Fisette-Paulhus Isabelle, Morin Mélanie, Fortin Julie, Gagnon Cynthia
From the: Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada.
Research centre of the Centre hospitalier universitaire de Sherbrooke, School of Rehabilitation, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Québec, Canada.
Physiother Can. 2024 Aug;76(3):259-268. doi: 10.3138/ptc-2022-0005. Epub 2023 Feb 8.
We present the development and the key elements of a clinical practice guideline (CPG) in physiotherapy aiming to address sexuality, more specifically impairments and limitations that can interfere with sexual activity in adults with a neuromuscular disorder (NMD).
The CPG was based on the Rare Knowledge Mining Methodological Framework (RKMMF) and included a literature review, consultation with physiotherapists, and validation by an interdisciplinary team. The EX-PLISSIT (extended, permission, limited information, specific suggestions, intensive therapy) model and the Competency Profile for physiotherapists in Canada were also used as frameworks to divide the CPG into sections. Here, we present the methodology for the CPG development and key elements related to physiotherapy assessment and treatment related to sexual activity in people with NMDs.
An extensive CPG was developed through a literature review, consultations, and a validation process. A total of 75 articles were included in the review. Twelve physiotherapists and four health professionals reviewed the CPG. Physiotherapists should address the following in their assessment: relationships; assistance required during sexual activity; urinary, vaginal, or anorectal symptoms; erectile dysfunction; pain; fatigue; and the impact of the NMD on sexuality. Interventions can target physical activity, positioning, muscle weakness, fatigue, decreased range of motion, erectile dysfunction, sensitivity disorders, lubrication, pain, incontinence, and cardiorespiratory implications.
The CPG promotes the importance of addressing sexuality and proposes different interventions that physiotherapists should integrate into their practice.
我们介绍一项物理治疗临床实践指南（CPG）的制定过程及关键要素，该指南旨在解决性方面的问题，更具体地说是针对神经肌肉疾病（NMD）成人患者中可能干扰性活动的损伤和限制。
该CPG基于罕见知识挖掘方法框架（RKMMF），包括文献综述、与物理治疗师的咨询以及跨学科团队的验证。EX - PLISSIT（扩展、许可、有限信息、具体建议、强化治疗）模型和加拿大物理治疗师能力概况也被用作框架，将CPG分为不同部分。在此，我们介绍CPG的制定方法以及与NMD患者性活动相关的物理治疗评估和治疗的关键要素。
通过文献综述、咨询和验证过程制定了一份详尽的CPG。综述共纳入75篇文章。12名物理治疗师和4名健康专业人员对CPG进行了评审。物理治疗师在评估中应关注以下方面：关系；性活动期间所需的协助；泌尿、阴道或肛门直肠症状；勃起功能障碍；疼痛；疲劳；以及NMD对性的影响。干预措施可针对身体活动、体位、肌肉无力、疲劳、活动范围减小、勃起功能障碍、感觉障碍、润滑、疼痛、尿失禁以及心肺方面的问题。
该CPG强调了解决性问题的重要性，并提出了物理治疗师应纳入其实践的不同干预措施。
