Pelvic floor outcomes in patients who have undergone general rehabilitation following surgery for colorectal cancer: a pilot study北大核心CSCD

BACKGROUND There is a paucity of evidence on changes in pelvic floor outcomes in patients with colorectal cancer (CRC) following general oncology rehabilitation. OBJECTIVE In patients following surgery for CRC, to explore changes in pelvic floor muscle function before and after a general oncology rehabilitation program;and to compare pelvic floor symptoms in patients undergoing the rehabilitation program to a matched control group. METHODS This pilot study was conducted as an observational study nested within a prospective study evaluating the feasibility of a general oncology rehabilitation program for patients following surgery for abdomino-pelvic cancer. In this nested study, pelvic floormuscle function was measured in 10 participants with CRC (rehabilitation group) before and immediately after the 8-week rehabilitationprogram and at 6-month follow-up. Data of 10 matched participants from the prospective study who completed questionnaires only at the same assessment time points were used as a control group.     

Pelvic floor symptoms,physical, and psychological outcomes of patients following surgery for colorectal cancer

Background: Little has been published regarding general and pelvic floor-related health status in patients who have undergone surgery for colorectal cancer (CRC). Objective: The objective of the study was to assess changes in pelvic floor symptoms, physical activity levels, psychological status, and health-related quality of life (HRQoL) in patients with CRC from pre- to 6 months postoperatively. Methods: Pelvic floor symptoms, physical activity levels, anxiety and depression, and HRQoL of 30 participants who were undergoing surgery for stages I–III CRC were evaluated pre- and 6 months postoperatively. Results: Six months postoperatively, there were no significant changes in severity of pelvic floor symptoms, or other secondary outcomes (physical activity levels, depression, global HRQoL) compared to preoperative levels (p > 0.05). However, fecal incontinence (p = 0.03) and hair loss (p = 0.003) measured with the HRQoL instrument were significantly worse. Participants were engaged in low levels of physical activity before (42.3%) and after surgery (47.4%). Conclusion: The findings of a high percentage of participants with persistent low physical activity levels and worse bowel symptoms after CRC surgery compared to preoperative levels suggest the need for health-care professionals to provide information about the benefits of physical activity and bowel management at postoperative follow-ups. Further investigation in larger studies is warranted.     

Ankle positions potentially facilitating greater maximal contraction of pelvic floor muscles: a systematic review and meta-analysis

Abstract

Objectives: To evaluate the effect of ankle positions on pelvic floor muscles in women.

Methods: Multiple databases were searched from inception-July 2017. Study quality was rated using the grading of recommendations, assessment, development, and evaluation system and the “threats to validity tool”.

Results: Four studies were eligible for inclusion. Meta-analysis revealed significantly greater resting activity of pelvic floor muscles in neutral ankle position (?1.36 (95% CI ?2.30, ?0.42) p?= 0.004) and induced 15° dorsiflexion (?1.65 (95% CI ?2.49, ?0.81) p?= 0.0001) compared to induced 15° plantar flexion. Significantly greater maximal voluntary contraction of pelvic floor was found in dorsiflexion compared to plantar flexion (?2.28 (95% CI ?3.96, ?0.60) p?= 0.008). Meta-analyses revealed no significant differences between the neutral ankle position and 15° dorsiflexion for either resting activity (0.30 (95% CI ?0.75, 1.35) p?= 0.57) or maximal voluntary contraction (0.97 (95% CI ?0.77, 2.72) p?= 0.27).

Conclusion: Pelvic floor muscle-training for women with urinary incontinence could be performed in standing with ankles in a neutral position or dorsiflexion to facilitate greater maximal pelvic floor muscle contraction. As urethral support requires resting contraction of pelvic floor muscles, decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with urinary incontinence might potentially experience more leakage during exertion in a standing position.

• Implications for rehabilitation

• Pooled analyses revealed that maximal voluntary contraction of pelvic floor muscle is greater in induced ankle dorsiflexion than induced plantar flexion.

