Change in Functional Status from Preoperative to One Year Postoperative in Patients Who Have Undergone Elective Open-Heart Surgery: A Repeated-Measures Study

Purpose: Although patient-related factors affect surgical outcomes, preoperative functional status is not measured by any cardiac risk score. Functional status can, however, be objectively measured using validated outcome tools such as the Late-Life Function and Disability Instrument (LLFDI). The purpose of this study was to determine 1) if there was a change over time in functional status, as measured by the LLFDI, in patients who underwent elective cardiac surgery, and if so, 2) what specific aspect(s) of functional status changed. Methods: A prospective longitudinal study of one year was conducted on elective cardiac surgery patients (n = 43) using the self-reported LLFDI, which measures Disability Frequency (frequency of participation in social tasks), Disability Limitation (ability to participate in social tasks) and Function Total (ease in performing routine activities). Higher scores indicate increased function and decreased disability. LLFDI scores were compared at three times (preoperative, six-week and one-year postoperative) using repeated measures ANOVA. Post hoc pairwise comparison was conducted for specific interactions. Results: Both Function Total and Disability Frequency significantly changed over time (p = 0.047 and p = 0.013, respectively). Specifically, patients’ function level was significantly higher one-year postoperative compared to preoperative (M difference = +3.48, SE = 1.48, p = 0.026). Likewise, Disability Frequency scores were significantly higher (i.e. more active) at one-year postoperative versus preoperative (M difference= +5.98, SE = 2.19, p = 0.033). Disability Limitation scores were not significantly different between any time points (p > 0.05). Conclusion: By one-year postoperative, patients demonstrated increased ease in their routine physical activities and were more participatory in social life tasks. Individuals who underwent elective cardiac surgery took more than six weeks to detect notable improvement in functional status, which was expected with a sternotomy approach. This study provides support for the use of the LLFDI as an effective tool to capture functional status in the cardiac population. These findings may assist cardiac patients in recovery timeline expectations.

Relationship Between Symptom Distress,Functional Status and Quality of Life in Patients with Low Back Myofascial Pain Syndrome

Objective:To explore the relationship between symptomatic functional status and quality of life of patients with low back myofascial pain syndrome(MPS).Methods:From July 2021 to June 2022,106 patients with low back myofascial pain syndrome in the Affiliated Hospital of Hebei University were selected as the research subjects.A total of 106 MPS patients were investigated with general information questionnaire,Memory Symptom Assessment Scale(MSAS),Oswestry Disability Index(ODI)and Short Form Questionnaire(SF-36).The relationship between quality of life and symptom distress and dysfunction was observed and analyzed based on symptom distress and dysfunction scores,SF-36 scores,and so on.Results:The total score of MSAS was 1.79±0.91.The overall symptom distress of the patients was moderate.The ODI score was 18.46±5.95.The functional disability of the patients was classified as moderately impaired.The MSAS-PHYS,MSAS-PSYCH,MSAS-GDI three scale scores were 2.14±0.75,1.69±0.88,1.55±0.46,respectively,and the variability of the three scales is relatively large;the dimension scores were significantly lower than those of the conventional scoring models,and P<0.05,indicating a statistical difference;the scores of each dimension of the patient’s quality of life were compared with the scores of symptom distress and functional status.The higher the symptom distress score,the lower the quality of life,with P<0.05,indicating a statistical difference;the higher the score of each dimension of functional status,the better the quality of life,showing a positive correlation,and P<0.05,indicating a statistical difference.Conclusion:MPS patients face a number of physical and psychological symptoms,and their functional status is limited.Nursing staff should implement health education and intervention measures according to the actual situation of the patients,so as to improve the quality of their lives.

