Meta-analysis Of The Effectiveness Of Biofeedback For Defecatory Disorder

Background: Defecatory disorder is one of the most common forms of chronic constipation. This functional defecation disorder is characterized by incomplete evacuation of fecal material from the rectum due to paradoxical contraction or failure to relax pelvic floor muscles when straining to defecate. It has been reported that biofeedback therapy is an effective treatment for defecatory disorder in numerous published studies, but the long-term efficacy of biofeedback therapy remains controversial. In recent years, several randomized controlled trials(RCT) have been completed and an updated meta-analysis of this topic seems timely.Objective: To evaluate the efficiency of biofeedback therapy for adult defecatory disorder with meta-analysis, so as to provide information for its clinical application.Methods: The literatures about biofeedback for defecatory disorder were searched from the following databases: the Cochrane library, Pubmed database, Web of science, CNKI, Wan fang database. The quality of these literatures was evaluated with the modified JADAD standard. The RevMan5Meta-analysis software was used in the meta-analysis.Results: Nine eligible studies were identified with a total of 638 participants. In the short-term efficacy, there was no significant difference between biofeedback therapies and non-invasive treatments for defecatory disorder(P>0.05). In the long-term efficacy, biofeedback therapies were significantly superior to those non-invasive treatments(P<0.00001). The short-term efficacy of invasive treatments were superior to those biofeedback therapies(P<0.01). In the long-term efficacy, biofeedback therapies were alittle superior to those invasive treatments(P=0.05), although this kind of difference was risky. In promoting the number of complete spontaneous bowel movement per week, biofeedback therapies were significantly superior to those non–biofeedback therapies(P<0.00001). In improving patient's visual analogue scale(VAS), there was no significant difference between biofeedback therapies and those non-biofeedback treatments(P>0.05).Conclusion:There is no significant difference between biofeedback therapies and non-invasive treatments in the short-term efficacy, but in the long-term efficacy, biofeedback therapies are significantly superior to non-invasive treatments and little superior to invasive treatment. In increasing number of complete spontaneous bowel movement per week,biofeedback therapies are also significantly superior to non-biofeedback treatments. This Meta-ananlysis implies that biofeedback therapy is one of effective therapeutics for defecatory disorder, especially when the conservative managements are invalid. Considering the risky of included RCTs, the long-term follow-up and high-quality RCTs are also required to verify theefficacy of this therapy.