Current status and influencing factors of pelvic floor muscle training adherence in rectal cancer patients with prophylactic ostomy

LIU Na; PI Hongying; GAO Na; SUN Yuze; WANG Tianze

doi:10.16016/j.2097-0927.202504065

您当前的位置：

首页 >

文章列表页 >

Current status and influencing factors of pelvic floor muscle training adherence in rectal cancer patients with prophylactic ostomy

Clinical Medicine | 更新时间：2025-07-25

- Current status and influencing factors of pelvic floor muscle training adherence in rectal cancer patients with prophylactic ostomy
- Journal of Army Medical University Vol. 47, Issue 14, Pages: 1660-1669(2025)
- 作者机构：
  
  1.解放军总医院：，第一医学中心普通外科医学部，北京
  2.解放军总医院：，卫勤训练中心，北京
  3.解放军医学院，北京
- 作者简介：
  
  PI Hongying， E-mail：phy301@sina.cn
- 基金信息：
  
  the Growth Project of Youth Independent Innovation Science Fund of Chinese PLA General Hospital(22QNCZ012)
- DOI：10.16016/j.2097-0927.202504065
  CLC： R473.6;R493;R735.37
- Received：16 April 2025，
  
  Revised：07 July 2025，
  
  Published：30 July 2025
- 稿件说明：
移动端阅览
刘娜，皮红英，高娜，等.直肠癌预防性造口患者盆底肌训练依从性现状及影响因素分析［J］.陆军军医大学学报，2025，47（14）：1660-1669.DOI：10.16016/j.2097-0927.202504065.

LIU N，PI H Y，GAO N，et al.Current status and influencing factors of pelvic floor muscle training adherence in rectal cancer patients with prophylactic ostomy［J］.J Army Med Univ，2025，47（14）：1660-1669.DOI：10.16016/j.2097-0927.202504065.
刘娜，皮红英，高娜，等.直肠癌预防性造口患者盆底肌训练依从性现状及影响因素分析［J］.陆军军医大学学报，2025，47（14）：1660-1669.DOI：10.16016/j.2097-0927.202504065. DOI：

LIU N，PI H Y，GAO N，et al.Current status and influencing factors of pelvic floor muscle training adherence in rectal cancer patients with prophylactic ostomy［J］.J Army Med Univ，2025，47（14）：1660-1669.DOI：10.16016/j.2097-0927.202504065. DOI：

摘要

目的

调查直肠癌预防性造口患者预防低位前切除术综合征（low anterior resection syndrome，LARS）盆底肌训练依从性现状并分析其影响因素。

方法

选取2024年1月至2025年2月在京津冀地区22家三级甲等医院普外科或胃肠外科行直肠癌保肛手术后成功行预防性造口还纳手术的247例患者作为研究对象，采用一般资料问卷、LARS知信行及需求问卷、盆底肌训练自我效能量表、盆底肌训练依从性问卷进行横断面调查，通过单因素分析、相关性分析筛选变量，LASSO回归与随机森林重要性排序进行特征变量选择，再对有意义的变量进行多重线性回归分析。

结果

247例患者预防LARS盆底肌训练依从性总体均分为（14.52±4.18）分，随机森林算法结果显示，当λ值为2.293时误差最小，对应的影响因素数目为7个，重要性排序居前7位的自变量为盆底肌训练自我效能、知信行总分、文化程度、主要照护者、肿瘤位置、造口还纳时间、放化疗。多重线性回归分析结果显示，盆底肌训练自我效能（

0.001，

=0.007， 95%

：0.004~0.009）、知信行总分（

0.001，

=0.052，95%

：0.035~0.070）、造口还纳时间（

0.030，

=-0.539， 95%

：-1.025~-0.

053）、放化疗（

0.045，

=-0.451， 95%

：0.010~0.892）是直肠癌预防性造口患者盆底肌训练依从性的相关因素（

0.05）。

结论

直肠癌预防性造口患者盆底肌训练依从性处于中等水平，盆底肌训练自我效能、知信行总分、造口还纳时间、放化疗与盆底肌训练依从性密切相关。

Abstract

Objective‍　‍To investigate the current status of pelvic floor muscle training (PFMT) adherence for preventing low anterior resection syndrome (LARS) in rectal cancer patients with prophylactic ostomy and analyze its influencing factors. Methods‍　‍A total of 247 patients who underwent preventive stoma reversal surgery after sphincter-preserving rectal cancer resection between January 2024 and February 2025 at 22 tertiary hospitals in the Beijing-Tianjin-Hebei region were recruited in this study. Their clinical data were collected through a general information questionnaire

