Investigation of the Association Between Knowledge-Attitude-Practice and Low Anterior Resection Syndrome Symptoms: The Chain Mediating Effect of Pelvic Floor Muscle Training Self-Efficacy and Adherence

Background Low anterior resection syndrome (LARS) severely impacts the quality of life in rectal cancer survivors. Patients undergoing sphincter-preserving surgery with prophylactic stomas often experience masked LARS symptoms, which emerge post-stoma reversal. Despite high LARS prevalence, effective prevention strategies remain understudied in nursing care. This study investigates whether (PFMT) self-efficacy and adherence mediate the relationship between LARS prevention knowledge-attitude-practice (KAP) and symptom severity, aiming to inform nurse-led behavioral interventions. Methods A cross-sectional survey was conducted on 247 patients who underwent successful prophylactic stoma reduction in the general surgery or gastrointestinal surgery departments of 22 tertiary first-class hospitals in China’s Beijing-Tianjin-Hebei region between January 2024 and February 2025. Data were collected using the General Information Questionnaire, LARS KAP and Needs Questionnaire, PFMT Self-Efficacy Scale, PFMT Adherence Questionnaire, and Memorial Sloan Kettering Intestinal Function Questionnaire. The model was examined using descriptive analysis, univariate analysis, Pearson’s correlation analysis, and the PROCESS Macro in SPSS 26.0. Mediation analysis was conducted using PROCESS Macro (Model 6). Results Participants exhibited moderate LARS symptoms 63.48 ± 17.02, with significant correlations between KAP 100.89 ± 28.55, PFMT self-efficacy 1034.13 ± 196.27, and adherence14.52 ± 4.18 ( P  < 0.01). Chain mediation analysis revealed that PFMT self-efficacy and adherence jointly mediated 11.40% of the total effect between KAP and LARS severity, highlighting their sequential role in symptom mitigation. Conclusion LARS symptoms persist post-stoma closure, yet PFMT self-efficacy and adherence serve as modifiable pathways linking KAP to symptom outcomes. To optimize postoperative care, nurses should prioritize structured LARS prevention education programs and integrate self-efficacy-building strategies to enhance PFMT adherence. These findings underscore the potential of theory-driven nursing interventions in reducing LARS burden.