Randomized controlled trial of biofeedback for fecal incontinence
Randomized controlled trial of biofeedback for fecal incontinence
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DOI：
10.1016/j.gastro.2003.09.039
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发表时间：
2003-11-01
期刊：
影响因子：
29.4
通讯作者：
Kamm, MA
中科院分区：
文献类型：
--
作者：
Norton, C;Chelvanayagam, S;Kamm, MA
背景与目的：行为治疗（生物反馈）已被报道可改善大便失禁，但尚未与标准护理进行比较。研究方法：共有171例大便失禁患者被随机分为4组：（1）标准护理（建议）;（2）建议加括约肌锻炼指导;（3）医院计算机辅助括约肌压力生物反馈;（4）医院生物反馈加使用家用脊髓电图生物反馈装置。结果测量包括日记、症状问卷、抑郁量表评分、患者变化评分、生活质量（简表36和疾病特异性）、心理状态（医院焦虑和抑郁量表）和肛门测压。结果：生物反馈产生的益处并不比有建议的标准护理更大（第3组改善53%，第1组改善54%）。两组之间在以下任何指标上都没有差异：尿失禁发作从每周2次的中位数减少到0次（P < 0.001）。尿失禁评分（最差= 20）从中位数11降至8（P < 0.001）。疾病特异性生活质量、简明36量表（活力、社会功能和心理健康）以及医院焦虑和抑郁量表均显著改善。患者改善了静息压、挤压压和持续挤压压（均P < 0.002）。这些改善在完成治疗后1年基本保持不变。结论：大便失禁的保守治疗可改善排便功能、生活质量、心理健康和肛门括约肌功能。在中期内保持效益。无论是骨盆底锻炼还是生物反馈都不上级辅以建议和教育的标准护理。
Background & Aims: Behavioral treatment (biofeedback) has been reported to improve fecal incontinence but has not been compared with standard care. Methods: A total of 171 patients with fecal incontinence were randomized to 1 of 4 groups: (1) standard care (advice); (2) advice plus instruction on sphincter exercises; (3) hospital-based computer-assisted sphincter pressure biofeedback; and (4) hospital biofeedback plus the use of a home electromyelogram biofeedback device. Outcome measures included diary, symptom questionnaire, continence score, patient's rating of change, quality of life (short-form 36 and disease specific), psychologic status (Hospital Anxiety and Depression scale), and anal manometry. Results: Biofeedback yielded no greater benefit than standard care with advice (53% improved in group 3 vs. 54% in group 1). There was no difference between the groups on any of the following measures: episodes of incontinence decreased from a median of 2 to 0 per week (P < 0.001). Continence score (worst = 20) decreased from a median of 11 to 8 (P < 0.001). Disease-specific quality of life, short-form 36 (vitality, social functioning, and mental health), and Hospital Anxiety and Depression scale all significantly improved. Patients improved resting, squeeze, and sustained squeeze pressures (all P < 0.002). These improvements were largely maintained 1 year after finishing treatment. Conclusions: Conservative therapy for fecal incontinence improves continence, quality of life, psychologic well-being, and anal sphincter function. Benefit is maintained in the medium term. Neither pelvic floor exercises nor biofeedback was superior to standard care supplemented by advice and education.