Recipient functional status impacts on short and long-term intestinal transplant outcomes in United States adults

BACKGROUND Recipient functional status prior to transplantation has been found to impact post-transplant outcomes in heart,liver and kidney transplants.However,information on how functional status,before and after transplant impacts post-transplant survival outcomes is lacking.AIM To investigate the impact of recipient functional status on short and long term intestinal transplant outcomes in United States adults.METHODS We conducted a retrospective cohort study on 1254 adults who underwent first-time intestinal transplantation from 2005 to 2022.The primary outcome was mortality.Using the Karnofsky Performance Status,functional impairment was categorized as severe,moderate and normal.Analyses were conducted using Kaplan-Meier curves and multivariable Cox regression.RESULTS The median age was 41 years,majority(53.4%)were women.Severe impairment was present in 28.3%of recipients.The median survival time was 906.6 days.The median survival time was 1331 and 560 days for patients with normal and severe functional impairment respectively.Recipients with severe impairment had a 56%higher risk of mortality at one year[Hazard ratio(HR)=1.56;95%CI:1.23–1.98;P<0.001]and 58%at five years(HR=1.58;95%CI:1.24–2.00;P<0.001)compared to patients with no functional impairment.Recipients with worse functional status after transplant also had poor survival outcomes.CONCLUSION Pre-and post-transplant recipient functional status is an important prognostic indicator for short-and long-term intestinal transplant outcomes.

Integrating Functional Status Information into Knowledge Graphs to Support Self-Health Management

Functional Status Information(FSI)describes physical and mental wellness at the whole-person level.It includes information on activity performance,social role participation,and environmental and personal factors that affect the well-being and quality of life.Collecting and analyzing this information is critical to address the needs for caring for an aging global population,and to provide effective care for individuals with chronic conditions,multi-morbidity,and disability.Personal knowledge graphs(PKGs)represent a suitable way for meaning in a complete and structured way all information related to people's FSI and reasoning over them to build tailored coaching solutions supporting them in daily life for conducting a healthy living.In this paper,we present the development process related to the creation of a PKG by starting from the HeLis ontology in order to enable the design of an Al-enabled system with the aim of increasing,within people,the self-awareness of their own functional status.In particular,we focus on the three modules extending the HeLis ontology aiming to represent(i)enablers and(ii)barriers playing potential roles in improving(or deteriorating)own functional status and(iii)arguments driving the FSI collection process.Finally,we show how these modules have been instantiated into real-world scenarios.

Association between follistatin-related protein 1 and the functional status of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis

Background:Follistatin-like 1(FSTL1)plays both pro-inflammatory and anti-inflammatory roles in the inflammatory processes.We investigated whether serum FSTL1 could predict the current anti-neutrophil cytoplasmic antibody-associated vasculitis(AAV)-specific indices.Methods:We randomly selected 74 patients with AAV from a prospective and observational cohort of Korean patients with AAV.Clinical and laboratory data and AAV-specific indices were recorded.FSTL1 concentration was determined using the stored sera.The lowest tertile of the short-form 36-item health survey(SF-36)was defined as the current low SF-36.The cutoffs of serum FSTL1 for the current low SF-36 physical component summary(PCS)and SF-36 mental component summary(MCS)were extrapolated by the receiver operator characteristic curve.Results:The median age was 62.5 years(55.4%were women).Serum FSTL1 was significantly correlated with SF-36 PCS(r=-0.374),SF-36 MCS(r=-0.377),and C-reactive protein(CRP)(r=0.307),but not with Birmingham vasculitis activity score(BVAS).In the multivariable linear regression analyses,BVAS,CRP,and serum FSTL1 were independently associated with the current SF-36 PCS(β=-0.255,β=-0.430,andβ=-0.266,respectively)and the current SF-36 MCS(β=-0.234,β=-0.229,andβ=-0.296,respectively).Patients with serum FSTL1≥779.8 pg/mL and those with serum FSTL1≥841.6 pg/mL exhibited a significantly higher risk of having the current low SF-36 PCS and SF-36 MCS than those without(relative risk 7.583 and 6.200,respectively).Conclusion:Serum FSTL1 could predict the current functional status in AAV patients.

FUNCTIONAL STATUS OF PANCREATIC ISLET IN ACUTE LEUKEMIA

Using enzymatic assay and radioimmunoassay, we studied the functional status of pancreatic islet in 50 patients with acute leukemia. Oral glucose tolerance test and insulin and C peptide release were made in 40 patients before and after treatment .14 patients who revealed diabetic curve and delayed insulin and C peptide release before treatment showed normal values in 6 after therapy. Five patients with impaired glucose tolerance and decreased insulin and C peptide release before treatment showed normalization of these parameters following therapy. Five patients with normal pretreatment values disclosed abnormal post-treatment results. The remaining 16 patients displayed normal results both before and after therapy. Anti-insulin antibodies were negative, and glucagon level was normal in all the 50 patients. The red cell insulin receptor binding rate analysed in 47 patients was significantly higher than in controls (P< 0.001). We considered that the disturbed glucose metabolism in acute leukemia was not uncommon mainly due to the dysfunction of pancreatic islet β cells as a result of islet damage by leukemic cells, the effect of corticosteroid and chemotherapy and the preexisting diabetes. Impaired glucose metabolism had no influence on therapeutic effect.