• As pelvic floor muscle strengthening involves achieving a greater maximal voluntary contraction, pelvic floor muscle training for women with stress urinary incontinence could be performed in standing either with ankles in a neutral position or dorsiflexion.

• Decreased resting activity in plantar flexion identified in the meta-analysis indicates that high-heel wearers with stress urinary incontinence might potentially experience more leakage during exertion in a standing position.

• Women with stress urinary incontinence should be advised to wear flat shoes instead of high-heels and should be cautioned about body posture and ankle positions assumed during exercise and daily activities.

     

非侵入式盆底肌康复疗法对产后盆底康复效果研究

目的:观察非侵入式盆底肌康复疗法对产后盆底肌康复的治疗效果。方法:将128例产后盆底功能障碍患者随机分为治疗组和对照组各64例。对照组只接受家庭自主的盆底肌训练治疗,每天不少于40分钟的训练。对照组使用非侵入盆底肌康复疗法治疗40分钟,每周3次。两组患者治疗前,治疗后6周、12周时分别进行疗效评价。观察两组患者的盆底功能障碍评分、盆底肌力Glazer评分,对比两组患者疗效差异。结果:两组患者盆底功能障碍评分、盆底肌力Glazer评分治疗6周后、12周均显著改善(P<0.01),但治疗组治疗6周后及12周后疗效明显优于对照组,差异有显著统计学意义(P<0.01)。结论:与患者自行盆底肌锻炼相比,非侵入式盆底肌康复疗法能更够显著地改善患者的盆底功能状态,提高患者生活质量,增强盆底肌力。非侵入式盆底肌康复疗法是产后盆底肌松弛的有效治疗方案,同时该疗法非侵入,无创、无痛更容易被广大患者接受。有益于促进中国妇女盆底功能障碍防治项目的进一步发展推广。     

分娩镇痛对足月初产女性产后盆底结构的近期影响

目的 观察分娩镇痛对足月初产女性产后盆底结构的近期影响。方法 回顾性分析230名于产后6～8周接受经会阴实时三维盆底超声检查的足月初产女性,根据是否接受分娩镇痛将其分为分娩镇痛组(n=70)和对照组(n=160);对比观察组间一般资料、产程、静息态、最大瓦尔萨尔瓦动作及盆底肌收缩状态下盆底超声参数,分析分娩镇痛对其盆底结构的影响。结果 分娩镇痛组与对照组受试者年龄、孕次、体质量指数(BMI)、新生儿体质量及产程差异均无统计学意义(P均>0.05)。静息态及最大瓦尔萨尔瓦动作下,组间膀胱颈位置、膀胱位置、子宫位置及直肠壶腹部位置差异均无统计学意义(P均>0.05);最大瓦尔萨尔瓦动作下,组间膀胱颈移动度及肛提肌裂孔面积差异亦无统计学意义(P均>0.05)。2组受试者肛提肌撕脱发生率及肛门内/外括约肌损伤率差异均无统计学意义(P均>0.05)。结论 分娩镇痛对足月初产女性产后早期盆底结构无明显影响。     

阴道分娩不同助产方式对盆底功能的影响

目的 采用经会阴三维超声探讨阴道分娩中不同助产方式对妇女盆底功能的影响。方法 选取经阴道分娩的产妇84名,按助产方式的不同分为会阴完整组32例、会阴侧切组30例、产钳助产组22例。分别获得静息状态、瓦氏动作和缩肛动作时盆隔裂孔图像,比较3组妇女产后盆隔裂孔前后径和面积的差异。结果 会阴完整组和会阴侧切组于静息状态、瓦氏动作和缩肛动作时盆隔裂孔的前后径、面积差异均无统计学意义（P均>0.05）。会阴完整组和产钳助产组在静息状态、瓦氏动作和缩肛动作时的盆隔裂孔前后径、面积,静息-瓦氏和静息-缩肛时盆隔裂孔改变面积差异均有统计学意义（P均<0.05）。结论 产钳对盆底功能的损伤大于自然阴道分娩,阴道分娩中,是否会阴切开对盆底功能损伤无明显差异。     

