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Biofeedback treatment for functional anorectal disorders: a comprehensive efficacy review.

Abstract

This review aimed to critically evaluate the literature on the efficacy of biofeedback for functional anorectal disorders, rate these biofeedback applications according to established guidelines, and make recommendations for this field based on the literature. The Medline and PsychInfo databases were searched to obtain all papers published from 1975 to 2003 that included the terms "biofeedback" and either "constipation" "pelvic floor dyssynergia" "fecal incontinence" or "anorectal pain." Adult and pediatric papers in any language were screened. Prospective studies with five or more participants and a description of the treatment protocol and outcome were selected for review. Seventy-four studies qualified for review: 33 trials on fecal incontinence (FI), 38 on pelvic floor dyssynergia (PFD) or functional constipation, and 3 on anorectal pain. Only 20% of studies were controlled outcome trials. Treatment protocols, etiological subgroups studied and outcome measures varied greatly. The overall average probability of successful treatment outcome for patients treated with biofeedback was 67.2% for functional FI and 62.4% for constipation. There were insufficient data to warrant such calculation for anorectal pain. According to standard efficacy rating criteria, biofeedback treatment is efficacious for functional constipation or PFD in children and probably efficacious in adults; probably efficacious for functional FI; and possibly efficacious for anorectal pain. Utilizing data from all applicable studies, we found that success rate per subject is significantly higher for biofeedback treatment than for standard medical care for PFD/functional constipation, and FI (p < .001 for both). Biofeedback treatment may therefore be viewed as a valuable adjunct to medical management of functional PFD/constipation and incontinence. A number of recommendations for future investigations are made based on the review.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Center for Functional Gastrointestinal and Motility Disorders, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080, USA. olafur_palsson@med.unc.edu

    ,

    Source

    MeSH

    Adult
    Anus Diseases
    Biofeedback, Psychology
    Child
    Clinical Trials as Topic
    Electromyography
    Fecal Incontinence
    Female
    Humans
    Male
    Pain Management

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, P.H.S.
    Review

    Language

    eng

    PubMed ID

    15497616

    Citation

    Palsson, Olafur S., et al. "Biofeedback Treatment for Functional Anorectal Disorders: a Comprehensive Efficacy Review." Applied Psychophysiology and Biofeedback, vol. 29, no. 3, 2004, pp. 153-74.
    Palsson OS, Heymen S, Whitehead WE. Biofeedback treatment for functional anorectal disorders: a comprehensive efficacy review. Appl Psychophysiol Biofeedback. 2004;29(3):153-74.
    Palsson, O. S., Heymen, S., & Whitehead, W. E. (2004). Biofeedback treatment for functional anorectal disorders: a comprehensive efficacy review. Applied Psychophysiology and Biofeedback, 29(3), pp. 153-74.
    Palsson OS, Heymen S, Whitehead WE. Biofeedback Treatment for Functional Anorectal Disorders: a Comprehensive Efficacy Review. Appl Psychophysiol Biofeedback. 2004;29(3):153-74. PubMed PMID: 15497616.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Biofeedback treatment for functional anorectal disorders: a comprehensive efficacy review. AU - Palsson,Olafur S, AU - Heymen,Steve, AU - Whitehead,William E, PY - 2004/10/23/pubmed PY - 2004/12/22/medline PY - 2004/10/23/entrez SP - 153 EP - 74 JF - Applied psychophysiology and biofeedback JO - Appl Psychophysiol Biofeedback VL - 29 IS - 3 N2 - This review aimed to critically evaluate the literature on the efficacy of biofeedback for functional anorectal disorders, rate these biofeedback applications according to established guidelines, and make recommendations for this field based on the literature. The Medline and PsychInfo databases were searched to obtain all papers published from 1975 to 2003 that included the terms "biofeedback" and either "constipation" "pelvic floor dyssynergia" "fecal incontinence" or "anorectal pain." Adult and pediatric papers in any language were screened. Prospective studies with five or more participants and a description of the treatment protocol and outcome were selected for review. Seventy-four studies qualified for review: 33 trials on fecal incontinence (FI), 38 on pelvic floor dyssynergia (PFD) or functional constipation, and 3 on anorectal pain. Only 20% of studies were controlled outcome trials. Treatment protocols, etiological subgroups studied and outcome measures varied greatly. The overall average probability of successful treatment outcome for patients treated with biofeedback was 67.2% for functional FI and 62.4% for constipation. There were insufficient data to warrant such calculation for anorectal pain. According to standard efficacy rating criteria, biofeedback treatment is efficacious for functional constipation or PFD in children and probably efficacious in adults; probably efficacious for functional FI; and possibly efficacious for anorectal pain. Utilizing data from all applicable studies, we found that success rate per subject is significantly higher for biofeedback treatment than for standard medical care for PFD/functional constipation, and FI (p < .001 for both). Biofeedback treatment may therefore be viewed as a valuable adjunct to medical management of functional PFD/constipation and incontinence. A number of recommendations for future investigations are made based on the review. SN - 1090-0586 UR - https://www.unboundmedicine.com/medline/citation/15497616/full_citation L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=15497616.ui DB - PRIME DP - Unbound Medicine ER -