Identifying the magnitude and impact of pelvic floor disorders in Veterans with lower limb amputation

确定下肢截肢退伍军人盆底疾病的严重程度和影响

• 批准号: 10586977
• 负责人: Sheila M Clemens
• 金额: --
• 依托单位: VA MEDICAL CENTER - LEXINGTON, KY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10586977
• 关键词: Address; Affect; Behavioral; Data; Distress; Enrollment; Equipment and supply inventories; Exhibits; Fecal Incontinence; Female; Femur; Genitourinary system; Health; Impairment; Increased frequency of micturition; Individual; Knowledge; Left; Limb Prosthesis; Low Back Pain; Lower Extremity; Measures; Outcome Measure; Participant; Patient Self-Report; Pelvic Floor Disorders; Pelvic Pain; Pelvic floor structure; Pelvis; Personal Satisfaction; Persons; Population; Prevalence; Prosthesis; Proxy; Psychometrics; Quality of life; Rehabilitation therapy; Reporting; Seminal; Sexual Dysfunction; Surveys; Symptoms; Syndrome; Urinary Incontinence; Veterans; Woman; Work; behavioral construct; cohort; design; disability; evidence base; fall risk; falls; health related quality of life; indexing; limb amputation; male; men; micturition urgency; physically handicapped; remote administration; sex; social; sound

Pelvic floor disorders (PFDs) is the broad term used to describe a number of impairments that affect millions of women and men in the U.S. Symptoms of PFDs resulting from over- or underactivity of pelvic musculature manifest in a variety of ways, including urinary and fecal incontinence, urinary frequency or urgency, as well sexual dysfunction and pelvic pain syndromes. Pelvic floor disorders are poorly understood in people with physical disabilities, and Veterans with lower limb amputation (LLA) are one such group of individuals. Pelvic floor disorders are effectively managed with conservative, non-pharmacological treatment, but left undiagnosed can adversely affect many facets of functioning and well-being. People with LLA frequently exhibit conditions associated with PFDs in the non-LLA population, including low back pain and heightened fall risk, yet the presence of PFDs have not been systematically assessed in individuals with LLA. With over a million people living with LLA in the U.S., this may pose a significant health burden that is currently not being addressed. The overall objective of this proposal is to better understand the magnitude and impact of PFDs on health-related quality of life in Veterans with LLA. We will explore the prevalence of PFDs amongst men and women with LLA and the physical and behavioral sequalae associated with the presence of symptoms of PFDs. We propose to comprehensively address the gaps in knowledge by administering surveys, including psychometrically sound outcome measures, to assess symptoms of PFDs, to 200 study participants of both sexes (n ≥ 100 females). All surveys will be remotely administered to participants, to optimize convenience and study enrollment. Our proposed study has three aims: Specific Aim 1: To estimate the prevalence of PFDs in a cohort of male and female Veterans with LLA. This descriptive aim will provide seminal data on the magnitude of PFDs in Veterans with LLA and can serve as a proxy estimate for rates in the LLA population in general. Estimates will be provided based on sex and level of LLA (trantibial, transfemoral, etc.) The primary measure of PFD symptoms will be the Pelvic Floor Distress Inventory (PFDI-20), with secondary measures administered to explore other aspects related to PFDs in men and women. Furthermore, this aim will assess the feasibility of collecting self-reported pelvic/urogenital information and the acceptability by Veterans to PFD-related survey items. Specific Aim 2: To examine associations between PFDs and low back pain, and prosthetic mobility in Veterans with LLA. This aim is designed to determine physical sequelae related to the presence of PFDs. We expect that (2A) there will be significant relationships between PFDs and scores on the Oswestry Disability Index as a measure of low back pain, and (2B) lower scores of prosthetic mobility, as measured by the Prosthetic Limb Users Survey of Mobility™ will be associated with PFDs. Specific Aim 3: To examine the extent to which PFDs contribute to fall risk and levels of activity participation in Veterans with LLA. This aim will examine the impact of reported PFDs relative to behavior constructs affecting health-related quality of life. We anticipate that (3A) there will be significant levels of association between PFDs with reported fall occurrence, and that (3B) the presence of PFDs will be associated with decreased activity participation, both social and work related. Impact. Successful completion of this work will establish an evidence base regarding PFDs in male and female Veterans with LLA. This SPiRE presents an opportunity to shift the paradigm of LLA rehabilitation by elevating the consideration of often-ignored variables that could be contributing to increased rates of falls, low back pain, and poorer quality of life in this population.

骨盆底疾病（PFDs）是用于描述影响数百万人的许多损伤的广义术语。 美国的女性和男性。骨盆肌肉组织活动过度或活动不足导致的PFDs症状 以各种方式表现，包括尿失禁和大便失禁，尿频或尿急，以及 性功能障碍和骨盆疼痛综合症。骨盆底疾病在患有 肢体残疾者和下肢截肢退伍军人就是这样一个群体。盆腔 通过保守的非药物治疗可以有效地控制地板疾病，但未被诊断 会对身体机能和健康的许多方面产生不利影响。患有LLA的人经常表现出 与非LLA人群中的PFDs相关，包括腰痛和跌倒风险增加，但 在患有LLA的个体中尚未系统地评估PFD的存在。有超过一百万人 在美国与LLA一起生活，这可能造成目前尚未解决的重大健康负担。的 本提案的总体目标是更好地了解PFDs对健康相关疾病的严重程度和影响， 生活质量在退伍军人与LLA。我们将探讨患有LLA的男性和女性中PFDs的患病率 以及与PFDs症状相关的身体和行为后遗症。我们建议 通过进行调查，包括心理测量， 对200名男女研究参与者（n ≥ 100名女性）进行结局测量，以评估PFDs的症状。所有 将对参与者进行远程调查，以优化便利性和研究入组。我们 拟议的研究有三个目标： 具体目标1：估计患有LLA的男性和女性退伍军人队列中PFDs的患病率。 这一描述性目的将提供有关LLA退伍军人中PFDs程度的开创性数据，并可作为 对一般LLA人群中的比率的替代估计。估计数将根据性别和 LLA（经胫骨、经股骨等）PFD症状的主要指标是骨盆底不适 清单（PFDI-20），采用二级措施探索与男性PFDs相关的其他方面 和妇女此外，该目标将评估收集自我报告的盆腔/泌尿生殖道疾病的可行性。 信息和退伍军人对PFD相关调查项目的可接受性。 具体目标2：检查PFDs与下背痛和假体活动度之间的相关性， 退伍军人与LA。该目的旨在确定与PFDs相关的身体后遗症。我们 预计（2A）PFDs与奥斯韦斯特里残疾指数评分之间存在显著关系 作为下背痛的量度，和（2B）假体活动性的较低评分，如通过假肢测量的 Mobility™的用户调查将与PFD相关联。 具体目标3：检查PFDs对跌倒风险和活动水平的影响程度 参加退伍军人与LLA。该目标将检查报告的PFDs相对于行为的影响 影响健康相关生活质量的结构。我们预计，（3A）将有显着水平的 PFDs与报告的跌倒发生率之间的关联，以及（3B）PFDs的存在将与 与社会和工作相关的活动参与减少。 冲击这项工作的成功完成将为男性和女性的PFD建立证据基础 退伍军人与LA。这个SPiRE提供了一个机会，通过提升 考虑经常被忽视的变量，这些变量可能导致福尔斯，腰痛， 生活质量下降。