三维超声评价足月妊娠经阴道分娩中外源激素的应用对盆底功能的影响

目的 采用经阴式三维超声评价足月妊娠经阴道分娩中应用外源激素对盆底功能的影响。方法 90名足月经阴道分娩的产妇按使用外源激素情况分为自然分娩组、催产素组和前列腺素E2（PGE2）组,各30名。于产后42天进行超声检查,分别获得静息状态、瓦氏和缩肛动作时盆隔裂孔图像,比较3组产妇盆隔裂孔前后径和面积。结果 自然分娩组和催产素组于静息、瓦氏和缩肛动作时盆隔裂孔的前后径、面积测量值差异均无统计学意义（P均>0.05）。PGE2组与自然分娩组、催产素组在静息、瓦氏和缩肛动作时盆隔裂孔测量值差异均有统计学意义（P均<0.05）。结论 足月妊娠经阴道分娩中应用不同外源激素的产妇产后盆底功能存在差异,应用外源PGE2对盆底功能的损伤大于应用催产素和自然阴道分娩;应用催产素对盆底功能的影响较自然阴道分娩无差异。     

Pelvic floor muscle training as a persistent nursing intervention: Effect on delivery outcome and pelvic floor myodynamia

PurposeTo evaluate the effect of pelvic floor muscle training as a nursing intervention on delivery outcomes and postpartum pelvic floor myodynamia.MethodsIn total, 106 nulliparas were randomised into an intervention group and control group. All nulliparas participated in a pelvic floor training programme led by a midwife. A pelvic floor physical therapist measured the women's pelvic floor myodynamia and taught them how to correctly perform pelvic muscle contractions before the intervention. A registered nurse monitored the intervention group via twice-weekly telephone checkups. The control group did not receive individual direction.ResultsThere were no differences in the rate of Caesarean section or elective Caesarean section between the two groups (χ² = 3.446, p = 0.076 and χ² = 2.343, p = 0.185, respectively). There was a difference in the timing of the second stage of labour between the two groups (t = 2.101, p = 0.040); no difference was observed in the timing of the other two stages of labour (t = 1.771, p = 0.081 and t = 1.142, p = 0.263, respectively). In addition, no differences were observed in the gestational weight gain (t = 0.196, p = 0.845), neonatal weight (t = 0.113, p = 0.911), rate of episiotomy (χ² = 0.932, p = 0.351) or rate of perineal laceration (χ² = 0.022, p = 0.982) between the two groups. The pelvic floor myodynamia of the intervention group had improved to a greater degree than that in the control group at 6 weeks and 3 months after delivery (p < 0.005).ConclusionPersistent nursing intervention for pregnant/postpartum women helped to shorten the second stage of labour and contributed to the recovery of postpartum pelvic floor myodynamia. The influence of this intervention on the delivery mode, and rates of episiotomy and perineal laceration remains unknown. Medical staff should strengthen health education programmes that involve pelvic floor functional rehabilitation.     

The effectiveness of web-based patient education and action and coping plans as an adjunct to patient treatment in physiotherapy: A randomized controlled trial

ABSTRACT

Objective: The study investigated: (1) the effect of combining web-based patient education (WBPE) with action and coping plans on patients’ adherence to physiotherapy and their subsequent functional outcomes; and (2) the participants’ satisfaction with the WBPE program. Methods: One hundred and eight participants enrolled in this 8-week two group randomized controlled trial. They were allocated to either the WBPE planning group or the attention-control group. The WBPE group made action and coping plans and were familiarized with their web-based program. The attention control group was given access to a web-based neutral information program about shoulder injuries and physiotherapy rehabilitation. Throughout the 8-week study physiotherapists measured the participants’ clinic-based adherence and participants recorded their home-based adherence using a self-report diary. Functional outcomes for all participants were measured at the beginning and end of the study. Participants provided feedback about their respective websites. Results: The intervention group had a significantly higher clinic based adherence than the control group (p < 0.04). Both groups had a significant improvement in shoulder function but there was no significant difference between them. Participants in the intervention group were highly satisfied with the WBPE program. The preferred delivery of physiotherapy by 87% of the intervention group was a combination of face-to-face appointments and WBPE. Control participants indicated that they would have appreciated information about shoulder exercises and the shoulder complex in their program. Discussion: The WBPE program was an effective adjunct to physiotherapy in terms of patient satisfaction and clinic-based treatment adherence.     

