Effects of early pelvic floor muscle exercise for sexual dysfunction radical prostatectomy recipients

Effects of early pelvic floor muscle exercise for sexual dysfunction radical prostatectomy recipients Lin Y, Yu T, Chia-Hsiang, Wand H, Lu K. Cancer Nursing 2012;35(2):106-114.

April 3,  2012 journal club, Jane O'Brien, PT. presented by Beth Shelly

Primary aim

To explore prevalence  of sexual dysfunction and to define the effect of PFM ex on sexual dysfunction after RP over several months.

Subjects

Men, aged 45-80 with normal erectile function pre surgery

Control group n= 27 (this group had more open procedures than the exercise group)

Experimental group= 35

Randomly chosen using sealed envelopes.

Study design/method

Experimental design

PreIntervention: 1 hour class on prostate anatomy, RP procedure, complications (UI & Ed ), IIEF-5 questionnaire, within 15 days after surgery, then again @ 3,6,9,12 months after intervention.

Ex group

PFM Ex, three 10 sec: 10 sec, hold relax, max 2x/day, in supine, sit, stand

PFM DVD

PFM biofeedback, 1st and 2nd visit

Control group

Nothing for 3 months

At 3 months, they started program the exercise group had done

Both groups

1 st month, weekly reminder calls

2 nd month, 1 x reminder calls until 12 months

Patients family also taught PFME and suggested to do with patient.

Groups treated equally, YES

Not blinded- subjects, therapists or assessors

Assessing outcome

outcome measures:

*family members asked about patient frequency (no compliance charting)

*IIEF-5. ( dx tool for ED) scores 5-25, 5-7 severe, 22-25, no ED

Good validity, accuracy and reliability for ED, after RP

Acceptable drop out rate... yes (14%)

72 recruited-62 completed study, 9 excluded, 1 w/d due to severe complications

Intention to treat, YES

Treatment effect.. Improved Sexual function

Results

Sexual dysfunction rate measured at Baseline, 3 mo, 6 mo, 9 mo, 12 mo

Percent of sever sexual dysfunction

Ex group: 100%, 94.3, 88.6, 82.9, 65.7

Control group: 100%, 100, 100, 96.3 92.6

See table 3

Question 2

Improved sexual function due to ex

See table 4 , significant difference in ex group

Conclusion

Early PFME is beneficial for improving sexual function post RD.

Impact on practice/ clinical significance

clinicians need to be involved with patients soon after RD. good marketing info for MDs to send these patients to us for education. Ortho PTs often train knee patients with exercises before their surgery. What if PTs were to see RD patients B4 surgery to educate them on these exercises  then soon after surgery , nurses train patients or they get referred to us. Perhaps more docs would send patients to PT if they know the info. If  patients were aware of the info, they would be more apt to come in.

Michelle shared her protocol for electrical stimulation for ED and night time leaking -

Pre mod 100 MHz, 20 min in clinic for 3 sessions, then at home if patient perceives a benefit. Electrodes placed at S1 and S4 – channel one on the right and channel 2 on the left.