a LARS Knowledge-Attitude-Practice and Needs questionnaire

a PFMT Self-Efficacy Scale

and a PFMT Adherence Questionnaire. Univariate analysis

correlation analysis

LASSO regression

and random forest importance ranking were applied to screen the variables

and multiple linear regression analysis was conducted to analyze the significant variables. Results‍　‍The overall PFMT adherence score was 14.52±4.18 among the 247 patients. The random forest algorithm identified 7 key predictors when the minimum error was achieved at a λ value of 2.293. The top 7 variables in importance ranking were PFMT self-efficacy

total knowledge-attitude-practice (KAP) score

education level

primary caregiver

tumor location

stoma reversal time

and chemoradiotherapy. Multiple linear regression analysis revealed that PFMT self-efficacy (

0.001

=0.007

95%

: 0.004~0.009)

total KAP score (

0.001

=0.052

95%

: 0.035~0.070)

stoma reversal time (

0.030

=-0.539

95%

: -1

.025~-0.053)

and chemoradiotherapy (

0.045

=-0.451

95%

: 0.010~0.892) were significant related factors of PFMT adherence (

0.05). Conclusion‍　‍PFMT adherence for LARS prevention is at a moderate level in rectal cancer patients with prophylactic ostomy. Key factors such as PFMT self-efficacy

total KAP score

stoma reversal time

and chemoradiotherapy are significantly correlated with PFMT adherence.

关键词

Keywords

references

BROCK H ， LAMBRINEAS L ， ONG H I ， et al . Preventative strategies for low anterior resection syndrome ［J］. Tech Coloproctol ， 2023 ， 28 （ 1 ）： 10 . DOI： 10.1007/s10151-023-02872-5 http://dx.doi.org/10.1007/s10151-023-02872-5 .

ANSAR M ， BODDETI S ， NOOR K ， et al . A systematic review of comparative effectiveness of interventions for low anterior resection syndrome： impacts on bowel function and quality of life ［J］. Cureus ， 2024 ， 16 （ 10 ）： e72772 . DOI： 10.7759/cureus.72772 http://dx.doi.org/10.7759/cureus.72772 .

ANNICCHIARICO A ， MARTELLUCCI J ， SOLARI S ， et al . Low anterior resection syndrome： can it be prevented？［J］. Int J Colorectal Dis ， 2021 ， 36 （ 12 ）： 2535 - 2552 . DOI： 10.1007/s00384-021-04008-3 http://dx.doi.org/10.1007/s00384-021-04008-3 .

SJÖVALL A ， LAGERGREN P ， JOHAR A ， et al . Quality of life and patient reported symptoms after colorectal cancer in a Swedish population ［J］. Colorectal Dis ， 2023 ， 25 （ 2 ）： 191 - 201 . DOI： 10.1111/codi.16332 http://dx.doi.org/10.1111/codi.16332 .

ASNONG A ， D’HOORE A ， VAN KAMPEN M ， et al . The role of pelvic floor muscle training on low anterior resection syndrome： a multicenter randomized controlled trial ［J］. Ann Surg ， 2022 ， 276 （ 5 ）： 761 - 768 . DOI： 10.1097/SLA.0000000 000005632 http://dx.doi.org/10.1097/SLA.0000000000005632 .

VAN DER HEIJDEN J G ， KALKDIJK-DIJKSTRA A J ， PIERIE J N ， et al . Pelvic floor rehabilitation after rectal cancer surgery： a multicenter randomized clinical trial （FORCE trial）［J］. Ann Surg ， 2022 ， 276 （ 1 ）： 38 - 45 . DOI： 10.1097/SLA.0000000000005353 http://dx.doi.org/10.1097/SLA.0000000000005353 .

BUDIN J S ， WATERS T L ， COLLINS L K ， et al . Incontinence is an independent risk factor for total hip and knee arthroplasty ［J］. Arthroplast Today ， 2024 ， 27 ： 101355 . DOI： 10.1016/j.artd.2024.101355 http://dx.doi.org/10.1016/j.artd.2024.101355 .

CHEN S Y ， TZENG Y L . Path analysis for adherence to pelvic floor muscle exercise among women with urinary incontinence ［J］. J Nurs Res ， 2009 ， 17 （ 2 ）： 83 - 92 . DOI： 10.1097/JNR.0b013e3181a53e7e http://dx.doi.org/10.1097/JNR.0b013e3181a53e7e .

SACOMORI C ， CARDOSO F L ， PORTO I P ， et al . The development and psychometric evaluation of a self-efficacy scale for practicing pelvic floor exercises ［J］. Braz J Phys Ther ， 2013 ， 17 （ 4 ）： 336 - 342 . DOI： 10.1590/S1413-35552013005000104 http://dx.doi.org/10.1590/S1413-35552013005000104 .