Effect of individualized physical rehabilitation programs on respiratory function in women with post-mastectomy syndrome

Purpose: The purpose of this study was to determine the effectiveness of an individualized physical rehabilitation programs aimed at improving respiratory function in women with post-mastectomy syndrome. Methods: In a randomized controlled trial 50 women with post-mastectomy syndrome were enrolled in the experimental group (EG, n = 25) or the comparison group (CG, n = 25). The program for the EG included: aqua aerobics (i.e. aqua jogging, aqua building, and aqua stretching); conditional swimming; and recreational aerobics. The program for the CG included: conditional swimming and Pilates exercises. Both intervention groups attended individualized physical rehabilitation programs three times per week for 48 weeks. The primary outcome measure was spirometry of the patients measured before, 6 and 12 months after the intervention. Results: This study demonstrated that most of the respiratory function parameters increased significantly in both groups over the year of exercise training. After the year of training the individualized physical rehabilitation program for the EG was significantly better (p < 0.01) as compared with the CG, except for inspiratory reserve volume and maximal voluntary ventilation, which were not statistically different. Conclusions: The results of the study suggest that individual programs of physical rehabilitation could be considered effective for the improvement of respiratory function of the patients with post-mastectomy syndrome. The results obtained could serve as a basis for more widespread clinical program development.     

The effects of multimodal rehabilitation on pain-related sickness absence – an observational study

Purpose: The aim of the current study was to examine the effects on sickness absence of multimodal rehabilitation delivered within the framework of a national implementation of evidence based rehabilitation, the rehabilitation guarantee for nonspecific musculoskeletal pain.

Method: This was an observational matched controlled study of all persons receiving multimodal rehabilitation from the last quarter of 2009 until the end of 2010. The matching was based on age, sex, sickness absence the quarter before intervention start and pain-related diagnosis. The participants were followed by register data for 6 or 12 months. The matched controls received rehabilitation in accordance with treatment-as-usual.

Results: Of the participants, 54% (N?=?3636) were on registered sickness absence at baseline and the quarter before rehabilitation. The average difference in number of days of sickness absence between the participants who received multimodal rehabilitation and the matched controls was to the advantage of the matched controls, 14.7 days (CI 11.7; 17.7, p?≤?0.001) at 6-month follow-up and 9.5 days (CI 6.7; 12.3, p?≤?0.001) at 12-month follow-up. A significant difference in newly granted disability pensions was found in favor of the intervention.

Conclusions: When implemented nationwide, multimodal rehabilitation appears not to reduce sickness absence compared to treatment-as-usual.

• Implications for Rehabilitation

• A nationwide implementation of multimodal rehabilitation was not effective in reducing sickness absence compared to treatment-as-usual for persons with nonspecific musculoskeletal pain.

• Multimodal rehabilitation was effective in reducing the risk of future disability pension for persons with nonspecific musculoskeletal pain compared to treatment-as-usual.

• To be effective in reducing sick leave multimodal rehabilitation must be started within 60 days of sick leave.

• The evidence for positive effect of multimodal rehabilitation is mainly for sick listed patients. Prevention of sick leave for persons not being on sick leave should not be extrapolated from evidence for multimodal rehabilitation.

     

Effectiveness of an Occupational Therapy Program on Cancer Patients with Dyspnea: Randomized Trial

Abstract

Background: Dyspnea is one of the leading causes of loss of autonomy among patients with advanced cancer. The management of these symptoms relies exclusively on pharmacological measures.

