Influencing factors of rehabilitation treatment effect in patients with postpartum pelvic floordysfunction and establishment of nomogram prediction model
Wu Zhirong, Zhu Yuping, Wan Lijuan
(1. Department of Obstetrics, Huai'an Hospital Affiliated to XuzhouMedical University, Jiangsu, Huai'an 223000, China; 2. Department of Obstetrics, Huai'an Maternal and Child Health Hospital, Jiangsu, Huai'an 223000, China)
Abstract: 【Abstract】 Objective To investigate the influencing factors of the rehabilitation treatment effect of postpartum pelvic floor dysfunction (PFD) patients, and to construct a nomogram model to predict the rehabilitation effect of PFD. Method From April 2020 to April 2022, 384 patients with PFD who were admitted to Huai'an Hospital Affiliated to Xuzhou Medical University and Huai'an Maternal and Child Health Hospital were selected as the research objects. All patients underwent biofeedback electrical stimulation therapy and Kegal training. After three months, the rehabilitation effect was determined and the patients were divided into good rehabilitation group (n=311) and poor rehabilitation group (n=73). The influencing factors of the rehabilitation effect of PFD patients were screened out through multivariate Logistic regression analysis, R 3.6.1 software was used to establish a line graph model to predict the rehabilitation effect of PFD. The predictive performance of the model was evaluated by the receiver operator characteristic (ROC), and the H-L goodness of fit test was performed. Result Among the 384 patients, the rate of poor recovery was 19.01%. There were differences in the proportion of elderly pregnant women, prenatal body mass index (BMI), number of deliveries, neonatal birth weight, pelvic floor muscle classification, stress urinary incontinence (SUI) degree classification, and Kegel training compliance between the two groups (all P<0.05). Multivariate Logistic regression analysis results show that the main factors affecting the rehabilitation effectof PFD were prenatal BMI (OR=1.741, 95%CI: 1.284-2.360, P<0.001), number of deliveries ≥2 (OR=2.229,95%CI: 1.412-7.385, P<0.005), birth weight of newborns (OR=2.688, 95%CI: 1.278-8.635, P<0.001),pelvic floor muscle classification ≤ class 1 (class 1: OR=2.223, 95%CI: 1.663-8.349, P=0.040; class 0:OR=3.223, 95%CI: 1.056-9.840, P=0.001), and poor Kegel training compliance (OR=3.092, 95%CI: 1.726-9.699, P=0.001) ; the above five influencing factors were introduced into R software to establish a nomogrammodel, the area under the curve (AUC) was 0.853 (95%CI: 0.794-0.912). H-L goodness of fit test indicatedthat the model had a high degree of differentiation and consistency in predicting the rehabilitation effectof PFD patients (χ2=0.837, P=0.416). Conclusion The nomogram prediction model constructed based on five influencing factors, including prenatal BMI, number of deliveries≥2, neonatal birth weight, pelvic floor muscle class ≤ class 1, and Kegel training compliance, has a strong effect in predicting the effect of rehabilitation therapy in PFD patients.
2023, Vol. 11 