谷瑞芮 . 产后压力性尿失禁妇女盆底肌训练依从性及影响因素研究［D］. 北京：北京协和医学院， 2019 . DOI： 10.27648/d.cnki.gzxhu.2019.000570 http://dx.doi.org/10.27648/d.cnki.gzxhu.2019.000570 .

GU R R . Study on compliance and influencing factors of pelvic floor muscle training in postpartum stress urinary incontinence women ［D］. Beijing ： Peking Union Medical College ， 2019 . DOI： 10.27648/d.cnki.gzxhu.2019.000570 http://dx.doi.org/10.27648/d.cnki.gzxhu.2019.000570 .

程欢，谷瑞芮，吴丽萍 . 产后压力性尿失禁妇女盆底肌训练知信行现状及影响因素分析［J］. 中华现代护理杂志， 2021 （ 9 ）： 1185 - 1189 . DOI： 10.3760/cma.j.cn115682-20200615-03903 http://dx.doi.org/10.3760/cma.j.cn115682-20200615-03903 .

CHENG H ， GU R R ， WU L P . Current situation and influencing factors of knowledge-attitude-practice of pelvic floor muscle training in women with postpartum stress urinary incontinence ［J］. Chin J Mod Nurs ， 2021 （ 9 ）： 1185 - 1189 . DOI： 10.3760/cma.j.cn115682-20200615-03903 http://dx.doi.org/10.3760/cma.j.cn115682-20200615-03903 .

FENWICK E K ， MAN R E K ， GAN A T L ， et al . Validation of a new diabetic retinopathy knowledge and attitudes questionnaire in people with diabetic retinopathy and diabetic macular edema ［J］. Transl Vis Sci Technol ， 2020 ， 9 （ 10 ）： 32 . DOI： 10.1167/tvst.9.10.32 http://dx.doi.org/10.1167/tvst.9.10.32 .

张玲，李君，杨名，等 . 湖南某三级甲等综合医院护士人文执业能力现状及影响因素：基于1196例问卷调查［J］. 南方医科大学学报， 2023 ， 43 （ 1 ）： 139 - 144 . DOI： 10.12122/j.issn.1673-4254.2023.01.20 http://dx.doi.org/10.12122/j.issn.1673-4254.2023.01.20 .

ZHANG L ， LI J ， YANG M ， et al . Investigation of medical humanistic practice ability of nurses and factors affecting their practices： a questionnaire-based analysis of 1196 cases in a general hospital in Hunan Province ［J］. J South Med Univ ， 2023 ， 43 （ 1 ）： 139 - 144 . DOI： 10.12122/j.issn.1673-4254.2023.01.20 http://dx.doi.org/10.12122/j.issn.1673-4254.2023.01.20 .

QUALITY O H . Pelvic floor muscle training for stress urinary incontinence， fecal incontinence， and pelvic organ prolapse： a health technology assessment ［J］. Ont Health Technol Assess Ser ， 2024 ， 24 （ 6 ）： 1 - 172 .

ZHU G J ， MALHOTRA R ， XIONG S Z ， et al . Community efficacy for non-communicable disease management and medication adherence： the sequential mediating role of self-efficacy and depressive symptoms ［J］. Patient Prefer Adherence ， 2023 ， 17 ： 3421 - 3433 . DOI： 10.2147/PPA.S436419 http://dx.doi.org/10.2147/PPA.S436419 .

LI S Y . The relationships among self-efficacy， social support， and self-care behavior in the elderly patients with chronic pain （a STROBE-compliant article）［J］. Medicine （Baltimore）， 2021 ， 100 （ 9 ）： e24554 . DOI： 10.1097/MD.0000000000024554 http://dx.doi.org/10.1097/MD.0000000000024554 .

VAINAUSKIENĖ V ， VAITKIENĖ R . Enablers of patient knowledge empowerment for self-management of chronic disease： an integrative review ［J］. Int J Environ Res Public Health ， 2021 ， 18 （ 5 ）： 2247 . DOI： 10.3390/ijerph18052247 http://dx.doi.org/10.3390/ijerph18052247 .

SACOMORI C ， LORCA L A ， MARTINEZ-MARDONES M ， et al . 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 ［J］. Trials ， 2021 ， 22 （ 1 ）： 448 . DOI： 10.1186/s13063-021-05396-1 http://dx.doi.org/10.1186/s13063-021-05396-1 .