Aims: To assess the effectiveness of a “occupational therapy program” to improve both personal functionality and respiratory function in patients with dyspnea.

Methods: Experimental, prospective, longitudinal, and randomized study. A total of 102 individuals from the inpatient oncology unit of the University Salamanca Hospital Complex were participated in this study. In addition to pharmacological treatment, the intervention group participated in the occupational therapy program.

Results: The study yielded statistically significant differences between the members of the experimental group and those of the control group in functionality levels, as well as statistically significant differences in the BODE global respiratory index scores (p?<?0.001), and in the dyspnea level scores (p?<?0.001) between both groups.

Conclusions: Comprehensive respiratory rehabilitation program from an occupational therapy perspective improve functionality and overall respiratory function levels in cancer patients suffering from dyspnea.     

The pilates method in the function of pelvic floor muscles: Systematic review and meta-analysis

BackgroundMany Pilates instructors believe that the method can produce significant improvement in the resistance of pelvic floor muscles, but it is known that about 49% of women who can contract this muscle do not perform an adequate contraction and cannot increase urethral closure pressure.ObjectivesTo evaluate the response of the Pilates method in the function of the pelvic floor muscles, compared to the control group, in healthy women.Search methodsThe following databases were searched from October to December 2016: PUBMED, SCIELO, LILACS, MEDLINE, WEB OF SCIENCE and CINAHL via PERIÓDICOS CAPES, without restriction of language and year of publication.Selection criteriaRandomized (RCTs), quasi-randomized, and non-randomized clinical trials assessing the effectiveness of the Pilates method for the fuction of pelvic floor muscles in healthy women were included.Data collection and analysisTwo reviewers independently selected the studies, assessed the risk of bias and performed the data extraction. Primary outcomes were the method of evaluation of strength, function, coordination, and symmetry of contraction of the pelvic floor muscles.Results4434 articles were identified and 2 articles were selected to compose this review and the meta-analysis. No between-group difference was demonstrated for the pelvic floor muscle function as measured by perineometry (p = 0.32).ConclusionsNo evidence showed a modification of the function of pelvic floor muscles in healthy women practicing the Pilates method.     

Physical activity and health-related quality of life in pediatric cancer patients following a 4-week inpatient rehabilitation program

Purpose

Chronic health conditions and impaired quality of life are commonly experienced in childhood cancer survivors. While rehabilitation clinics support patients in coping with the disease, studies evaluating an inpatient rehabilitation program on promoting physical activity (PA) and health-related quality of life (HRQoL) are missing.

Methods

A 4-week inpatient rehabilitation program was prospectively evaluated. One hundred fifty patients with leukemia or lymphoma (N = 86), brain tumors (N = 38), and sarcomas (N = 26) were enrolled on average 17 months after cessation of acute medical treatment. PA amount and cadence (indicating the intensity of walking activity) using the StepWatch? 3 Activity Monitor and HRQoL global and physical well-being scores using the KINDL^® questionnaire were assessed before, immediately after, and 6 and 12 months following the program and analyzed using multiple linear mixed models.

Results

Significant effects on PA were only found at 12-month follow-up for amount and cadence variables (all p < 0.05). While leukemia and lymphoma patients revealed the highest PA level throughout the study, rehabilitation effects were more pronounced for cadence variables in brain tumor and sarcoma patients. The rehabilitation program had immediate (t = 4.56, p < 0.001) and sustainable effects on HRQoL global scores (6-month follow-up, t = 4.08, p < 0.001; 12-month follow-up, t = 3.13, p < 0.006).

Conclusions

Immediate and sustainable increases in HRQoL indicate that a 4-week rehabilitation program is beneficial for improving psychosocial well-being, while the significant increase in PA levels could be related to general recovery as well. The lack of a control group hampers the evaluation of the rehabilitation program on promoting PA levels in pediatric cancer patients.

