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International Journal of Colorectal Disease

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01-06-2013 | Original Article

Short-term outcomes after rehabilitation treatment in patients selected by a novel rehabilitation score system (Brusciano score) with or without previous stapled transanal rectal resection (STARR) for rectal outlet obstruction

Authors: L. Brusciano, P. Limongelli, G. del Genio, C. Di Stazio, G. Rossetti, S. Sansone, S. Tolone, F. Lucido, A. D’Alessandro, G. Docimo, L. Docimo

Published in: International Journal of Colorectal Disease | Issue 6/2013

Abstract

Purpose

The purpose of this study was to examine short-term outcomes of rehabilitation treatment in patients with or without previous stapled transanal resection (STARR) for rectal outlet obstruction by using a novel rehabilitation score system (Brusciano score).

Methods

This is a retrospective cohort study conducted at a single tertiary referral institution including all patients with chronic functional constipation admitted to the outpatient unit from 2004 to 2009.

Results

Among 330 consecutive patients, 247 (74.8 %) (204 females and 43 males) showing a significantly higher rehabilitation score (mean of 15.7 ± 1.8; range, 7–25) than healthy controls (mean, 3.2 ± 1.2; range 2–6) (p < .0001) were selected for rehabilitation. Of the 247 patients evaluated, group A (no previous surgery) consisted of 170 patients (53 males; mean age, 44.8 ± 12.9 years; range, 19–80) of which 38 presented mixed constipation, whereas group B (previous surgery) consisted of 77 patients (18 males; mean age, 47.0 ± 11.2 years; range, 22–81). The Brusciano score, Agachan–Wexner score and quality of life improved in both groups of patients after treatment. Better improvements of Brusciano and Agachan-Wexner scores were observed in patients with previous STARR (group B).

Conclusions

The rehabilitation score system employed in this study seems to be a useful tool in selecting and assessing the outcome of patients who might benefit from rehabilitation treatment. Constipation and quality of life were significantly improved by the rehabilitation treatment. Further studies are needed to clarify either the impact of rehabilitation treatment on long-term outcome of patients treated for rectal outlet obstruction or its role in those who develop problems over time.

Higgins PD, Johanson JF (2004) Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol 99:750–759PubMedCrossRef

Bassotti G, Chistolini F, Nzepa FS, Morelli A (2003) Colonic propulsive impairment in intractable slow-transit constipation. Arch Surg 138:1302–1304PubMedCrossRef

Whitehead WE, Wald A, Diamant NE, Enck P, Pemberton JH, Rao SS (1999) Functional disorders of the anus and rectum. Gut 45(Suppl 2:II):55–59

Pescatori M, Spyrou M, d’Urso Pulvirenti A (2006) A prospective evaluation of occult disorders in obstructed defecation using the ‘iceberg diagram’. Colorectal Dis 8:785–789PubMedCrossRef

Rao S, Tuteja AK, Vellema T, Kempf J, Stessman M (2004) Dyssynergic defecation: demographics, symptoms, stool patterns, and quality of life. J Clin Gastroenterol 38:1–6CrossRef

Frank L, Kleinman L, Farup C, Taylor L, Miner P Jr (1999) Psychometric validation of a constipation symptom assessment questionnaire. Scand J Gastroenterol 34:870–877PubMedCrossRef

Nyam DC, Pemberton JH, Ilstrup DM, Rath DM (1997) Long-term results of surgery for chronic constipation. Dis Colon Rectum 40:273–279PubMedCrossRef

Boccasanta P, Venturi M, Stuto A et al (2004) Stapled transanal rectal resection for outlet obstruction: a prospective, multicenter trial. Dis Colon Rectum 47:1285–1297PubMedCrossRef

van Laarhoven CJ, Kamm MA, Bartram CI, Halligan S, Hawley PR, Phillips RK (1999) Relationship between anatomic and symptomatic long-term results after rectocele repair for impaired defecation. Dis Colon Rectum 42:204–211PubMedCrossRef

10.

Brusciano L, Limongelli P, del Genio G et al (2007) Useful parameters helping proctologists to identify patients with defaecatory disorders who might benefit from pelvic floor rehabilitation. Tech in Coloproctol 11:45–50CrossRef

11.

Brusciano L, Limongelli P, Del Genio G et al (2009) Clinical and instrumental parameters in patients with constipation and incontinence: their potential implications in the functional aspects of these disorders. Int J Colorectal Dis 24:961–967PubMedCrossRef

12.

Battaglia E, Serra AM, Buonafede G et al (2004) Long-term study on the effects of visual biofeedback and muscle training as a therapeutic modality in pelvic floor dyssynergia and slow transit constipation. Dis Colon Rectum 47:90–95PubMedCrossRef

13.

Bourcier AP (1994) Physical therapy for female pelvic floor disorders. Curr Opin Obstet Gynecol 6:331–335PubMedCrossRef

14.

Pucciani F, Rottoli ML, Bologna A et al (1998) Pelvic floor dyssynergia and bimodal rehabilitation: results of combined pelviperineal kinesitherapy and biofeedback training. Int J Colorect Dis 13:124–130CrossRef

15.

Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G (2006) Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology 130:657–664PubMedCrossRef

16.

Farup PG, Vandvik PO, Aabakken L (2005) How useful are the Rome II criteria for identification of upper gastrointestinal disorders in general practice? Scand J Gastroenterol 40:1284–1289PubMedCrossRef

17.

Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD (1996) A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 39:681–685PubMedCrossRef

18.

Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97PubMedCrossRef

19.

Messelink B, Benson T, Berghmans B et al (2005) Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn 24:374–380PubMedCrossRef

20.

Di Benedetto P (2004) La valutazione neuro-fisiatrica perineale. In: Di Benedetto P (ed) Riabilitazione uro-ginecologica. Minerva Medica, Edizioni, pp 99–103

21.

Morin M, Dumoulin C, Bourbonnais D, Gravel D, Lemieux MC (2004) Pelvic floor maximal strength using vaginal digital assessment compared to dynamometric measurements. Neurourol Urodyn 23:336–341PubMedCrossRef

22.

De Troyer A (1983) Mechanical role of the abdominal muscles in relation to posture. Respir Physiol 53:341–353PubMedCrossRef

23.

Kera T, Maruyama H (2005) The effect of posture on respiratory activity of the abdominal muscles. J Physiol Anthropol Appl Human Sci 24:259–265PubMedCrossRef

24.

Piloni V, Pomerri F, Platania E et al (1994) The National Workshop on Defecography: anorectal deformities with a functional origin (prolapse, intussusception, rectocele). Radiol Med 87:789–795PubMed

25.

Brusciano L, Limongelli P, Pescatori M et al (2007) Ultrasonographic patterns in patients with obstructed defecation. Int J Colorectal Disease 22(8):969–977CrossRef

26.

Plevnik S (1985) A new method for testing and strengthening of pelvic floor muscles. Proceedings of the International Continence Society 267–268

27.

Bourdiol R (1986) Podo-Réflexo-Cinésiologie. Ed. Maisonneuve

28.

Norton C, Gibbs A, Kamm MA (2006) Randomized, controlled trial of anal electrical stimulation for fecal incontinence. Dis Colon Rectum 49:190–196PubMedCrossRef

29.

Pucciani F, Iozzi L, Masi A, Cianchi F, Cortesini C (2003) Multimodal rehabilitation for faecal incontinence: experience of an Italian centre devoted to faecal disorder rehabilitation. Tech Coloprocto l7:139–147CrossRef

30.

Marquis P, De La Loge C, Dubois D, McDermott A, Chassany O (2005) Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire. Scand J Gastroenterol 405:540–551CrossRef

31.

Madoff RD, Parker SC, Varma MG, Lowry AC (2001) Faecal incontinence in adults. Lancet 364:621–632CrossRef

32.

Laycock J, Jerwood D (2001) Pelvic floor muscle assessment: the PERFECT scheme. Physiotherapy 87:631–642CrossRef

33.

Pages IH, Jahr S, Schaufele MK, Conradi E (2001) Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women. Am J Phys Med Rehabil 80:494–502PubMedCrossRef

34.

Chang HS, Myung SJ, Yang SK et al (2003) Effect of electrical stimulation in constipated patients with impaired rectal sensation. Int J Colorectal Dis 18:433–438PubMedCrossRef

35.

Jorge JM, Habr-Gama A, Wexner SD (2003) Biofeedback therapy in the colon and rectal practise. Appl Psychophysiol Biofeedback 28:47–61PubMedCrossRef

36.

Hay-Smith EJ, Dumoulin C (2006) Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 25(1):CD005654

37.

Hong Ho Y, Tan M, Su Goh H (1996) Clinical and physiologic effects of biofeedback in outlet obstruction constipation. Dis Colon Rectum 39:520–524CrossRef

38.

Whitehead WE, Orr WE, Engel BT, Schuster MM (1982) External anal sphincter response to rectal distension: learned response or reflex. Psychophysiology 19:57–62PubMedCrossRef

39.

Sangwan YP, Coller JA, Schoetz DJ, Murray JJ, Roberts PL (1995) Latency measurements of rectoanal reflexes. Dis Colon Rectum 38:1281–1285PubMedCrossRef

40.

Korolija D, Sauerland S, Wood-Dauphinée S et al (2004) Evaluation of quality of life after laparoscopic surgery: evidenced-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 18:879–897PubMedCrossRef

Title: Short-term outcomes after rehabilitation treatment in patients selected by a novel rehabilitation score system (Brusciano score) with or without previous stapled transanal rectal resection (STARR) for rectal outlet obstruction
Authors: L. Brusciano
P. Limongelli
G. del Genio
C. Di Stazio
G. Rossetti
S. Sansone
S. Tolone
F. Lucido
A. D’Alessandro
G. Docimo
L. Docimo
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 6/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-012-1565-9

At a glance: The STEP trials

Springer Medicine

Short-term outcomes after rehabilitation treatment in patients selected by a novel rehabilitation score system (Brusciano score) with or without previous stapled transanal rectal resection (STARR) for rectal outlet obstruction

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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