A Review Of Biofeedback For Adult Chronic Constipation: A Meta-analysis

Objective: To assess the effect (harms) of biofeedback therapy for adult chronic constipation. Search Strategy: MEDLINE (1950 to February 2008), EMBASE (1966 to February 2008), Chinese VIP database(1989 to February 2008); Current Controlled Trials (www.controlled-trials.com) and the National Research Register (www.update-software.com/National/nrr-frame. html). Selection Criteria: Randomized, quasi-randomized and well-controlled researches about biofeedback for constipation in adult. Data Collection: Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. Adverse effects information was collected from the articles. Method: The quality of included randomized controlled trials with the people suffered from chronic constipation was evaluated and Meta-analysis was conducted. Result: Eight trials involving 488 patients were included, of them 65 were male. Efficiency: Using treatment satisfaction as an indicator: two trials compared biofeedback VS non—biofeedback therapy (including placebo, diazepam and sham biofeedback) had difference statistically (chi2=0.04, df=1, p=0.85,12=0%, OR 5.87, 95%CI 2.68～12.85); one trial compared biofeedback therapy with laxatives showed difference statistically (OR=8.00, 95%CI 3.18～20.12); two trials compared biofeedback therapy VS diaphragmatic breathing had no difference statistically (chi2=0.98, df=1, p=0.32,12=0%, OR 1.42, 95%CI 0.63～3.20); one trail compared electromyography biofeedback with manometry biofeedback directly, and there showed no difference statistically(OR 0.38, 95%CI 0.08～1.90).Using stool frequency as an indicator, biofeedback therapy had no difference statistically compared with electronic stimulation therapy, and had difference when compared with biofeedback plus acupuncture after therapy one month follow-up. There was no report about adverse effect. Conclusion: Biofeedback is an effective method for the patients with functional defecation disorder comparing laxatives, diet therapy and non-biofeedback therapy, especially for pelvic floor dyssynergic patients. Slow transit should not be an exclusion criterion for those patients. Diaphragmatic breathing is as effective as biofeedback therapy if proper used.