Ağrılı Mesane Sendromu/İnterstisyel Sistit Tedavisinde Biyopsikososyal Yaklaşım ile Konvansiyonel Yaklaşımın Karşılaştırılması

Abstract

The aim of this study was to compare the effectiveness of a biopsychosocial and conventional approach-based physiotherapy and rehabilitation program in the treatment of Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) in a randomized design. Twenty-eight female patients with symptoms of BPS/IC related pain, pressure, and discomfort for more than 6 months were included in the study and they were randomly assigned to either Biopsychosocial Approach (Group 1) or Conventional Approach (Group 2). In addition to standard patient education, patients in the biopsychosocial approach group received pain neuroscience education, cognitive-targeted exercises, and relaxation training. Transcutaneous electrical nerve stimulation and stretching exercises were applied to the patients in the conventional approach group. All treatments were applied in two sessions per week for six weeks. Primary outcome measures such as symptom severity and pain intensity were measured by the Interstitial Cystitis Symptom and Problem Scale and the Visual Analog Scale, respectively. Secondary outcome measures such as urinary symptoms, disability, pain cognitions (pain catastrophization and self-efficacy), psychological symptoms, and quality of life were evaluated by the Bladder Diary, Pain Disability Index, Pain Catastrophizing Scale (PCS), Pain Self-Efficacy Questionnaire, Hospital Anxiety and Depression Scale, and Short Form-36 (SF-36), respectively. Self-reported feeling of improvement is assessed by the Global Rating of Change Scale. In both groups, symptom severity and pain severity, which are primary outcome measures, improved over time (p<0.05). Considering the changes in secondary outcome measures over time, it was found that the number of daytime voids, nocturia, depression, and quality of life (energy/vitality, mental health, social functioning, pain, and general health perception sub-domains) significantly improved in the biopsychosocial approach group (p<0.05). In the conventional approach group, it was observed that disability, the helplessness sub-domain of the PCS and the energy/vitality sub-domain of the SF-36 improved over time (p<0.05). For all outcome measures, the interaction effect (group x time effect) was not significant (p>0.05). As a result of this study, it was found that the effects of the biopsychosocial and the conventional approach in BPS/IC on symptom severity and pain intensity were not different. In addition, it was determined that the biopsychosocial approach could be effective in improving pain cognitions (pain catastrophization and self-efficacy). In conclusion, there is a need for randomized controlled trials with larger sample sizes and long-term follow-up in order to examine the effectiveness of biopsychosocial-based physiotherapy and rehabilitation approaches in the management of BPS/IC.