Efficacy Of Biofeedback Training Research Articles

Utility of the Balloon-Evacuation Test for Identifying Patients With Dyssynergic Defecation

Background/Aims: Dyssynergic defecation (DD) accounts for 30-40% of patients with chronic constipation and is particularly prevalent in referral practices. Standard treatments (ST) including exercise, avoidance of constipating drugs, and increasing fluid & fiber intake often fail to improve symptoms. Laxatives provide inconsistent relief of constipation related symptoms, particularly in DD patients. Recent studies suggest that biofeedback (BF) therapy provides an effective treatment for DD patients. Aims: To conduct a systematic review and meta-analysis of randomized-controlled trials (RCTs) comparing BF therapy to standard treatments in DD patients. Methods: A search of MEDLINE, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials, ACP Journal Club, DARE, CMR, HTA, and abstracts from major GI meetings was performed. RCTs comparing the efficacy of BF vs. ST for weekly bowel movement (BM) frequency or global satisfaction in patients with DD were selected. Meta-analysis was performed using metan command in Strata 10.1. A funnel plot was created to assess for publication bias. The heterogeneity of the pooled estimate was tested with the inconsistency index (I2) statistic. Subgroup analyses (type of BF, duration of follow-up, study location, primary & secondary study outcomes, concurrent laxative use) were performed to account for any observed heterogeneity. Results: Systematic review identified >1000 citations. Upon detailed review, 7 treatment trials were identified of which 4 studies which randomized 241 patients with DD fulfilled our inclusion criteria and were included in the meta-analysis. Patients treated with BF reported an increase of 1.30 BM/ week, compared to 0.87 BM/week for patients treated with ST (WMD: 01.11, 95% CI: -0.99-3.20). Significant heterogeneity amongst studies was noted. Three studies reported data on patient satisfaction. The number of patients reporting satisfaction with therapy was higher in the BF group compared to the ST group (75.0% vs. 36.7%, RR: 2.15, 95% CI: 1.64-2.81, I2=81%). No other constipation-related outcomes were consistently reported amongst the included trials. Conclusions: These results suggest that BF therapy offers benefits for global satisfaction in patients with DD. Our analysis identified the need for further large, well designed clinical trials and the development of a common set of outcome measures which can be applied to randomized trials evaluating the efficacy of BF training for DD. Though stool frequency is commonly employed as the primary outcome measure in constipation trials, our results raise questions about whether this endpoint is the most appropriate primary outcome for trials evaluating BF for DD.

Pelvic floor dyssynergia: Efficacy of biofeedback training

Background and study aims Paradoxical contraction of the pelvic floor during attempts to defaecate is described as pelvic floor dyssynergia (anismus). It is a behavioural disorder (no associated morphological or neurological abnormalities); consequently, biofeedback training has been recommended as a behavioural therapy for such a disorder. The aim of the present study was to evaluate long-term satisfaction of patients diagnosed with pelvic floor dyssynergia after biofeedback. Patients and methods Sixty patients (35 females and 25 males) with a mean age of 30 ± 12 years and a 4 year duration of constipation were included. Forty-five patients had normal colonic transit and 15 patients had slow colonic transit. History, physical examination and barium enema were done to exclude constipation secondary to organic causes. Colonic and pelvic floor functions (colon-transit time, anorectal manometry, EMG and defaecography) were performed before and after biofeedback treatments. Patients were treated on a weekly basis with an average of (6 ± 2) sessions. Results At the end of sessions, 55 out of 60 patients (91.6%) reported a subjectively overall improvement. Symptoms of dyschezia were reported less frequently after biofeedback. Age and gender were not predictive factors of outcome. No symptoms at initial assessment were predictive for patient’s satisfaction but the only factor of predictive value was the diagnosis of anismus and the motivated patient who wanted to continue the sessions. Conclusion Biofeedback remains a morbidity free, low-cost and effective outpatient therapy for well-motivated patients complaining of functional constipation and diagnosed as pelvic floor dyssynergia.

Still stable after all these years: Long term efficacy of biofeedback training in fecal incontinence

Still stable after all these years: Long term efficacy of biofeedback training in fecal incontinence

Efficacy of biofeedback training in improving faecal incontinence and anorectal physiologic function.

The efficacy of biofeedback treatment on faecal incontinence and anorectal function was evaluated in eight patients with faecal incontinence treated with biofeedback training and medical therapy. Outcome and anorectal function were compared with nine faecal incontinent patients who received medical therapy alone. Three month follow up showed that 50% of patients in the biofeedback plus conventional treatment group and 56% of those treated conventionally only had improved. One year follow up showed that 13% in the biofeedback group were free of soiling and an additional 25% had improved. The results were similar in the conventionally treated group--11% were free of soiling and an additional 44% improved. Anal pressures at rest and squeeze, the rectal distension volume that induced sustained inhibition of both the external and internal anal sphincter, and continence to rectally infused saline were significantly reduced in both groups of patients compared with controls (p less than 0.05). Biofeedback treatment had no effect on these abnormal anorectal functions in either patients who improved or those who did not. The improvement in faecal incontinence was probably due to medical intervention or regression of symptoms with time, or both, and not the result of biofeedback training.

Clinical applications of biofeedback training. A review of evidence.

The published reports on clinical applications of biofeedback training are summarized and critically reviewed. Only in the area of electromyogram feedback for muscle retraining, elimination of subvocal speech while reading, and elimination of tension headaches does the evidence support strong conclusions on the efficacy of biofeedback training.