Authors (including presenting author) :
KWAN WS(1), POON M (2), CHAN PF(2), MAK MYM(1)
Affiliation :
(1) Department of Physiotherapy, TMH
(2) Department of Surgery, TMH
Introduction :
A temporary ileostomy is a common procedure in colorectal surgery, bypassing the entire colon, rectum and anus which allow the intestines to rest and heal. After the surgery, patients may face weakened abdominal muscle strength and reduced cardiopulmonary fitness. Uncertainty of how to resume previous physical activities and exercises are often being reported. Another challenge is the disuse pelvic floor muscle which would pose the risk of bowel incontinence after stoma reversal surgery. Collaborative input from health care team is indicated to enhance the quality of care in this group of patients
Objectives :
(1) To provide optimal stoma care and promote patients’ adaptation to life with temporary ileostomy.
(2) To minimize the complications after ileostomy reversal
Methodology :
Ileostomy care program has been established in August 2019 by a multi-disciplinary team which is composed of surgeons, nurses, dietitians and physiotherapists. The patients under the program are referred for out-patient physiotherapy at discharge. First physiotherapy appointment would be arranged 6 to 8 weeks post-surgery, allowing the wound and stoma condition to stabilized. The first session includes the components below:
(1) Assessment of the abdominal muscle power and endurance, anal sphincter strength (Modified Oxford Grading) and cardiopulmonary status (6-minute walk test)
(2) Education and practice of core muscle stabilization exercise, pelvic floor muscle exercise and large muscle group strengthening exercise
(3) Prescription of aerobic exercise according to patients’ physical status and interests.
(4) Advise on adaptation and precaution in returning to normal life
An exercise leaflet has been designed to facilitate the home exercise. A follow up session would be scheduled 2 months later which the home exercise compliance and the ability to perform the taught exercise are evaluated.
Result & Outcome :
8 patients have been referred for physiotherapy service from to August to November 2020. 3 patients have completed 2 physiotherapy sessions and demonstrated good exercise compliance. They were asked to complete a questionnaire for evaluating the program. All the respondents were satisfied with the program and reflected improved confidence in resuming normal physical exercise and establishing regular exercise regime.
The preliminary feedback from the participants are encouraging. Evaluation of the program effectiveness with quantitative data will be conducted in long term.
