Andrews University, Berrien Springs, MI, USA.
Mama LLC, Boston, MA, USA.
Int Urogynecol J. 2021 Sep;32(9):2311-2324. doi: 10.1007/s00192-021-04845-4. Epub 2021 Jun 5.
Childbirth-related pelvic fistula (CRF) often requires surgery, yet even with successful repair, mental health conditions, musculoskeletal impairments, urinary and fecal incontinence and sexual dysfunction persist for many women. Postoperative rehabilitation, (i.e., physiotherapy, mental health counseling) may address these concerns and has been reported for this population. This review aims to summarize the literature and level of evidence of rehabilitative care practices in fistula care to inform clinical practice, research and policy recommendations.
A systematic literature review was conducted using Africa-Wide Information, CINAHL, Cochrane, Embase, Global Health, PAIS Index, PubMed and SCOPUS searching keywords and MeSH terms to identify women with CRF admitted for surgery. Two researchers progressively screened titles, abstracts and full-text articles. Eligible articles were classified primary if intervention details and outcomes were reported or secondary if rehabilitation was described, but no specific outcomes reported. Relevant study details, strengths and limitations, and key findings were extracted.
Eighteen articles were included: eight primary, ten secondary. Primary articles reported on urethral plugs for postoperative urinary incontinence (UI) (2/8), menstrual cup to manage UI (1/8), physiotherapy and health education (3/8) and mental health counseling (2/8). Secondary articles describe rehabilitation components in the context of program descriptions, qualitative analyses or reviews. All evidence was low or very low quality.
Research on rehabilitative care is very limited and highlights inconsistencies in practice. This review provides support for the feasibility of rehabilitation and establishes the need for future interventional studies that involve a comparator and reliable outcome measures.
分娩相关的骨盆瘘（CRF）通常需要手术，但即使手术成功，许多女性仍会持续存在心理健康问题、肌肉骨骼损伤、尿失禁和粪失禁以及性功能障碍。术后康复（例如物理治疗、心理健康咨询）可能会解决这些问题，并且已经有报道针对该人群开展了此类康复。本综述旨在总结瘘管护理中康复护理实践的文献和证据水平，为临床实践、研究和政策建议提供信息。
使用非洲-wide 信息、CINAHL、 Cochrane、Embase、全球健康、PAIS 索引、PubMed 和 SCOPUS 搜索关键词和 MeSH 术语，进行了系统的文献综述，以确定接受手术治疗的 CRF 女性。两名研究人员逐步筛选标题、摘要和全文文章。符合条件的文章如果干预细节和结果有报道，则归类为主要文章，如果仅描述了康复但没有具体报告结果，则归类为次要文章。提取了相关研究的详细信息、优势和局限性以及关键发现。
共纳入 18 篇文章：8 篇主要文章，10 篇次要文章。主要文章报道了术后尿失禁（UI）的尿道塞（2/8）、月经杯管理 UI（1/8）、物理治疗和健康教育（3/8）和心理健康咨询（2/8）。次要文章描述了康复内容，背景是方案描述、定性分析或综述。所有证据的质量均为低或极低。
关于康复护理的研究非常有限，突出了实践中的不一致性。本综述为康复的可行性提供了支持，并确定了未来需要进行干预性研究的必要性，包括比较组和可靠的结果测量。
