ottawa, ON. ; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON. ; School of Psychology, University of Ottawa, Ottawa, ON
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Lai X, Wong FKY, Ching SSY. Review of bowel dysfunction of rectal cancer patients during the first five years after sphincter-preserving surgery: a population in need of nursing attention. Eur J Oncol Nurs 2013; 17:681-92. [PMID: 23871359 DOI: 10.1016/j.ejon.2013.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 06/14/2013] [Accepted: 06/21/2013] [Indexed: 01/11/2023]
Abstract
PURPOSE The aim of the review was to summarize the longitudinal changes in bowel dysfunction among patients with rectal cancer within the first five years following sphincter-preserving resection. METHODS A series of literature searches were conducted on six English-language electronic databases. Articles published after 1990 were searched. A total of 29 articles (reporting 27 studies) was found. RESULTS Bowel dysfunction, including an alteration in the frequency of bowel movements, incontinence, abnormal sensations, and difficulties with evacuation, is reported among patients with rectal cancer within the first five years after sphincter-preserving resection. These problems are most frequent and severe within the first year, especially within the first six months, and stabilize after one year. Some of the problems may last for years. CONCLUSION Supportive care for bowel dysfunction is needed, and should include the provision of information and psychological support delivered in multiple steps. Oncology nurses can play an important role in providing supportive care for rectal cancer patients with bowel dysfunction.
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Affiliation(s)
- Xiaobin Lai
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
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Maris A, Devreese AM, D'Hoore A, Penninckx F, Staes F. Treatment options to improve anorectal function following rectal resection: a systematic review. Colorectal Dis 2013; 15:e67-78. [PMID: 23017030 DOI: 10.1111/codi.12036] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Common problems after rectal resection are loose stools, faecal incontinence, increased frequency and evacuation difficulties, for which there are various therapeutic options. A systematic review was conducted to assess the outcome of treatment options aimed to improve anorectal function after rectal surgery. METHOD Publications including a therapeutic approach to improve anorectal function after rectal surgery were searched using the following databases: MEDLINE, PubMed, EMBASE, Pedro, CINAHL, Web of Science, PsychInfo and the Cochrane Library. The focus was on outcome parameters of symptomatic improvement of faecal incontinence, evaluation of defaecation and quality of life. RESULTS The degree of agreement on eligibility and methodological quality between reviewers calculated with kappa was 0.85. Fifteen studies were included. Treatment options included pelvic floor re-education (n=7), colonic irrigation (n=2) and sacral nerve stimulation (SNS) (n=6). Nine studies reported reduced incontinence scores and a decreased number of incontinent episodes. In 10 studies an improvement in resting and squeeze pressure was observed after treatment with pelvic floor re-education or SNS. Three studies reported improved quality of life after pelvic floor re-education. Significant improvement of the Fecal Incontinence Quality of Life Scale was found in three studies after SNS. CONCLUSION Conservative therapies such as pelvic floor re-education and colonic irrigation can improve anorectal function. SNS might be an effective solution in selected patients. However, methodologically qualitative studies are limited and randomized controlled trials are needed to draw evidence-based conclusions.
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Affiliation(s)
- A Maris
- Department of Rehabilitation Sciences, Neuromotor Rehabilitation Research Group, KU Leuven, Belgium
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