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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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Yin L, Fan L, Tan R, Yang G, Jiang F, Zhang C, Ma J, Yan Y, Zou Y, Zhang Y, Wang Y, Zhang G. Bowel symptoms and self-care strategies of survivors in the process of restoration after low anterior resection of rectal cancer. BMC Surg 2018; 18:35. [PMID: 29866087 PMCID: PMC5987619 DOI: 10.1186/s12893-018-0368-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/24/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose of this research is to identify the bowel symptoms and self-care strategies for rectal cancer survivors during the recovery process following low anterior resection surgery. METHODS A total of 100 participants were investigated under the structured interview guide based on the dimensions of "symptom management theory". RESULTS 92% of participants reported changes in bowel habits, the most common being the frequent bowel movements and narrower stools, which we named it finger-shaped consistency stools. The 6 most frequently reported bowel symptoms were excessive flatus (93%), clustering (86%), urgency (77%), straining (62%), bowel frequency (57%) and anal pendant expansion (53%). Periodic bowel movements occurred in 19% participants. For a group of 79 participants at 6 to 24 months post-operation, 86.1% reported a significant improvement of bowel symptoms. Among 68 participants of this subgroup with significant improvements, 70.5% participants reported the length of time it took was at least 6 months. Self-care strategies adopted by participants included diet, bowel medications, practice management and exercise. CONCLUSIONS It is necessary to educate patients on the symptoms experienced following low anterior resection surgery. Through the process of trial and error, participants have acquired self-care strategies. Healthcare professionals should learn knowledge of such strategies and help them build effective interventions.
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Affiliation(s)
- Lishi Yin
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Ling Fan
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Renfu Tan
- Medical University of Chongqing, Chongqing City, 400000 China
| | - Guangjing Yang
- Nursing Department, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Fenglin Jiang
- Department of Cardiovascular, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Chao Zhang
- Department of Nephrology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Jun Ma
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Yang Yan
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Yanhong Zou
- Science and Education Department, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Yaowen Zhang
- Department of Emergency and the Intensive Care Unit, Chongqing Hospital of Traditional Chinese Medicine, No. 6 Road Panxi seven branch, Chongqing City, 400000 China
| | - Yamei Wang
- Department of Emergency and the Intensive Care Unit, Chongqing Hospital of Traditional Chinese Medicine, No. 6 Road Panxi seven branch, Chongqing City, 400000 China
| | - Guifang Zhang
- Department of Emergency and the Intensive Care Unit, Chongqing Hospital of Traditional Chinese Medicine, No. 6 Road Panxi seven branch, Chongqing City, 400000 China
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Bowel Dysfunction and Self-management for Bowel Symptoms After Sphincter-Preserving Surgery. Cancer Nurs 2017; 40:E9-E16. [DOI: 10.1097/ncc.0000000000000393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Herrinton LJ, Altschuler A, McMullen CK, Bulkley JE, Hornbrook MC, Sun V, Wendel CS, Grant M, Baldwin CM, Demark-Wahnefried W, Temple LKF, Krouse RS. Conversations for providers caring for patients with rectal cancer: Comparison of long-term patient-centered outcomes for patients with low rectal cancer facing ostomy or sphincter-sparing surgery. CA Cancer J Clin 2016; 66:387-97. [PMID: 26999757 PMCID: PMC5618707 DOI: 10.3322/caac.21345] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/13/2016] [Accepted: 02/09/2016] [Indexed: 12/14/2022] Open
Abstract
For some patients with low rectal cancer, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients who are eligible for sphincter-sparing surgery may not be well served by the surgery, and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects after the two surgeries has not been synthesized. Therefore, this systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. The goals are: 1) to improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) to increase the patient's participation in the decision; 3) to alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, to improve patients' long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient. CA Cancer J Clin 2016;66:387-397. © 2016 American Cancer Society.
