Current status and influencing factors of pelvic floor muscle training adherence in rectal cancer patients with prophylactic ostomy

To investigate the current status of pelvic floor muscle training (PFMT) adherence for preventing low anterior resection syndrome (LARS) in rectal cancer patients with prophylactic ostomy and analyze its influencing factors.

A total of 247 patients who underwent preventive stoma reversal surgery after sphincter-preserving rectal cancer resection between January 2024 and February 2025 at 22 tertiary hospitals in the Beijing-Tianjin-Hebei region were recruited in this study. Their clinical data were collected through a general information questionnaire, a LARS Knowledge-Attitude-Practice and Needs questionnaire, a PFMT Self-Efficacy Scale, and a PFMT Adherence Questionnaire. Univariate analysis, correlation analysis, LASSO regression, and random forest importance ranking were applied to screen the variables, and multiple linear regression analysis was conducted to analyze the significant variables.

The overall PFMT adherence score was 14.52±4.18 among the 247 patients. The random forest algorithm identified 7 key predictors when the minimum error was achieved at a λ value of 2.293. The top 7 variables in importance ranking were PFMT self-efficacy, total knowledge-attitude-practice (KAP) score, education level, primary caregiver, tumor location, stoma reversal time, and chemoradiotherapy. Multiple linear regression analysis revealed that PFMT self-efficacy (P<0.001, β=0.007, 95%CI: 0.004~0.009), total KAP score (P<0.001, β=0.052, 95%CI: 0.035~0.070), stoma reversal time (P<0.030, β=-0.539, 95%CI:-1.025~-0.053), and chemoradiotherapy (P<0.045, β=-0.451, 95%CI: 0.010~0.892) were significant related factors of PFMT adherence (P<0.05).

PFMT adherence for LARS prevention is at a moderate level in rectal cancer patients with prophylactic ostomy. Key factors such as PFMT self-efficacy, total KAP score, stoma reversal time, and chemoradiotherapy are significantly correlated with PFMT adherence.