Abstract

Efficacy of Supervised Pelvic Floor Muscle Training and Biofeedback vs Attention-control Treatment in Adults with Fecal Incontinence

Ussing A1, Dahn I2, Due U3, Sørensen M2, Petersen J4, Bandholm T5. Clin Gastroenterol Hepatol. 2018 Dec 20. pii: S1542-3565(18)31391-0. doi: 10.1016/j.cgh.2018.12.015. [Epub ahead of print]
 
     

Author information

1 Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark, Kettegaards Allé 30, DK-2650 Hvidovre; Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark, Kettegaards Allé 30, DK-2650 Hvidovre. Electronic address: anja.ussing@regionh.dk.

2 Department of Surgical and Medical Gastroenterology, Copenhagen University Hospital, Hvidovre, Denmark, Kettegaards Allé 30, DK-2650 Hvidovre.

3 Department of Obstetrics and Gynaecology, Herlev Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark; Department of Occupational and Physical Therapy, Herlev Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark.

4 Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark, Kettegaards Allé 30, DK-2650 Hvidovre; Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark.

5 Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark, Kettegaards Allé 30, DK-2650 Hvidovre; Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark, Kettegaards Allé 30, DK-2650 Hvidovre; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Copenhagen University Hospital, Hvidovre, Denmark, Kettegaards Allé 30, DK-2650 Hvidovre.

Abstract

BACKGROUND & AIMS: Pelvic floor muscle training (PFMT) in combination with conservative treatment is recommended as first-line treatment for patients with fecal incontinence, although its efficacy is unclear. We investigated whether supervised PFMT in combination wsith conservative treatment is superior to attention-control massage treatment and conservative treatment in adults with fecal incontinence.

METHODS: We performed a randomized, controlled, superiority trial of patients with fecal incontinence at a tertiary care center at a public hospital in Denmark. Ninety-eight adults with fecal incontinence were randomly assigned to groups that received supervised PFMT and biofeedback plus conservative treatment or attention-control treatment plus conservative treatment. The primary outcome was rating of symptom changes, after 16 weeks, based on scores from the Patient global impression of improvement scale (PGI-I). Secondary outcomes were changes in Vaizey incontinence score (Vaizey Score), Fecal Incontinence Severity Index, and Fecal Incontinence Quality of Life Scale.

RESULTS: In the intention to treat analysis, participants in the PFMT group were significantly more likely to report improvement in incontinence symptoms, based on PGI-I scores (unadjusted odds ratio, 5.16; 95% CI, 2.18-12.19; P = .0002). The PFMT group had a larger reduction in mean Vaizey score (reduction of -1.83 points; 95% CI, -3.57 to -0.08, P = .04). There were no significant differences in condition-specific quality of life. In the per-protocol analyses, the superiority of PFMT was increased. No adverse events were reported.

CONCLUSIONS: In a randomized controlled trial of patients with fecal incontinence, we found that participants who received supervised PFMT group had 5-fold higher odds of reporting improvements in fecal incontinence symptoms and had a larger mean reduction of incontinence severity, based on Vaizey score. Clinicaltrials.gov no: NCT01705535.

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