OFLUOGLU C B ， AYDIN I C ， ALTUNTAS Y E ， et al . Impact of pelvic floor muscle training on sphincter function and quality-of-life in patients who underwent low anterior resection： a comparative evaluation ［J］. North Clin Istanb ， 2024 ， 11 （ 4 ）： 336 - 342 . DOI： 10.14744/nci.2024.37786 http://dx.doi.org/10.14744/nci.2024.37786 .

MITCHELL K M ， PEREIRA-EDWARDS M . Exploring integrated threshold concept knowledge as a route to understanding the epistemic nature of the evidence-based practice mindset ［J］. J Prof Nurs ， 2022 ， 42 ： 34 - 45 . DOI： 10.1016/j.profnurs.2022.05.011 http://dx.doi.org/10.1016/j.profnurs.2022.05.011 .

KARALIS M ， WIESEN K . Motivational interviewing ［J］. Nephrol Nurs J ， 2007 ， 34 （ 3 ）： 336 - 338 .

SIEBERT J ， SIEBERT J U . Enhancing misinformation correction： New variants and a combination of awareness training and counter-speech to mitigate belief perseverance bias ［J］. PLoS One ， 2024 ， 19 （ 2 ）： e0299139 . DOI： 10.1371/journal.pone.0299139 http://dx.doi.org/10.1371/journal.pone.0299139 .

SIEBERT J ， SIEBERT J U . Effective mitigation of the belief perseverance bias after the retraction of misinformation： Awareness training and counter-speech ［J］. PLoS One ， 2023 ， 18 （ 3 ）： e0282202 . DOI： 10.1371/journal.pone. 0282202 http://dx.doi.org/10.1371/journal.pone.0282202 .

KANNIS-DYMAND L ， HUGHES E ， MULGREW K ， et al . Examining the roles of metacognitive beliefs and maladaptive aspects of perfectionism in depression and anxiety ［J］. Behav Cogn Psychother ， 2020 ， 48 （ 4 ）： 442 - 453 . DOI： 10.1017/S1352465820000144 http://dx.doi.org/10.1017/S1352465820000144 .

MAISTRENKOL N A ， KHVATOV A A ， SAZONOV A A ， et al . Preventive colostomy in planned treatment of patients with rectal cancer ［J］. Vestn Khir Im I I Grek ， 2015 ， 174 （ 4 ）： 24 - 29 .

ZHANG X ， ZHOU L ， ZHANG F J ， et al . Network analysis of psychosocial adaptation in intestinal stoma patients： a national cross-sectional study in China ［J］ . J Adv Nurs ， 2025 . DOI： 10.1111/jan.16928 http://dx.doi.org/10.1111/jan.16928 .

Jr CHAPMAN W C ， KIM H ， BAUER P ， et al . Total neoadjuvant therapy with short-course radiation： us experience of a neoadjuvant rectal cancer therapy ［J］. Dis Colon Rectum ， 2022 ， 65 （ 2 ）： 198 - 206 . DOI： 10.1097/DCR.0000000000001997 http://dx.doi.org/10.1097/DCR.0000000000001997 .

ZOUHAL H ， ABDERRAHMAN A B ， JAYAVEL A ， et al . Effects of passive or active recovery regimes applied during long-term interval training on physical fitness in healthy trained and untrained individuals： a systematic review ［J］. Sports Med Open ， 2024 ， 10 （ 1 ）： 21 . DOI： 10.1186/s40798-024-00673-0 http://dx.doi.org/10.1186/s40798-024-00673-0 .

PETERSEN A C ， FYFE J J . Post-exercise cold water immersion effects on physiological adaptations to resistance training and the underlying mechanisms in skeletal muscle： a narrative review ［J］. Front Sports Act Living ， 2021 ， 3 ： 660291 . DOI： 10.3389/fspor.2021.660291 http://dx.doi.org/10.3389/fspor.2021.660291 .

CROSSWELL A D ， MORENO P I ， RAPOSA E B ， et al . Effects of mindfulness training on emotional and physiologic recovery from induced negative affect ［J］. Psychoneuro-endocrinology ， 2017 ， 86 ： 78 - 86 . DOI： 10.1016/j.psyneuen. 2017.08.003 http://dx.doi.org/10.1016/j.psyneuen.2017.08.003 .

YU T ， CAO X L ， WU G J ， et al . Analysis of clinical predictive factors of pathologic complete response after neoadjuvant chemoradiotherapy in rectal cancer ［J］. Chin Med J ， 2016 ， 96 （ 16 ）： 1274 - 1277 . DOI： 10.3760/cma.j.issn.0376-2491.2016.16.010 http://dx.doi.org/10.3760/cma.j.issn.0376-2491.2016.16.010 .

