부인과 암 생존자들의 골반 기저 기능장애가 삶의 질에 미치는 영향 조사 및 삶의 질 향상을 위한 신경조정술을 통합한 골반 기저근 재활 프로그램 개발
Impact of Pelvic Floor Dysfunction on Quality of Life in Cancer Survivors and Development of Pelvic Floor Muscle Rehabilitation Program
- 주제(키워드) Cancer survivor , Pelvic floor muscle , Rehabilitation , Quality of life
- 발행기관 아주대학교
- 지도교수 나은우
- 발행년도 2011
- 학위수여년월 2011. 2
- 학위명 박사
- 학과 및 전공 일반대학원 의학과
- 실제URI http://www.dcollection.net/handler/ajou/000000011698
- 본문언어 영어
- 저작권 아주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
Purpose: This study was designed to evaluate the pelvic floor dysfunction and its impact on quality of life in gynecological cancer survivors and to assess the effects of pelvic floor muscle rehabilitation program on pelvic floor dysfunction and quality of life in gynecological cancer survivors by a prospective randomized controlled trial. Methods: Thirty-four subjects with gynecological cancer and 16 healthy women completed a Korean version of pelvic floor questionnaire and Korean version of the EORTC QLQ-C30 and QLQ-CX24. Gynecological cancer survivors were randomly allocated to exercise group performing Pelvic Floor Rehabilitation Program (PFRP) or control group. All gynecological cancer survivors completed a Korean version of pelvic floor questionnaire and Korean version of the EORTC QLQ-C30 and QLQ-CX 24 and MEP by sacral and transcranial magnetic stimulation and pelvic floor strength were examined at the baseline and post-intervention at 1 month. Results: Gynecological cancer survivors have more pelvic floor dysfunction that have a relevant impact on HRQOL especially physical functioning compared to the healthy women. The exercise group had a significant improvement in pelvic floor dysfunction with comparison to the control group (p < 0.001). A significant short-term training effect was observed in exercise group in terms of more increase in pelvic muscle strength and higher rise in amplitude of motor evoked potential at sacral stimulation than in the control group. Conclusions: Gynecological cancer and treatment procedures cause important problems that have a negative effect on quality of life. Pelvic floor dysfunction improved after PFRP in gynecological cancer survivors. These preliminary results support the feasibility of a substantive trial of PFMT for pelvic floor dysfunction in gynecological cancer survivors.
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Ⅰ. INTRODUCTION 1
Ⅱ. MATERIALS AND METHODS 5
A. Participations 5
B. Methods 6
1. Pelvic Floor Rehabilitation Program Protocol 6
2. Measurements 9
3. Blinding 12
4. Assessment of Exercise Adherence and Adverse Events 13
5. Statistical Analyses 13
Ⅲ. Results 15
A.Pelvic floor dysfunction and its impact on quality of life 15
1. Comparison of pelvic floor symptom with reference group 17
2. Relation of pelvic floor symptom with muscle strength and MEP 21
3. Comparison of HRQOL outcomes with reference group 23
4. Impact of pelvic floor dysfunction on HRQOL outcome 25
B.Effectiveness of pelvic floor rehabilitation program 27
1. Change in prevalence of pelvic floor dysfunction 33
2. Changes in pelvic muscle strength and MEP 35
3. Changes in HRQOL outcomes 39
Ⅳ. DISCUSSION 42
Ⅴ. CONCLUSION 49
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LIST OF FIGURES
Fig 1. Site of sacral stimulation 11
Fig 2. Mean functional scores of patients with gynecological cancer compared with reference group 23
Fig 3. Mean symptom scores of patients with gynecological cancer compared with reference group 24
Fig 4. Flow chart of participants through the randomized controlled trial of the exercise program and analysis 32
Fig 5. Comparison changes of mean functional scores of exercise group compared with control group in EORTC C-30 40
Fig 6. Comparison changes of mean functional and symptom scores of exercise group compared with control group in EORTC QLQ CX-24 41
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LIST OF TABLES
Table 1. Demographic and disease-related characteristics of gynecological
cancer survivors and reference group 16
Table 2. Prevalence of pelvic floor symptoms in gynecological cancer group
and reference group 18
Table 3. Sexual questionnaire item analysis 19
Table 4. Comparison of pelvic muscle strength between incontinence and continence
group in gynecological cancer survivors 22
Table 5. Relationship among generic HRQOL outcomes and pelvic
floor dysfunction 26
Table 6. Baseline comparative characteristic between the two groups
in gynecological cancer survivors 28
Table 7. Differences of prevalence in pelvic floor dysfunction between exercise
and control groups 34
Table 8. Comparison of pelvic floor strength and MEP between exercise
and control groups at baseline and after exercise 37