Development of an accurate nursing program based on function in chronic venous leg ulcers:protocol for matching function status with nursing interventions using the Delphi survey

Objective: Venous leg ulceration(VLU) is one of the complications of lower extremity venous reflux and reflux disorder of severe diseases, with many adverse effects on patient’s work and life. Nowadays, more and more patients with VLU accept wound care in community setting. Clinical nurses generally take care of the patients based on their own experiences. Healing in VLU is an incredibly complex process, which puzzles even experts. The majority of general nurses do not have this level of expertise, especially those nurses serving in community. Function is the basis of nursing activities. Patients always show different clinical manifestations and selfcare abilities due to various function states, which cannot be reflected completely by the existing nursing practice. How to describe nursing practice standardized in order to demonstrate the effectiveness of interventions and facilitate interdisciplinary communication is another urgent problem. Therefore, the aim of this project is to develop an accurate nursing program based on function in chronic venous leg ulcers, which can both satisfy the needs of patients and promote nursing revolution.Methods: This study will use International Classification of Functioning Disability and Health as a framework to choose suitable functions and to filter function classification standards of chronic venous leg ulcers through evidence-based systematic research.Nursing interventions related to VLU are selected based on Nursing Interventions Classification, adding other nursing activities by methods of evidence-based systematic review and clinical observation. Then, nursing interventions and function status are matched through steering committee. Finally, the Delphi survey method is adopted to make nursing program native and scientific.Conclusions: This study is expected to be very significant and meaningful in using standardized nursing terminology. The nursing program established could better meet the needs of both patients with chronic venous leg ulcers and clinical nurses, promoting the development of wound specialist and standardized nursing language.

Exercise as a modality to improve heart transplantation-related functional impairments: An article review

Heart transplantation(HT),the treatment choice of advanced heart failure pa-tients,is proven effective in increasing the survival and functional status of the recipients.However,compared to normal controls,functional status is lower in HT recipients.Exercise given in cardiac rehabilitation has been shown to improve exercise capacity as measured with peak oxygen uptake(VO2 peak)and muscle strength after completion of the program and cessation of exercise results in loss of exercise benefits.Several factors related to cardiac denervation and the use of immunosuppressive agents in HT recipients result in functional impairments including cardiovascular,pulmonary,exercise capacity,psychological,and qua-lity of life(QoL)problems.High-intensity interval training(HIIT)is the most common type of exercise used in HT recipients and given as a hospital-based program.Improvement of functional impairments was found to have occurred due to primarily musculoskeletal adaptations through improvement of muscle structure and aerobic capacity and cardiovascular adaptations.In general,exercise given after transplantation improved VO2 peak significantly and improvement was better in the HIIT group compared to moderate intensity continuous training or no-exercise groups.Improvement of QoL was ascribed to improve-ment of exercise capacity,symptoms,pulmonary function,physical capacity improve-ment,anxiety,and depression.

The Chinese classification system compared with TNM staging in prognosis of patients with primary hepatic carcinoma after resection

