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Title: Challenges in evaluating pelvic floor physiotherapy based strategies in low anterior resection syndrome: a systematic review and qualitative analysis.
Austin Authors: Lambrineas, Lauren J;Brock, Henry G;Ong, Hwa Ian;Tisseverasinghe, Santha;Carrington, Emma;Heriot, Alexander;Burgess, Adele N ;Proud, David ;Mohan, Helen
Affiliation: Surgery
Department of Surgery, University of Melbourne, Melbourne, Australia.
Imperial College Healthcare, London, UK.
Peter MacCallum Cancer Centre, Melbourne, Australia.
Department of Surgery, University of Melbourne, Melbourne, Australia.
Issue Date: 3-Jan-2024
Date: 2024
Publication information: Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland 2024-01-03
Abstract: Physiotherapy is an established treatment strategy for low anterior resection syndrome (LARS). However, data on its efficacy are limited. This is in part due to the inherent challenges in study design in this context. This systematic review aims to analyse the methodology of studies using pelvic floor physiotherapy for treatment of LARS to elucidate the challenges and limitations faced, which may inform the design of future prospective trials. A systematic review of the literature was undertaken through MEDLINE, Embase and Cochrane Library, yielding 345 unique records for screening. Five studies were identified for review. Content thematic analysis of study limitations was carried out using the Braun and Clarke method. Line-by-line coding was used to organize implicit and explicit challenges and limitations under broad organizing categories. Key challenges fell into five overarching categories: patient-related issues, cancer-related issues, adequate symptomatic control, intervention-related issues and measurement of outcomes. Adherence, attrition and randomization contributed to potential bias within these studies, with imbalance in the baseline patient characteristics, particularly gender and baseline pelvic floor function scores. Outcome measurements consisted of patient-reported measures and quality of life measures, where significant improvements in bowel function according to patient-reported outcome measures were not reflected in the quality of life scores. Upcoming trial design in the area of pelvic floor physiotherapy for faecal incontinence related to rectal cancer surgery can be cognisant of and design around the challenges identified in this systematic review, including the reduction of bias, exclusion of the placebo effect and the potential cultural differences in attitude towards a sensitive intervention.
DOI: 10.1111/codi.16839
ORCID: 0000-0002-7347-9863
Journal: Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland
PubMed URL: 38173138
ISSN: 1463-1318
Type: Journal Article
Subjects: LARS
cancer survivorship
colorectal cancer
faecal incontinence
functional recovery
low anterior resection syndrome
pelvic floor physiotherapy
rectal cancer
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