     

盆底肌锻炼联合电刺激促进产后盆底器官功能康复的研究

目的 探讨在产后早期进行盆底肌训练,促进产后盆底器官功能恢复的效果.方法 将330例产妇随机分为综合组120例、实验组100例和对照组110例.综合组在产后第2天进行盆底肌训练联合低频电刺激;实验组在产后第2天单纯进行盆底肌训练;对照组只接受常规保健指导.产褥期满(即产后42 d)对3组产妇进行盆底耻骨、盆底肌(PC肌)张力评分、尿失禁程度及子宫缩复情况的评定,并对结果进行比较.结果 综合组、实验组、对照组产妇盆底PC肌张力评分、排尿状况比较有显著差异.综合组、实验组产妇产后42 d各项检查结果显著优于对照组;综合组与实验组比较无显著差异.结论 产后早期进行盆底肌训练联合低频电刺激有利于产后盆底器官功能的恢复,明显降低盆底功能障碍性疾病(PFD)的发生.     

Evaluation of the structured bowel management program in inpatient rehabilitation: a prospective study

Purpose: The purpose of this study is to evaluate the impact of the structured bowel management program (SBMP) in an inpatient rehabilitation service. Method: Prospective recruitment of consecutive patients admitted to the rehabilitation unit (n?=?100). Each patient was assessed for bowel dysfunction on admission and an individualised SBMP was instituted based on the clinical needs. The assessments were at baseline (T1), and discharge from ward (T2) using validated questionnaires. Program evaluation was at 3-month (T3) post-discharge. Results: Participants were predominantly female (52%), mean age 68?±?13 years. Almost one-half (43%) had neurological conditions and 41% musculoskeletal problems. At admission, 62% self-reported bowel dysfunction, mainly constipation (82%) and faecal incontinence (FI) (11%). At T2, participants showed significant improvement in bowel habit and stool consistency (Bristol stool chart, p?p?p?p?r?=?0.5–0.7). No adverse effects were reported. Conclusions: Bowel management should be a priority within rehabilitative services. Evidence-based SBMP can improve bowel symptoms and enhance overall QoL in patients admitted to rehabilitation settings.

• Implications for Rehabilitation

• Bowel dysfunction is common in inpatient rehabilitation settings.

• A structured bowel management program can improve bowel symptoms and enhance overall QoL in patient.

• Bowel management should be a priority for patients admitted to rehabilitation settings.

     

The efficacy of stretching exercises to reduce posterior shoulder tightness acutely in the postoperative population: a single blinded randomized controlled trial

Background: Posterior shoulder tightness (PST) is a postoperative complication leading to pain, impaired mobility, and reduced function. Despite the potential morbidity associated with PST, no studies have investigated the efficacy of shoulder-stretching methods in the postsurgical population. The purpose of this study was to determine the short-term efficacy of two stretches designed to reduce PST. Methods: The study enrolled 63 patients [mean age 51 (12) years, height 173.7 (3.6) cm, body mass 88.2 (17.9) kg]. The study was a single-blinded randomized control trial in which patients who had arthroscopic shoulder surgery were assigned to one of three groups: [(horizontal adduction stretch (n = 21), supine sleeper (n = 21), or control (n = 21)]. Dependent variables included measurements of internal rotation mobility, sidelying PST, pain, and the QuickDASH. Following the physical therapy (PT) initial evaluation, subjects were instructed to perform the allocated intervention twice daily until their first follow-up appointment 48–72 h following the initial PT visit. Results: Between group analyses of dependent variables revealed significant differences within PST measurements (p = 0.005) (eta squared = 0.14) taken at baseline and follow-up (48–72 h) favoring horizontal adduction stretching. Post-hoc testing demonstrated superiority of horizontal adduction stretching over both the supine sleeper group (p = 0.01) and control (p = 0.002). Discussion and conclusion: The horizontal adduction stretch is more effective at reducing acute PST in the postoperative shoulder population when compared to the supine sleeper stretch and no stretch at all. Knowledge of efficacious stretching methods may serve to reduce the potential morbidity associated with postoperative stiffness.     

