Kegel Exercises, Biofeedback, Electrostimulation, and Peripheral Neuromodulation Improve Clinical Symptoms of Fecal Incontinence and Affect Specific Physiological Targets: An Randomized Controlled Trial.
Kegel Exercises, Biofeedback, Electrostimulation, and Peripheral Neuromodulation Improve Clinical Symptoms of Fecal Incontinence and Affect Specific Physiological Targets: An Randomized Controlled Trial.
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凯格尔运动、生物反馈、电刺激和周围神经调节可改善大便失禁的临床症状并影响特定的生理目标：一项随机对照试验。
DOI：
10.5056/jnm20013
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发表时间：
2021-01-30
影响因子：
3.4
通讯作者：
Clavé P
中科院分区：
文献类型：
--
作者：
Mundet L;Rofes L;Ortega O;Cabib C;Clavé P
大便失禁（FI）是社区居住妇女的一种常见疾病，对生活质量（QoL）有重大影响。临床实践中常用的治疗方法-凯格尔运动，生物反馈，电刺激和经皮神经调节-的研究结果不一致，有些缺乏方法的严谨性，使得科学证据薄弱。目的是评估这4种治疗方法对社区FI女性的临床疗效及其对严重程度、生活质量和肛门直肠生理学的影响。对150例女性FI患者进行了随机对照试验，采用肛门直肠测压和肛门内超声检查进行评估，并测定阴部神经末梢运动潜伏期、肛门/直肠感觉诱发电位、临床严重程度和生活质量。将患者随机分为以下组之一：Kegel（对照）、生物反馈+ Kegel、电刺激+ Kegel和神经调节+ Kegel，治疗3个月并重新评估，然后在6个月后随访。平均年龄为61.09 ± 12.17岁。所有治疗后FI和QoL的严重程度均以相似的方式显著改善。对生理的影响是治疗特异性Kegel和电刺激+ Kegel，增加静息压（P < 0.05）。生物反馈+ Kegel、电刺激+ Kegel和神经调节+ Kegel均显著增加挤压压（P < 0.01）。生物反馈+ Kegel组和电刺激+ Kegel组的挤压耐力显著提高（P < 0.01）。生物反馈+ Kegel、电刺激+ Kegel、神经调节+ Kegel组直肠感觉阈值降低（P < 0.05），电刺激+ Kegel组肛门感觉诱发电位潜伏期缩短（P < 0.05）。所评估的FI治疗对严重程度和生活质量具有强大且相似的疗效，但会影响特定的病理生理机制。这种治疗特异性有助于基于病理生理表型开发更有效的FI多模式算法治疗。
Fecal incontinence (FI) is a prevalent condition among community-dwelling women, and has a major impact on quality of life (QoL). Research on treatments commonly used in clinical practice—Kegel exercises, biofeedback, electrostimulation, and transcutaneous neuromodulation—give discordant results and some lack methodological rigor, making scientific evidence weak. The aim is to assess the clinical efficacy of these 4 treatments on community-dwelling women with FI and their impact on severity, QoL and anorectal physiology. A randomized controlled trial was conducted on 150 females with FI assessed with anorectal manometry and endoanal ultrasonography, and pudendal nerve terminal motor latency, anal/rectal sensory-evoked-potentials, clinical severity, and QoL were determined. Patients were randomly assigned to one of the following groups Kegel (control), biofeedback + Kegel, electrostimulation + Kegel, and neuromodulation + Kegel, treated for 3 months and re-evaluated, then followed up after 6 months. Mean age was 61.09 ± 12.17. Severity of FI and QoL was significantly improved in a similar way after all treatments. The effect on physiology was treatment-specific Kegel and electrostimulation + Kegel, increased resting pressure (P < 0.05). Squeeze pressures strongly augmented with biofeedback + Kegel, electrostimulation + Kegel and neuromodulation + Kegel (P < 0.01). Endurance of squeeze increased in biofeedback + Kegel and electrostimulation + Kegel (P < 0.01). Rectal perception threshold was reduced in the biofeedback + Kegel, electrostimulation + Kegel, and neuromodulation + Kegel (P < 0.05); anal sensory-evoked-potentials latency shortened in patients with electrostimulation + Kegel (P < 0.05). The treatments for FI assessed have a strong and similar efficacy on severity and QoL but affect specific pathophysiological mechanisms. This therapeutic specificity can help to develop more efficient multimodal algorithm treatments for FI based on pathophysiological phenotypes.
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影响因子：
29.4
作者：
Bharucha, Adil E.;Zinsmeister, Alan R.;Melton, L. Joseph, III
通讯作者：
Melton, L. Joseph, III
DOI：
10.1308/003588410x12628812459652
发表时间：
2010-07-01
影响因子：
1.4
作者：
Findlay, John M.;Yeung, Justin M. C.;Maxwell-Armstrong, Charles
通讯作者：
Maxwell-Armstrong, Charles
影响因子：
24.5
作者：
LOENINGBAUCKE, V
通讯作者：
LOENINGBAUCKE, V
影响因子：
3.9
作者：
Norton, C;Gibbs, A;Kamm, MA
通讯作者：
Kamm, MA
影响因子：
29.4
作者：
Norton, C;Chelvanayagam, S;Kamm, MA
通讯作者：
Kamm, MA