Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia.
Department of Surgery, The University of Sydney, Sydney, NSW, Australia.
Tech Coloproctol. 2020 Sep;24(9):909-918. doi: 10.1007/s10151-020-02230-9. Epub 2020 May 5.
Dyssynergic defaecation is a common form of functional constipation that responds poorly to conservative interventions. This systematic review and meta-analysis assesses the effectiveness of biofeedback therapy for dyssynergic defaecation using global clinical improvement as the primary outcome, and resolution of the dyssynergic pattern on anorectal physiology and quality of life as secondary outcomes.
MEDLINE, EMBASE, CENTRAL, PsychInfo, CINAHL, Scopus, and Web of Science were searched from inception to March 2019 using a predefined strategy. Randomised controlled trials of adult patients with dyssynergic defaecation and a biofeedback treatment arm were eligible for review. Studies including patients with secondary forms of constipation were excluded. Data abstraction and risk of bias assessments were conducted by consensus between two authors.
Eleven trials including 725 participants were included in the narrative review. Sixty-three percent of patients treated with biofeedback reported clinical improvement. Six studies included in the meta-analysis showed biofeedback superior to non-biofeedback therapy for the primary outcome (OR 3.63, CI 1.10-11.93, p = 0.03). Heterogeneity between trials and overall risk of bias was high.
Biofeedback therapy is recommended for patients referred to tertiary units with dyssynergic defaecation who fail conservative therapy. Future research should be directed towards identifying validated outcomes and the optimum method for delivering biofeedback therapy. Home biofeedback therapy may improve accessibility and recruitment to future clinical trials.
协同性排便障碍是一种常见的功能性便秘形式，对保守干预反应不佳。本系统评价和荟萃分析评估了生物反馈疗法对协同性排便障碍的疗效，以全球临床改善为主要结局，以肛门直肠生理学和生活质量的协同模式解决为次要结局。
从开始到 2019 年 3 月，使用预设策略在 MEDLINE、EMBASE、CENTRAL、PsychInfo、CINAHL、Scopus 和 Web of Science 上进行了搜索。符合纳入标准的研究为：患有协同性排便障碍的成年患者，且有生物反馈治疗组的随机对照试验。排除包括继发性便秘患者的研究。数据提取和偏倚风险评估由两位作者共同进行。
纳入了 11 项试验，共 725 名参与者。接受生物反馈治疗的患者中有 63%报告有临床改善。纳入荟萃分析的 6 项研究表明，生物反馈在主要结局（OR 3.63，CI 1.10-11.93，p=0.03）方面优于非生物反馈治疗。试验之间存在高度异质性和总体偏倚风险。
对于保守治疗失败的转诊至三级单位的协同性排便障碍患者，推荐使用生物反馈治疗。未来的研究应致力于确定验证的结局和提供生物反馈治疗的最佳方法。家庭生物反馈治疗可能会提高未来临床试验的可及性和招募率。