BACKGROUND: The life expectancy of a patient with primary hepatic carcinoma (PHC) is hard to predict, and it is related to many prognostic factors. The Chinese classification system including five parameters: tumor, vascular thrombosis, lymph node metastasis, distant metastasis and Child-Pugh stage developed in 1999 was adopted by the 8th National Conference on liver Cancer of the Chinese Anti-Cancer Association in 2001. In this study, the discriminatory ability of the Chinese classification system -was compared with that of the TNM staging in patients for resection of PHC, in addition to the evaluation of prognostic value. METHODS: The data of 246 patients who had undergone resection of PHC from January 1986 to December 2000 (average age, 51 years; male/female ratio, 213/33) were retrospectively studied. Among the 246 patients, 227 were followed up for at least 3 years. RESULTS: The 1-, 3-, 5-, 7-, and 10-year tumor-free survival rates were 55% , 30% , 25% , 20% and 18% , respectively. The Chinese classification system was better than the TNM staging system in predicting survival rate of patients with PHC, as confirmed by survival curves shown by the Kaplain-Meier method. The mean survival time was 155, 70, 39, 16, and 4 months in patients with die Chinese classification stages Ⅰa, Ⅰb, Ⅱa,Ⅱb, and Ⅲ, respectively. The 1-, 3-, 5-, 7-, and 10-year tumor-free survival rates of the Chinese classification system and TNM staging were statistically significant and had a slightly positive relationship. The predictive capacity of the Chinese classification system was confirmed in any two subgroups of patients undergoing operation. COX proportional hazards regression analysis showed that the Chinese classification system was the only independent prognostic factor for survival. CONCLUSIONS: Taking both tumor extension and liver function into account, we consider that the Chinese classification system making up for the deficiency of UICC TNM staging is more precise in predicting the prognosis of patients with resection of PHC.

Staging of hepatocellular carcinoma

Clinical staging systems for hepatocellular carcinoma (HCC) provide guides to patient assessment and therapeutic decision making. The most commonly used staging systems for HCC internationally are the Okuda classification and the pathologic tumor node metastasis (TNM) classification. But each has its own limitations. New staging systems for HCC have recently been reported from Italy, France, Spain and China. In this review, we evaluated the staging systems of HCC and discussed the natural history and prognosis of tumors of different stages. We believe that a reliable new staging system of HCC patients will be established in the near future.

Depression among caregivers of patients with dementia:Associative factors and management approaches

As elderly people increasingly come to represent a higher proportion of the world’s population,various forms of dementia are becoming a significant chronic disease burden.The World Health Organization emphasizes dementia care as a public health priority and calls for more support for family caregivers who commonly play a significant,central role in dementia care.Taking care of someone with dementia is a long-term responsibility that can be stressful and may lead to depression among family caregivers.Depression and related behavioral and cognitive changes among caregivers could in turn affect the status and prognosis of the dementia patient.This review article explores depression in dementia caregivers and summarizes proposed mechanisms,associated factors,management and research findings,and proposes future research directions.

Outcomes of early physiotherapy in patients with cerebral aneurysms treated by surgical clipping or endovascular embolization

Early physiotherapy was given to 124 patients with ruptured or unruptured cerebral aneurysms who were treated by surgical clipping or endovascular embolization.Patients were divided into four groups according to their Hunt and Hess grade at admission and aneurysm treatment modality： Group 1,Hunt and Hess grade≤II and surgical clipping;Group 2,Hunt and Hess grade≤II and endovascular embolization;Group 3,Hunt and Hess grade≥III and surgical clipping;Group 4,Hunt and Hess grade≥III and endovascular embolization.Level of consciousness was evaluated using the Glasgow Coma Scale,functional status using the Glasgow Outcome Scale,level of the mobility using the Mobility Scale for acute stroke patients,and independence in activities of daily living using the Barthel Index.After early physiotherapy,the level of consciousness and functional status improved significantly in Groups 1,3,and 4;mobility improved significantly in all groups;and independence in activities of daily living improved significantly in Groups 1 and 3.At discharge, Groups 1 and 2 had better functional status than Groups 3 and 4.Level of consciousness,functional status,mobility and independence in activities of daily living improved after early physiotherapy. These findings suggest that early physiotherapy improved the prognosis of patients with cerebral aneurysms who were treated by surgical clipping or endovascular embolization.Patients with a worse clinical status at presentation had a poorer functional status at discharge.The outcome of physiotherapy was not affected by whether surgical clipping or endovascular embolization was chosen for treatment of the aneurysm.

