Summary of results and general discussion 219 9 Chapter 7 Pelvic floor physical therapy in the treatment of chronic anal fissure (PAF-trial): outcome of Quality of Life CAF is associated with reduced quality of life.6 This chapter outlines the results of the effects of PFPT on quality of life in patients with CAF who were included in the PAFtrial using the Short-Form 36 Health Survey (RAND-36). Quality of life and pain ratings were outcomes of the study and were measured at 8- and 20-week follow-up. Between December 2018 and July 2021, 100 patients, (50 women and 50 men, with a median age of 44.6 years [range19-68]), completed the RAND-36 questionnaire and visual analog (VAS) pain score at admission. A significant improvement was found at 20-week follow-up in all domains of the RAND-36; physical functioning, pain, health change (p<0.001); physical role, vitality, general health, social functioning, emotional role, mental health (p<0.05). VAS pain was significantly reduced at 8 weeks (mean estimated difference 1.98; 95% CI. 1.55 to 2.42, p<0.001) and remained significant at 20-week follow-up (p<0.001). The difference between the groups as regards change in the mean pain intensity scores at 8 weeks was 2.48 (95% CI. -3.20 to -1.75; p<0.001). Compared to the reference values of the general Dutch population, the patients in our study with a CAF and pelvic floor dysfunction reported an impaired quality of life in 8 of 9 domains of the RAND-36. After treatment significant lower scores were found in 2 out of 9 domains. The results of this study provide evidence that treatment by PFPT improves quality of life and reduces pain, making it an important tool in management of CAF and concomitant pelvic floor dysfunction. Chapter 8 Pelvic floor physical therapy in patients with chronic anal fissure: long term follow-up of a randomized controlled trial The optimal management of CAF is quite challenging, mainly because of its recurrent nature. Our aim was to determine the outcomes of the PAF-trial and fissure recurrence in patients who completed the 2 months of PFPT at 1-year follow-up. The treatment protocol was followed by 133 patients. 97 patients (71%) completed the 1-year follow-up, 48 women (49.5%) and 49 men (50.5%) with a mean age of 44,4 ±11.6 years (range 19-68). In the total group of patients, mean resting electromyographic values of the pelvic floor significantly improved from baseline to follow-up at 1 year (mean estimated difference 2.20 µV; 95% CI, 1.79 to 2.61; p<0.001).
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