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

盆底疾病(PFDs)是一个宽泛的术语，用来描述影响数百万人的多种损害 美国女性和男性因骨盆肌肉活动过度或不足而导致的PFDs症状 表现为各种形式，包括尿失禁和大便失禁、尿频或尿急 性功能障碍和盆腔疼痛综合征。盆底疾病患者对此知之甚少 肢体残疾退伍军人(LLA)就是这样一类人。骨盆 通过保守的非药物治疗可以有效地治疗楼层紊乱，但没有得到诊断。 可能会对功能和福祉的许多方面产生不利影响。患有LLA的人经常表现出 在非LLA人群中与PFDs相关，包括下腰痛和摔倒风险增加，但 尚未对LLA患者是否存在PFD进行系统评估。有100多万人 在美国与LLA一起生活，这可能会构成一个重大的健康负担，目前还没有得到解决。这个 这项提案的总体目标是更好地了解PFDs对与健康有关的疾病的规模和影响 退伍军人LLA患者的生活质量我们将探索在患有LLA的男性和女性中PFDs的患病率 以及与出现PFDs症状相关的身体和行为后遗症。我们建议 通过管理调查，包括心理测量学，全面解决知识方面的差距 结果评估PFDs症状的指标，对200名男女研究参与者(n≥100名女性)进行。全 调查将远程管理参与者，以优化便利性和学习登记。我们的 建议的研究有三个目标： 具体目标1：评估患有LLA的男性和女性退伍军人队列中PFDs的患病率。 这一描述性目标将提供有关患有LLA的退伍军人中PFDs大小的开创性数据，并可用作 对LLA人口总体比率的代理估计。将根据性别和性别水平提供估计 LLA(经股动脉、股动脉等)盆底窘迫是衡量PFD症状的主要指标。 清单(PFDI-20)，实施次级措施，以探索与男性PFDs有关的其他方面 还有女人。此外，这一目标将评估收集自我报告的盆腔/泌尿生殖系统的可行性。 退伍军人对PFD相关调查项目的信息和可接受性。 具体目标2：检查PFDs与下腰痛和假体活动度之间的关系 路易斯安那的老兵。这一目的是为了确定与PFDs存在相关的物理后遗症。我们 期望(2)PFDs和OSwestry残障指数的分数之间存在显著的关系 作为下腰痛的衡量标准，以及(2B)假肢测量的假体活动度得分较低 移动性™的用户调查将与PFD相关联。 具体目标3：审查PFDs对跌倒风险和活动水平的贡献程度 参加退伍军人与LLA。这一目的将审查报告的人格特征相对于行为的影响 影响与健康相关的生活质量的结构。我们预计(3A)将有大量的 PFDs与报告的跌倒事件之间的关联，以及(3B)PFDs的存在将关联 与社会活动和工作相关的活动参与度下降。 冲击力。这项工作的成功完成将建立关于男性和女性PFDs的证据基础 路易斯安那的老兵。这个尖顶提供了一个机会，通过提升LLA康复的范式 考虑到经常被忽视的变量，这些变量可能导致跌倒、下腰痛、 在这些人口中，生活质量更差。

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.