PAF-study: results on quality of life 173 7 Introduction Chronic anal fissure (CAF) is a common proctological problem associated with reduced quality of life.1 CAF is defined as a longitudinal ulcer in the squamous epithelium2 and gives rise to distressing symptoms of bleeding and pain during and after defecation. The incidence of CAF is nearly 0.11% (1.1 cases per 1000 persons) and varies considerably according to age and sex.3 Persistence of symptoms for long periods may lead to functional and psychosocial impairment,4 and seeking medical care is often delayed due to embarrassment.5 Furthermore in patients with CAF, there is a high degree of depression, anxiety disorders and stress.1 Health related quality of life (QoL) can be influenced by physical, psychological, and social factors, an individual’s life experience and general well-being.1,6 The purpose of health related QoL evaluations is to move beyond clinical symptoms by examining how patients perceive and experience the impact on well-being and daily life.6,7 The most common generic instrument to measure QoL is the validated Medical Outcomes 36-Item Short-Form Health Survey (SF-36) used for decision-making for health care policies and clinical interventions.8 Although there is a need to integrate aspects of functional and psychosocial impairment into medical care,9 only a few studies studied QoL in patients with CAF. Recently, the Pelvic floor Anal Fissure study (PAF-trial) was completed, which is a randomized controlled trial demonstrating the beneficial effects of pelvic floor physical therapy (PFPT) on an improvement of pelvic floor muscle tone and function, VAS pain scores, fissure healing and complaint reduction.10 The aim of PFPT is to increase awareness and proprioception, to improve muscle relaxation, elasticity of the pelvic floor muscles, to restore abdominopelvic coordination and reduce pain.11,12 In the PAF-trial we also hypothesised that treatment of PFPT will improve QoL. Here, we present the results of QoL measured with the Short-Form RAND-36 (RAND-36)13 and VASpain ratings in patients with CAF and pelvic floor dysfunction who were included in the PAF-trial. Furthermore, to better elucidate the results, the study compares baseline and posttreatment values with reference values of the RAND-36 of the general Dutch population.13 Materials and Methods Study design Quality of life was assessed with the RAND-36 in the PAF-trial.14 The PAF-trial is a single-centre, parallel, randomized controlled trial. The design involved allocation of all appropriate consecutive patients older than 18 years with
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