Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA.
Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.
Neurogastroenterol Motil. 2023 Nov;35(11):e14667. doi: 10.1111/nmo.14667. Epub 2023 Sep 25.
Effect of biofeedback on improving anorectal manometric parameters in incomplete spinal cord injury is unknown. A short-term biofeedback program investigated any effect on anorectal manometric parameters without correlation to bowel symptoms.
This prospective uncontrolled interventional study comprised three study subject groups, Group 1: sensory/motor-complete American Spinal Injury Association Impairment Scale (AIS) A SCI (n = 13); Group 2 (biofeedback group): sensory incomplete AIS B SCI (n = 17) (n = 3), and motor-incomplete AIS C SCI (n = 8), and AIS D SCI (n = 6); and Group 3: able-bodied (AB) controls (n = 12). High-resolution anorectal manometry (HR-ARM) was applied to establish baseline characteristics in all subjects for anorectal pressure, volume, length of pressure zones, and duration of sphincter squeeze pressure. SCI participants with motor-incomplete SCI were enrolled in pelvic floor/anal sphincter bowel biofeedback training (2 × 6-week training periods comprised of two training sessions per week for 30-45 min per session). HR-ARM was also performed after each of the 6-week periods of biofeedback training.
Compared to motor-complete or motor-incomplete SCI participants, AB subjects had higher mean intra-rectal pressure, maximal sphincteric pressure, residual anal pressure, recto-anal pressure gradient, and duration of squeeze (p < 0.05 for each of the endpoints). No significant difference was evident at baseline between the motor-complete and motor-incomplete SCI groups. In motor-incomplete SCI subjects, the pelvic floor/anal sphincter biofeedback protocol failed to improve HR-ARM parameters.
Biofeedback training program did not improve anal manometric parameters in subjects with motor-incomplete or sensory-incomplete SCI. Biofeedback did not change physiology, and its effects on symptoms are unknown.
Utility of biofeedback is limited in patients with incomplete spinal cord injury in terms of improving HR-ARM parameters.
生物反馈对改善不完全性脊髓损伤患者肛直肠测压参数的影响尚不清楚。本短期生物反馈方案旨在研究生物反馈对肛直肠测压参数的影响，而不与肠症状相关。
本前瞻性非对照干预研究包括三组研究对象，组 1：感觉/运动完全性美国脊髓损伤协会损伤分级（AIS）A 级 SCI（n=13）；组 2（生物反馈组）：感觉不完全 AIS B 级 SCI（n=17）（n=3）、运动不完全 AIS C 级 SCI（n=8）和 AIS D 级 SCI（n=6）；组 3：健康对照组（AB）（n=12）。所有受试者均行高分辨率肛直肠测压（HR-ARM），以确定肛直肠压力、容量、压力区长度和括约肌收缩压持续时间等基线特征。运动不完全 SCI 受试者参加盆底/肛门括约肌肠生物反馈训练（2 个 6 周训练期，每周 2 次，每次 30-45 分钟）。生物反馈训练结束后，也进行了 HR-ARM 检查。
与运动完全或运动不完全 SCI 受试者相比，AB 组受试者的直肠内压、最大括约肌压、残余肛门压、直肠肛门压力梯度和收缩压持续时间更高（各终点 p<0.05）。运动完全和运动不完全 SCI 组之间在基线时无显著差异。在运动不完全 SCI 受试者中，盆底/肛门括约肌生物反馈方案未能改善 HR-ARM 参数。
生物反馈训练方案不能改善运动不完全或感觉不完全性脊髓损伤患者的肛直肠测压参数。生物反馈并未改变生理状况，其对症状的影响尚不清楚。
在改善 HR-ARM 参数方面，生物反馈在不完全性脊髓损伤患者中的应用有限。
