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Brünahl C1, Klotz SGR1, Ketels G2, Löwe B1
1University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany, 2University Medical Center Hamburg-Eppendorf, Department of Physiotherapy, Hamburg, Germany
Background: Chronic pelvic pain syndrome (CPPS) is a chronic pain condition with high prevalence rates in women and men worldwide. It is associated with a multifactorial etiology and potential multisystem effects. Myofascial symptoms, psychosocial factors like pain catastrophizing or stress and psychiatric co-morbidities like depression or anxiety are frequent in these patients. However, treatment of patients with CPPS remains challenging. The European Association of Urology guidelines recommend multimodal treatment approaches including psychotherapy and physiotherapy.
Purpose: The aim of this study is to test the feasibility of combined psychotherapy and physiotherapy for female and male patients with CPPS and to explore changes in patient-relevant outcomes compared to a control group.
Methods: A feasibility study with a crossover design based on the principles of a ´cohort multiple randomized controlled trial´ was conducted to test a combined therapy for patients with CPPS. Study subjects were recruited from the interdisciplinary outpatient clinic for CPPS at the University Medical Center Hamburg-Eppendorf. The study consisted of two consecutive treatment modules (cognitive behavioural psychotherapy and physiotherapy). The modules consisted of nine weekly sessions. The control group underwent treatment as usual. Feasibility as the primary outcome was analysed in terms of the demand, acceptability, and practicality. Secondary study outcomes were measured using validated self-rating-scales and physical examinations.
Results: 36 patients were assigned to the Intervention and 24 patients to the control group. In terms of Satisfaction with the treatment, the average rating for the whole program was 6.00 (SD ± 1.04) on a scale from 1 to 7. The evaluation for the physiotherapy module was on average 5.84 (SD ± 1.63), the evaluation of the psychotherapy 5.36 (SD ± 1.38). Furthermore, the psychometric measures showed a positive effect of the intervention on several psychometric factors compared to the control group.
Conclusion(s): The feasibility study showed, that a multi professional intervention seems to be more effective in reducing CPPS specific symptoms as conventional treatments. This effects were particularly visible in terms of pain reduction and improved quality of life.
Implications: In the future, a multicenter randomized controlled trial is urgently needed to test the efficacy of the multiprofessional intervention. The study clearly showed the importance of multi-professional collaboration in treating patients with CPPS.
Keywords: Chronic pelvic pain syndrome, Physical therapy, Interdisciplinary management
Funding acknowledgements: PRANA Foundation in the Stifterverband für die Deutsche Wissenschaft e.V.
Purpose: The aim of this study is to test the feasibility of combined psychotherapy and physiotherapy for female and male patients with CPPS and to explore changes in patient-relevant outcomes compared to a control group.
Methods: A feasibility study with a crossover design based on the principles of a ´cohort multiple randomized controlled trial´ was conducted to test a combined therapy for patients with CPPS. Study subjects were recruited from the interdisciplinary outpatient clinic for CPPS at the University Medical Center Hamburg-Eppendorf. The study consisted of two consecutive treatment modules (cognitive behavioural psychotherapy and physiotherapy). The modules consisted of nine weekly sessions. The control group underwent treatment as usual. Feasibility as the primary outcome was analysed in terms of the demand, acceptability, and practicality. Secondary study outcomes were measured using validated self-rating-scales and physical examinations.
Results: 36 patients were assigned to the Intervention and 24 patients to the control group. In terms of Satisfaction with the treatment, the average rating for the whole program was 6.00 (SD ± 1.04) on a scale from 1 to 7. The evaluation for the physiotherapy module was on average 5.84 (SD ± 1.63), the evaluation of the psychotherapy 5.36 (SD ± 1.38). Furthermore, the psychometric measures showed a positive effect of the intervention on several psychometric factors compared to the control group.
Conclusion(s): The feasibility study showed, that a multi professional intervention seems to be more effective in reducing CPPS specific symptoms as conventional treatments. This effects were particularly visible in terms of pain reduction and improved quality of life.
Implications: In the future, a multicenter randomized controlled trial is urgently needed to test the efficacy of the multiprofessional intervention. The study clearly showed the importance of multi-professional collaboration in treating patients with CPPS.
Keywords: Chronic pelvic pain syndrome, Physical therapy, Interdisciplinary management
Funding acknowledgements: PRANA Foundation in the Stifterverband für die Deutsche Wissenschaft e.V.
Topic: Women's & men's pelvic health; Pain & pain management
Ethics approval required: Yes
Institution: Medical Association Hamburg, Germany
Ethics committee: IRB
Ethics number: PV4220 (17 August 2012) and PV4801 (02 December 2014)
All authors, affiliations and abstracts have been published as submitted.
