PAF-study, long term follow-up 193 8 eligible for this study. Patients with an abscess or fistula, Crohn’s disease or ulcerative colitis, anorectal malignancy, prior rectal radiation, and pregnancy were excluded from the study. Interventions At baseline, patients in both groups received information about toilet behaviour, the pelvic floor and lifestyle advice. All patients continued their conservative measures including the use of ointment (diltiazem or isosorbide dinitrate) during the treatment period. PFPT consisted of 5 face-to-face appointments of 45-minutes in a period of 8 consecutive weeks, using a treatment protocol. Details of this treatment protocol were prescribed earlier.13 Data collection of the questionnaires was facilitated by a secure on-line system called Castor EDC.20 Patients received the questionnaires by e-mail through the Castor system at baseline and 1-year follow-up. Outcome measures Primary outcome was muscle tone at rest during EMG-registration of the pelvic floor at baseline and 1-year follow-up. Secondary outcomes contained fissure recurrence, average pain intensity during defecation on a VAS-scale, pelvic floor (dys)function, complaint reduction measured with the Proctoprom18 and quality of life measured with the Short-Form RAND-36.19 All outcomes were measured at baseline and 1-year follow-up. Statistical analysis Data were analysed using Statistical Packages for Social Sciences (SPSS, Chicago, II, USA, version 26.0). Descriptive methods were used to assess quality of data, homogeneity of treatment groups and endpoints. Normality of the data were analysed with histograms. Data are presented using mean (SD), median (min-max) for the numeric and non-normal variables and frequency (percentages) for categorical variables. A paired t test and Wilcoxon signed rank was used to compare continuous variables within groups. McNemar was used to compare categorical variables within groups. Comparison between groups for continuous variables was made by repeated measure analysis of variance using a mixed model after transformation of the data to enhance normality, with treatment, time (categorical) and their interaction as fixed
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