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Affiliation(s)
- Lisa J Herrinton
- Senior Research Scientist, Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Andrea Altschuler
- Senior Consultant, Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Carmit K McMullen
- Investigator, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Joanna E Bulkley
- Senior Research Associate, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Mark C Hornbrook
- Chief Scientist, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Virginia Sun
- Assistant Professor, Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA
| | - Christopher S Wendel
- Research Instructor, Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ
| | - Marcia Grant
- Distinguished Professor, Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA
| | - Carol M Baldwin
- Professor Emerita and Southwest Borderlands Scholar, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Wendy Demark-Wahnefried
- Professor and Webb Endowed Chair of Nutrition Sciences, Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Larissa K F Temple
- Colorectal Surgical Oncologist, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert S Krouse
- Staff General and Oncologic Surgeon, Professor of Surgery, Southern Arizona Veterans Affairs Health Care System and University of Arizona College of Medicine, Tucson, AZ
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Wells CI, Vather R, Chu MJJ, Robertson JP, Bissett IP. Anterior resection syndrome--a risk factor analysis. J Gastrointest Surg 2015; 19:350-9. [PMID: 25326125 DOI: 10.1007/s11605-014-2679-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/08/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Evacuatory dysfunction after distal colorectal resection varies from incontinence to obstructed defaecation and is termed anterior resection syndrome. The aim of this study was to identify risk factors for the development of anterior resection syndrome. METHODS All anterior resections undertaken at Auckland Hospital from 2002 to 2012 were retrospectively evaluated. An assortment of patient and peri-operative variables were recorded. Cases were stratified by the occurrence of anterior resection syndrome symptoms from 1 to 5 years post-operatively. RESULTS A total of 277 patients were identified. Prevalence of anterior resection syndrome decreased progressively from 61 % at 1 year to 43 % at 5 years. Univariate analysis identified anastomotic height, surgeon, pT stage, procedure year and temporary diversion ileostomy as recurring significant correlates (p < 0.05). Logistic regression identified lower anastomotic height (odds ratio (OR) 2.11, 95 % confidence interval (CI) 1.05-4.27; p = 0.04) and obstructive presenting symptoms (OR 6.71, 95 % CI 1.00-44.80; p = 0.05) as independent predictors at 1 and 2 years, respectively. Post-operative chemotherapy was a predictor at 1 year (OR 1.93, 95 % CI 1.04-3.57; p = 0.03). Temporary diverting ileostomy was an independent predictor at 2 (OR 2.49, 95 % CI 1.04-5.95; p = 0.04), 3 (OR 4.17, 95 % CI 1.04-16.78; p = 0.04), 4 (OR 8.05, 95 % CI 1.21-53.6; p = 0.03), and 5 years (OR 49.60, 95 % CI 2.17-1134.71; p = 0.02) after adjusting for anastomotic height. CONCLUSIONS Anastomotic height, post-operative chemotherapy and obstructive presenting symptoms were independent predictors at 1 and 2 years. Temporary diversion ileostomy was an independent predictor for the occurrence of anterior resection syndrome at 2, 3, 4 and 5 years even after correcting for anastomotic height. Prospective assessment is required to facilitate more accurate risk factor analysis.
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Affiliation(s)
- Cameron I Wells
- Department of Surgery, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
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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: 2.4] [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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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: 2.1] [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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Bartlett L, Sloots K, Nowak M, Ho YH. Biofeedback therapy for symptoms of bowel dysfunction following surgery for colorectal cancer. Tech Coloproctol 2011; 15:319-26. [DOI: 10.1007/s10151-011-0713-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 06/26/2011] [Indexed: 12/17/2022]
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Abstract
BACKGROUND Fecal incontinence affects up to 11% of Australian community-dwelling adults and 72% of nursing home residents. Biofeedback is a recommended conservative therapy when medication and pelvic floor exercises have failed to improve patient outcomes. OBJECTIVE This study aimed to investigate the impact of a new exercise regimen on the severity of fecal incontinence and the quality of life of participants. DESIGN This was a randomized clinical study. SETTINGS This study was conducted at the Anorectal Physiology Clinic, Townsville Hospital, Queensland, Australia. PATIENTS Seventy-two participants (19 male), with a mean age of 62.1 years, attended 5 clinic sessions: 4 weekly sessions followed by 4 weeks of home practice and a follow-up assessment session. A postal survey was conducted 2 years later. INTERVENTION Thirty-seven patients (12 male) were randomly assigned to the standard clinical protocol (sustained submaximal anal and pelvic floor exercises) and 35 patients (7 male) were randomly assigned to the alternative group (rapid squeeze plus sustained submaximal exercises). MAIN OUTCOME MEASURES The main outcomes were measured by use of the Cleveland Clinic Florida Fecal Incontinence score and the Fecal Incontinence Quality of Life Scale survey tool. RESULTS No significant differences were found between the 2 exercise groups at the beginning or at the end of the study or as a result of treatment in objective, quality-of-life, or fecal incontinence severity measures. Sixty-nine participants completed treatment. The severity of fecal incontinence decreased significantly (11.5/20 to 5.0/20, P < .001). Eighty-six percent (59/69) of participants reported improved continence. Quality of life significantly improved for all participants (P < .001). Results were sustained 2 years later. Patients who practiced at least the prescribed number of exercises had better outcomes than those who practiced fewer exercises. LIMITATIONS This study was limited because it involved a heterogeneous sample, it was based on subjective reporting of exercise performance, and loss to follow-up occurred because of the highly mobile population. CONCLUSIONS Patients attending this biofeedback program attained significant improvement in the severity of their fecal incontinence and in their quality of life. Although introduction of rapid muscle squeezes had little impact on fecal incontinence severity or patient quality of life, patient exercise compliance at prescribed or greater levels did.
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