Effect of Psychological Education Combined with Progressive Muscle Relaxation Training on the Symptom Cluster and Rehospitalization Rate of Elderly Patients with Coronary Heart Disease

Objective:To investigate the effect of psychological education combined with progressive muscle relaxation training on the symptom cluster and rehospitalization of elderly patients with coronary heart disease.Methods:This study is a longitudinal randomized controlled study involving 140 elderly patients with coronary heart disease.The patients were divided into two groups:an intervention group and a control group,with 70 cases in each group,via random number table.The patients in the control group received routine nursing,whereas those in the intervention group received psychological education combined with progressive muscle relaxation training for 4 weeks on the basis of routine nursing.The effect of the intervention was evaluated before intervention,at the end of 1 month,3 months,and 6 months after intervention.Results:At the end of 1 month,3 months,and 6 months,the sleep,fatigue,anxiety,and functional status of the patients in the intervention group were significantly better than those of the control group,with statistical significance difference(P<0.05).The rehospitalization rate of the intervention group was lower than that of the control group,and the difference was statistically significant(X2=10.685,P=0.001).Conclusion:Psychological education combined with progressive muscle relaxation training is effective in alleviating the symptom cluster of elderly patients with coronary heart disease and reducing their rehospitalization rate;thus,it should be popularized.

Association between Clinical Characteristics and Quality of Life in Older People with Stroke at Hospital Discharge

Objective: The number of people with stroke increases worldwide. The stroke survivors live with disabilities and those influence their quality of life (QOL). This study was aimed to investigate the association between clinical characteristics and QOL of the older people with stroke at discharge from the hospital. Methods: This is a cross-sectional study. The participants were 113 stroke survivors aged 60 years and older admitted to the stroke unit. Quality of life was the study’s outcome which measured by using the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF). Primary clinical characteristics were measured by the National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and Modified Rankin Scale (mRS). Potential confounding factors were age, sex, education levels, marital status, current occupation, and comorbidity (hypertension, diabetes mellitus, dyslipidemia, and heart disease). Multiple linear regression was used for data analysis. Results: The main effects of clinical outcomes were high BI Score that had a significant difference association with QOL (β = 0.312, 95% CI = 0.042, 0.296, P = 0.009), lower mRS score also had significant difference association with QOL (β= -0.371, 95%CI = -5.394, -1.162, P = 0.003) after all adjusting. Additional risk factor in this study was marital status (currently married) (β= 0.155, 95% CI = 0.226, 8.666, P = 0.039). Conclusion: Low function status and severe stroke disability as the clinical characteristics were associated with QOL in older people with stroke at hospital discharge. An additional factor was marital status (currently married).

Background Activity of the Cerebral Cortex and Superficial Muscles of the Fingers in Men with Different Levels of Individual EEG a-Frequency

A test group consisting of 104 healthy men from the ages of 19 to 21 was divided into two groups according to the magnitude of their IAF （individual EEG Gt-ffequency） median--groups with high （n = 53, IA 〉 10.04 Hz） and low （n = 51, IAF 〈 10.03 Hz） levels of IAF. Differences between the groups in terms of the power and coherence of EEG oscillations and the EMG signal average amplitude at rest were estimated. It was found that the dominant role of the thalamocortical interactions （thalamus and cortex） in the group of testees having a high IAF causes the greater differentiation and rationality of the downstream effects on muscles and provides more economic baselines and contractile capabilities of the leading hand flexor muscles. Increased non-specific influences of the limbic system and reticular formation in providing the testees＇ cortical activity under conditions of a low frequency are accompanied by a smaller lateral and reciprocal specificity in the downstream impacts, and by a lower performance of supraspinal irmervations.

A Cognitive Behavioural Intervention for the Treatment of Vasovagal and Unexplained Syncope

Vasovagal syncope and unexplained syncope are the most commonly observed types of syncope in outpatient and hospital settings. Medical interventions usually target at the physiological mechanisms responsible for loss of consciousness in an attempt to limit the frequency of recurrences. However, this type of intervention does not take into account the psychological and functional impact of syncope, nor the importance of psychological variables in triggering and maintaining syncope. In the present pilot study, four participants presenting significant psychological distress and recurrent syncope were treated using a multimodal intervention targeting at both the medical and psychological aspects of the problem. Results showed a significant reduction in the frequency of syncope/presyncope, in the level of emotional distress experienced, as well as improved functional status in three of the four participants. Several recommendations are made to medical practitioners and psychologists, in view of identifying patients likely to benefit from this type of intervention or components thereof.