CHEN D C ， ZHONG Q H ， CHEN S . Basics of vascular damage and progress of diagnosis and treatment in radiation intestinal injury ［J］. Chin J Gastrointest Surg ， 2020 ， 23 （ 8 ）： 817 - 822 . DOI： 10.3760/cma.j.cn.441530-20200511-00270 http://dx.doi.org/10.3760/cma.j.cn.441530-20200511-00270 .

SUGITANI Y ， ITO K ， ONO S . Patient preferences for attributes of chemotherapy for lung cancer： discrete choice experiment study in Japan ［J］. Front Pharmacol ， 2021 ， 12 ： 697711 . DOI： 10.3389/fphar.2021.697711 http://dx.doi.org/10.3389/fphar.2021.697711 .

HIRAOUI M ， GMADA N ， AL-HADABI B ， et al . Effects of multimodal training program on muscle deoxygenation in women with breast cancer： a randomized controlled trial ［J］. Physiol Int ， 2022 ， 109 （ 2 ）： 246 - 260 . DOI： 10.1556/2060.2022.00148 http://dx.doi.org/10.1556/2060.2022.00148 .

HIRAOUI M ， AL BUSAFI M ， AL-HADABI B ， et al . Effects of combined resistance and aerobic training program on myoelectric activity of Vastus Lateralis in patients with breast cancer during adjuvant chemotherapy period ［J］. Eur Rev Med Pharmacol Sci ， 2023 ， 27 （ 22 ）： 11169 - 11179 . DOI： 10.26355/eurrev_202311_34486 http://dx.doi.org/10.26355/eurrev_202311_34486 .

YUAN C D ， ZHOU B Z ， WANG N Y ， et al . Evidence-based control of stress response on intraoperative physiological indexes and recovery of patients undergoing gastrointestinal surgery ［J］. World J Gastroenterol ， 2025 ， 31 （ 8 ）： 102331 . DOI： 10.3748/wjg.v31.i8.102331 http://dx.doi.org/10.3748/wjg.v31.i8.102331 .

郭涛，朱文韬，李祥飞，等 . 京津冀医疗一体化对医疗卫生资源影响的政策效应研究［J］. 中国卫生经济， 2025 ， 44 （ 4 ）： 26 - 31 .

GUO T ， ZHU W T ， LI X F ， et al . Research on the policy effect of the Beijing-Tianjin-Hebei medical integration strategy on medical and health resources ［J］. Chin Health Econ ， 2025 ， 44 （ 4 ）： 26 - 31 .

赵泽众 . 全国人大代表马永平：推动优质医疗资源在京津冀流动起来［N］. 河北日报， 2025-03-03 . DOI： 10.28326/n.cnki.nhbrb.2025.001118 http://dx.doi.org/10.28326/n.cnki.nhbrb.2025.001118 .

ZHAO Z Z . Ma Yongping， a deputy to the national people’s congress： promote the flow of high-quality medical resources in the Beijing-Tianjin-Hebei region ［N］. Hebei Daily ， 2025-03-03 . DOI： 10.28326/n.cnki.nhbrb.2025.001118 http://dx.doi.org/10.28326/n.cnki.nhbrb.2025.001118 .

BERNDT A E . Sampling methods ［J］. J Hum Lact ， 2020 ， 36 （ 2 ）： 224 - 226 . DOI： 10.1177/0890334420906850 http://dx.doi.org/10.1177/0890334420906850 .

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Moderated-mediating effect of influencing factors and coping styles of treatment adherence in pulmonary tuberculosis patients based on knowledge-attitude-practice model

Incidence, risk factor and recovery of low anterior resection syndrome following sphincterpreserving surgery for rectal cancer: a retrospective analysis of 337 cases

Value of dynamic contrast enhanced magnetic resonance imaging in evaluation of extramural venous invasion in rectal cancer

Short-term outcome of laparoscopic versus open resections for rectal cancer in 165 unselected patients

Retreatment for locally recurrent rectal cancer

Related Author

LI Ying1

LIU Jiaqing1

CHEN Yong1

LIU Shili1

WANG Geng1

FENG Xinyu3

ZHANG Liwen2

ZHANG Rui1

Related Institution

Department of Social Medicine and Health Service Management, Faculty of Military Preventive Medicine, Army Medical University (Third Military Medical University)

Chongqing Public Health Medical Center

Tuberculosis Prevention and Treatment Institute of Pengshui Miao and Tujia Ethnicity Autonomous County

Department of General Surgery, Xinqiao Hospital, Third Military Medical University

Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University

⁰