早期盆底肌肉训练及电刺激治疗对产后盆底康复影响的研究

目的:探讨产后早期盆底肌肉训练及电刺激预防和治疗盆底功能障碍性疾病(pelvic floor dysfunction,PFD)的有效性,PFD发生的相关因素。方法:选取阴道分娩产后早期盆底康复训练的初产妇284例作为研究对象。分为3个研究组:低风险组(n=98)、高风险组(n=92)和PFD组(n=94);3个研究组根据是否行盆底康复治疗再分为观察组和对照组。比较各组盆底康复治疗前后PFD的发生及改善、盆底肌肉的肌力变化情况,分析阴道分娩后PFD发生的危险因素。结果:3组结果表明:低风险组治疗前后盆底肌力变化及PFD的发生,差异无统计学意义;高风险组及PFD组治疗后盆底肌肉的肌力及PFD较治疗前明显提高(P0.05);会阴侧切、阴道助产、会阴裂伤、巨大儿、第二产程延长、产后尿潴留比较,高风险组和PFD组明显高于低风险组(P0.05);高风险组与PFD组比较,会阴侧切、会阴裂伤、巨大儿、第二产程延长、产后尿潴留比例明显提高(P0.05);3组分娩镇痛比较差异无统计学意义;患者年龄、体重指数、是否阴道助产、新生儿出生体重、第二产程是否延长、产后是否发生尿潴留是PFD发生的独立因素(P0.05),而分娩镇痛与PFD发生无相关性。结论:对阴道分娩存在PFD高危因素的产妇,进行早期盆底肌肉训练及电刺激康复治疗,可预防阴道分娩后PFD的发生,是PFD非手术治疗的有效方法。     

The impact of Professional Boundaries for Health Professionals (PBHP) training on knowledge,comfort, experience,and ethical decision-making: a longitudinal randomized controlled trial

Purpose: A randomized controlled trial was conducted to evaluate the impact of Professional Boundaries for Health Professionals (PBHP) training program on the knowledge, comfort, experience, and ethical decision-making of multidisciplinary practitioners facing client–practitioner boundary dilemmas.

Methods: In all, 36 rehabilitation practitioners from an Australian state-wide spinal cord injuries service were assigned to experimental and control groups. The Boundaries in Practice (BIP) Scale measured outcomes at four points: pre, post, 3 months, and 1 year. The control group received the training after 3 months. Nonparametric Friedman’s two-way analysis of variance was used to examine the trajectories over time.

Results: Analysis was conducted using the data of 10 experimental and 13 control group participants who responded at four data collection points. The experimental group showed significant improvement in knowledge (χ²?=?10.673, p?=?0.014) and comfort (χ²?=?9.727, p?=?0.021) managing professional boundaries post-training. The control group showed no significant change in knowledge or comfort. No significant change was seen in experience across either experimental (χ²?=?3.609, p?=?0.307) or control group (χ²?=?7.800, p?=?0.050). Ethical decision-making improved in the control group (χ²?=?13.188, p?=?0.004) following training, however remained unchanged in the experimental group.

Conclusions: The findings do not definitively support this training approach. Ethical decision-making may improve more substantially within the practice context and organizational culture change. Multifaceted approaches are indicated.

• Implications for Rehabilitation

• Ethical dilemmas related to boundaries between clients and practitioners are a frequent occurrence in the rehabilitation setting.

• In a relatively small sample, the current randomized trial provided inconclusive evidence on the benefit of a 1-day needs-oriented training program to improve knowledge, comfort, and ethical decision-making.

• Randomized trials of education and training for rehabilitation practitioners are fraught with challenges in the clinical environment of the rehabilitation setting.

• Multifaceted training approaches, management support and training as well as changes to policy and organizational context in the rehabilitation setting may be needed to more holistically address the issues surrounding professional boundaries in the rehabilitation setting.