Health Evaluation for Hypertensive Population Using Exercise Testing and Health-related Quality of Life Questionnaire

Objectives This study aims to assess the impacts of hypertension on health-related quality of life (HRQOL), as well as cardiovascular functional status (CVFS). Methods An instrument was presented based on WHOQOL-BREF and SP-16 questionnaire and exercise testing. 57 normotensive and 76 hypertensive subjects aged 35-65 year-old participated the health survey using this instrument. Based on the exercise testing results of the two groups, a discriminate function was established and used to investigate cardiovascular risk factors for hypertensive population. Results The results showed that persons with hypertension rated significantly lower scores on physical health (i.e. limitation in performing daily activities and problems with work or mobility) than did normotensives (P < 0.01). The discriminant score obtained from the exercise testing results was capable of reflecting the impacts of hypertension on CVFS. Conclusions The method presented in this paper provides a more powerful tool to estimate the effects of health interventions and medical therapy for hypertensive population than just self-rated HRQOL questionnaire.

Comprehensive geriatric assessment and its role in oncology:a brief review

As the global population ages,the incidence of cancer among older adults is increasing.The management of older patients with cancer poses unique challenges due to the age-related physiological changes,multiple comorbidities,and functional decline often observed in this population.Comprehensive Geriatric Assessment(CGA)has emerged as a valuable tool in oncology to evaluate the overall health and functional status of older cancer patients in order to optimise cancer care for older adults.This comprehensive approach acknowledges the unique challenges faced by elderly patients with cancer and seeks to optimize outcomes by considering their specific circumstances and individual requirements.

Functional connectivity changes during migraine treatment with electroacupuncture at Shuaigu(GB8)

Objective:To investigate the changes in the functional connectivity(FC)in the right insula between migraine without aura(MWoA)and healthy controls by using resting-state functional magnetic resonance imaging(rs-fMRI),and to observe the instant alteration of FC in MWoA during electroacupuncture(EA)stimulation at Shuaigu(GB8).Methods:A total of 30 patients with MWoA(PM group)and 30 healthy controls(HC group)underwent rs-fMRI scans.The PM group underwent a second rs-fMRI scan while receiving EA at GB8.The right insula subregions,including the ventral anterior insula(vAI),dorsal anterior insula(dAI)and posterior insula(PI),were selected as the seed points for FC analysis.Results:Aberrant FC,including dAI with right postcentral gyrus,PI with left precuneus,was found among PM before EA(PMa),PM during EA(PMb)and HC.Meanwhile,decreased FC between dAI and the right postcentral gyrus was found in the PMa compared to the HC and PMb.Increased FC between the PI and left precuneus was found in the PMa compared to the HC and PMb.Correlation analysis showed that the FC value of the right postcentral gyrus in PMa was negatively correlated with the scores of Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety.The FC value of the left precuneus in PMa was positively correlated with the visual analogue scale score.Conclusion:The alteration of FC between the right insula subregions and multiple brain regions may be an important index for MWoA.EA at GB8 was able to adjust the FC between the right insula subregions and parietal lobe,namely,the right dAI and right postcentral gyrus,and the right PI and left precuneus,thereby rendering an instant effect in the management of MWoA.

Effect of continuous nursing on treatment compliance and side effect management of coronary heart disease

BACKGROUND There are relatively few studies on continuing care of coronary heart disease(CHD),and its research value needs to be further clarified.AIM To investigate the effect of continuous nursing on treatment compliance and side effect management in patients with CHD.METHODS This is a retrospective study with patients from January 2021 to 2023.The study was divided into two groups with 30 participants in each group.Self-rating anxiety scale(SAS)and Self-rating depression scale(SDS)were used to assess patients'anxiety and depression,and medical coping questionnaire was used to assess patients'coping styles.The pelvic floor dysfunction questionnaire(PFDI-20)was used to assess the status of pelvic floor function,including bladder symptoms,intestinal symptoms,and pelvic symptoms.RESULTS SAS score decreased from 57.33±3.01before treatment to 41.33±3.42 after treatment,SDS score decreased from 50.40±1.45 to 39.47±1.57.The decrease of these two indexes was statistically significant(P<0.05).PFDI-20 scores decreased from the mean 16.83±1.72 before treatment to 10.47±1.3the mean after treatment,which was statistically significant(P<0.05).CONCLUSION The results of this study indicate that pioneering research in continuous care of CHD has a positive impact on improving patients'treatment compliance,reducing anxiety and depression levels,and improving coping styles and pelvic floor functional status.