A randomized clinical trial to assess the effectiveness of pre- and post-surgical pelvic floor physiotherapy for bowel symptoms, pelvic floor function, and quality of life of patients with rectal cancer: CARRET protocol
Date
2021-01Author
Sacomor, Cinara
Lorca, Luz Alejandra
Martinez-Mardones, Mónica
Salas-Ocaranza, Roberto Ignacio
Reyes-Reyes, Guillermo Patricio
Pizarro-Hinojosa, Marta Natalia
Plasser-Troncoso, Jorge
Materias
Rectal cancer
Pelvic floor
Low anterior resection syndrome
Rehabilitation
Prevention
Physiotherapy
Bowel symptoms
Quality of life
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Abstract
Background: There is scarcity of trials about preventative strategies for low anterior resection syndrome (LARS) in
rectal cancer patients. The aim of this study is to evaluate the effectiveness of a pre- and post-surgical pelvic floor
rehabilitation program on the bowel symptoms, pelvic floor function, and quality of life of rectal cancer patients.
Methods: A randomized controlled trial with parallel groups (pelvic floor rehabilitation versus control group), with a blinded
evaluator. Participants and setting: 56 stage I to III rectal cancer patients aged from 18 to 80 years old undergoing sphincter
preservation surgery at Hospital del Salvador and who have a sufficient knowledge of Spanish. Main outcome measures:
ICIQ-B questionnaire for intestinal symptoms, high-resolution anorectal manometry (Alacer Multiplex 24-channel manometry
equipment) for anorectal function, pelvic floor muscle strength test with Oxford Modified Scale, and a quality of life test with
the EORTC QLQ C30 questionnaire. The evaluations will be carried out at five stages: before surgery, before and after the
pelvic floor rehabilitation, and during a 3-month and 1-year follow-up. Interventions: one pre-rehabilitation session and 9 to
12 sessions of pelvic floor rehabilitation, including patient education, pelvic floor muscle exercises, pelvic floor
electromyography biofeedback, and capacitive and sensory rectal training with a balloon probe. Rehabilitation will begin 3–
5weeks before the ileostomy is removed (four sessions) and around 3 weeks after stoma removal (5–8 sessions).
Discussion: We expect the program to improve the bowel symptoms, pelvic floor function, and quality of life of rectal
cancer patients.