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Biofeedback therapy in fecal incontinence and constipation.
Neurogastroenterol Motil 2009; 21(11):1133-41NM

Abstract

We examine the collected evidence for efficacy of biofeedback therapy (BFT) in incontinence and constipation by means of meta-analysis of randomized controlled trials. PubMed search was performed to identify treatment trials that match quality criteria (adequate control groups, randomization). They were entered into meta-analyses using fixed effect models and computing odds ratio (OR) and 95% confidence interval (CI) of treatment effects. For constipation, eight BFT trials were identified. In four trials, electromyographic (EMG) BFT was compared to non-BFT treatments (laxatives, placebo, sham training and botox injection), while in the remaining four studies EMG BFT was compared to other BFT (balloon pressure, verbal feedback) modes. Meta-analyses revealed superiority of BFT to non-BFT (OR: 3.657; 95% CI: 2.127-6.290, P < 0.001) but equal efficacy of EMG BFT to other BF applications (OR: 1.436; CI: 0.692-3.089; P = 0.319). For fecal incontinence, a total of 11 trials were identified, of which six compared BFT to other treatment options (sensory training, pelvic floor exercise and electrical stimulation) and five compared one BFT option to other modalities of BFT. BFT was equal effective than non-BFT therapy (OR: 1.189, CI: 0.689-2.051, P = 0.535). No difference was found when various modes BFT were compared (OR: 1.278, CI: 0.736-2.220, P = 0.384). Included trials showed a substantial lack of quality and harmonization, e.g. variable endpoints and missing psychological assessment across studies. BFT for pelvic floor dyssynergia shows substantial specific therapeutic effect while BFT for incontinence is still lacking evidence for efficacy. However, in both conditions the mode of BFT seems to play a minor role.

Authors+Show Affiliations

University Hospital, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany. paul.enck@uni-tuebingen.deNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

19566591

Citation

Enck, P, et al. "Biofeedback Therapy in Fecal Incontinence and Constipation." Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, vol. 21, no. 11, 2009, pp. 1133-41.
Enck P, Van der Voort IR, Klosterhalfen S. Biofeedback therapy in fecal incontinence and constipation. Neurogastroenterol Motil. 2009;21(11):1133-41.
Enck, P., Van der Voort, I. R., & Klosterhalfen, S. (2009). Biofeedback therapy in fecal incontinence and constipation. Neurogastroenterology and Motility : the Official Journal of the European Gastrointestinal Motility Society, 21(11), pp. 1133-41. doi:10.1111/j.1365-2982.2009.01345.x.
Enck P, Van der Voort IR, Klosterhalfen S. Biofeedback Therapy in Fecal Incontinence and Constipation. Neurogastroenterol Motil. 2009;21(11):1133-41. PubMed PMID: 19566591.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biofeedback therapy in fecal incontinence and constipation. AU - Enck,P, AU - Van der Voort,I R, AU - Klosterhalfen,S, Y1 - 2009/06/30/ PY - 2009/7/2/entrez PY - 2009/7/2/pubmed PY - 2009/12/16/medline SP - 1133 EP - 41 JF - Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society JO - Neurogastroenterol. Motil. VL - 21 IS - 11 N2 - We examine the collected evidence for efficacy of biofeedback therapy (BFT) in incontinence and constipation by means of meta-analysis of randomized controlled trials. PubMed search was performed to identify treatment trials that match quality criteria (adequate control groups, randomization). They were entered into meta-analyses using fixed effect models and computing odds ratio (OR) and 95% confidence interval (CI) of treatment effects. For constipation, eight BFT trials were identified. In four trials, electromyographic (EMG) BFT was compared to non-BFT treatments (laxatives, placebo, sham training and botox injection), while in the remaining four studies EMG BFT was compared to other BFT (balloon pressure, verbal feedback) modes. Meta-analyses revealed superiority of BFT to non-BFT (OR: 3.657; 95% CI: 2.127-6.290, P < 0.001) but equal efficacy of EMG BFT to other BF applications (OR: 1.436; CI: 0.692-3.089; P = 0.319). For fecal incontinence, a total of 11 trials were identified, of which six compared BFT to other treatment options (sensory training, pelvic floor exercise and electrical stimulation) and five compared one BFT option to other modalities of BFT. BFT was equal effective than non-BFT therapy (OR: 1.189, CI: 0.689-2.051, P = 0.535). No difference was found when various modes BFT were compared (OR: 1.278, CI: 0.736-2.220, P = 0.384). Included trials showed a substantial lack of quality and harmonization, e.g. variable endpoints and missing psychological assessment across studies. BFT for pelvic floor dyssynergia shows substantial specific therapeutic effect while BFT for incontinence is still lacking evidence for efficacy. However, in both conditions the mode of BFT seems to play a minor role. SN - 1365-2982 UR - https://www.unboundmedicine.com/medline/citation/19566591/Biofeedback_therapy_in_fecal_incontinence_and_constipation_ L2 - https://doi.org/10.1111/j.1365-2982.2009.01345.x DB - PRIME DP - Unbound Medicine ER -