Pre-rehabilitation of the pelvic floor before radiation therapy for cervical cancer: a pilot study
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ORIGINAL ARTICLE
Pre-rehabilitation of the pelvic floor before radiation therapy for cervical cancer: a pilot study Cinara Sacomori 1 & Paulina Araya-Castro 2 & Paulette Diaz-Guerrero 3 & Ingrid Alanis Ferrada 1 & Angélica Claudia Martínez-Varas 4 & Kamilla Zomkowski 5 Received: 4 November 2019 / Accepted: 9 June 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis The objective was to evaluate pelvic floor muscle (PFM) function regarding strength, activation and incontinence, approximately 1 month before and after radiation therapy in women with cervical cancer. Methods This was a pilot study of 49 women with cervical cancer at stages I to III. These women attended an educational session with a physical therapist who taught them to perform preventive pelvic floor muscle exercises (PFMEs; slow and fast contractions and the “knack”) at home before, during and after radiation therapy. The women received instructions for performing PFME prior to radiation therapy. The modified Oxford scale, electromyography (EMG), the International Consultation on Incontinence Questionnaire Short Form to assess urinary incontinence and two questions for faecal and gas incontinence were used. Results Twenty-eight women (57%; mean age = 44 years, range 27–66) completed the study, 21 (43%) were lost to follow-up. There was no significant change from baseline to post-radiation therapy in muscle strength, EMG records and incontinence (p > 0.05). The median of PFM strength was equal at baseline and after intervention (median = 2; IQR = 1). Conclusions The results of this study suggest that pre-rehabilitation teaching PFMEs might be a protective factor for preserving PFM strength and preventing incontinence 1 month after radiation therapy. It is a feasible intervention. Keywords Cervical cancer . Radiotherapy . Brachytherapy . Pelvic floor . Muscle strength . Pre-rehabilitation
Introduction Cervical cancer treatment, e.g. radiotherapy, is considered a risk factor for pelvic floor dysfunction (PFD) because it produces functional, anatomical, neurological, vascular, or myofascial alterations [1]. Studies suggest that radiotherapy (external beam radiation and intracavitary radiation, known as
* Paulina Araya-Castro [email protected] 1
Universidad Bernardo O’Higgins, School of Kinesiology, Santiago, Chile
2
Universidad del Desarrollo, Escuela de Kinesiología, Santiago, Chile
3
Instituto Nacional del Cáncer, Rehabilitation Service, North Metropolitan Health Service, Santiago, Chile
4
Universidad San Sebastián, Postgraduation Program on Oncological Physical Therapy, Santiago, Chile
5
Universidade do Sul de Santa Catarina, Departamento de Fisioterapia, Palhoça, Santa Catarina, Brazil
brachytherapy) has a greater effect on the pelvic floor (PF) than other treatments because it causes actinic injuries [2, 3]. Adverse effects from radiation can be divided into acute, subacute, and chronic (or late) effects. Acute effects are more common, affecting organs that depend on rapid self-renewal, p
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