The Effectiveness of Biofeedback for Patients with Functional Constipation：a Meta-analysis

doi:10.12114/j.issn.1007-9572.2018.00.132

Abstract

Abstract: Objective　To systematically evaluate the effectiveness of biofeedback on patients with functional constipation.Methods　From January 2007 to July 2016，randomized controlled trials were retrieved from multiple electronic databases including CNKI，CBM，Wanfang Data Knowledge Service Platform，VIP，PubMed，Cochrane Library，EMBase，Web of Science，JBI，RNAO，Nursing Consult，BIOSIS Previews，Medline and Springerlink.Studies were selected according to inclusion and exclusion criteria，and data were analyzed by RevMan 5.3.Results　A total of 8 RCTs with 688 patients were included.The results of meta-analysis supported the effectiveness of biofeedback on improving the subjective feelings of defecation in patients with functional constipation〔RR=1.47，95%CI（1.03，2.08），P=0.03〕 and reducing the need for digit use during defecation〔RR=0.47，95%CI（0.27，0.81），P=0.007〕.Biofeedback also improved the discharge rate of colonic transit test〔MD=9.83，95%CI（5.18，14.18），P<0.000 1〕，and decreased the anorectal pressure〔MD=-49.70，95%CI（-86.60，-12.79），P=0.008〕.Conclusion　Biofeedback can improve the subjective feelings of defecation in patients with functional constipation and discharge rate of colonic transit test，as well as reduce the need for digit use during defecation and the anorectal pressure with functional constipation.Due to the fact that effectiveness on improving patient satisfaction after treatment and decreasing the anal resting pressure are still not certain，with the heterogeneity of indicators and inadequate included studies，more multi-centered randomized controlled trials with large sample size and good quality are needed in the future to confirm the effectiveness of biofeedback.

Key words: Constipation, Biofeedback, Meta-analysis

摘要： 目的　系统评价生物反馈训练对功能性便秘患者的干预效果。方法　计算机检索中国知网（CNKI）、中国生物医学文献数据库（CBM）、万方数据知识服务平台、中文科技期刊数据库（VIP）、PubMed、Cochrane Library、EMBase、Web of Science、JBI循证护理数据库、RNAO、Nursing Consult、BIOSIS Previews、Medline、Springerlink等数据库中关于生物反馈训练治疗功能性便秘患者的随机对照试验。检索时间为2007年1月—2016年7月。依据文献纳入及排除标准进行筛查，提取资料，评价文献质量，采用RevMan 5.3软件进行Meta分析。结果　最终纳入8项研究，包括688例研究对象。Meta分析结果显示，生物反馈训练治疗功能性便秘有效率高于对照组〔RR=1.47，95%CI（1.03，2.08），P=0.03〕，需人工协助排便比例低于对照组〔RR=0.47，95%CI（0.27，0.81），P=0.007〕，肠道标志物排出率高于对照组〔MD=9.83，95%CI（5.18，14.18），P<0.000 1〕，用力排便时肛门压低于对照组〔MD=-49.70，95%CI（-86.60，-12.79），P=0.008〕。结论　生物反馈训练能够有效改善功能性便秘患者的排便主观体验，降低需人工协助排便比例及用力排便时肛门压，提高肠道标志物排出率，但是否能降低患者的肛门静息压、提高满意度方面尚缺乏有力证据。由于本研究评价指标间存在异质性，因此，需要更多临床多中心、大样本、高质量的研究进一步评价生物反馈训练对功能性便秘患者的综合效果。

关键词: 便秘, 生物反馈, Meta分析

WU Xiaodan,ZHONG Jiudi,WEN Yongshan, et al. The Effectiveness of Biofeedback for Patients with Functional Constipation：a Meta-analysis[J]. Chinese General Practice, 2019, 22(5): 606-611. DOI: 10.12114/j.issn.1007-9572.2018.00.132.
吴晓丹,钟就娣,温咏珊等. 生物反馈训练对功能性便秘患者干预效果的Meta分析[J]. 中国全科医学, 2019, 22(5): 606-611. DOI: 10.12114/j.issn.1007-9572.2018.00.132.

References

［1］TACK J，MULLER-LISSNER S，STANGHELLINI V，et al．Diagnosis and treatment of chronic constipation—a European perspective［J］．Neurogastroenterol Motil，2011，23（8）：697-710．DOI：10.1111/j.1365-2982.2011.01709.x.
［2］BELSEY J，GREENFIELD S，CANDY D，et al．Systematic review：impact of constipation on quality of life in adults and children［J］．Aliment Pharmacol Ther，2010，31（9）：938-949．DOI：10.1111/j.1365-2036.2010.04273.x.
［3］BELSEY J，GREENFIELD S，CANDY D，et al．Systematic review：impact of constipation on quality of life in adults and children［J］．Aliment Pharmacol Ther，2010，31（9）：938-949．DOI：10.1111/j.1365-2036.2010.04273.x.
［4］胡晔东，李炜，徐文，等．生物反馈治疗盆底功能障碍型便秘的疗效分析［J］．同济大学学报（医学版），2014，35（3）：95-98．DOI：10.3969/j.issn1008-0392.2014.03.022.
HU Y D，LI W，XU W，et al．Biofeedback therapy for patients with pelvic floor dysfunction constipation［J］．Journal of Tongji University（Medical Science），2014，35（3）：95-98．DOI：10.3969/j.issn1008-0392.2014.03.022.
［5］宋玉磊，林征，林琳，等．生物反馈治疗联合综合护理干预对功能性便秘患者临床症状及生活质量的影响［J］．中华护理杂志，2012，47（6）：485-487．DOI：10.3761/j.issn.0254-1769.2012.06.001.
SONG Y L，LIN Z，LIN L，et al．The long-term clinical efficacy of biofeedback therapy for patients with functional constipation［J］．Chinese Journal of Nursing，2012，47（6）：485-487．DOI：10.3761/j.issn.0254-1769.2012.06.001.
［6］NIKJOOY A，MAROUFI N，EBRAHIMI TAKAMJANI I，et al．MR defecography：a diagnostic test for the evaluation of pelvic floor motion in patients with dyssynergic defecation after biofeedback therapy［J］．Med J Islam Repub Iran，2015，29：188.
［7］罗马委员会.功能性胃肠病罗马Ⅲ诊断标准［J］．胃肠病学，2006，11（12）：761-765．DOI：10.3969/j.issn.1008-7125.2006.12.017.
Rome Committee.Diagnostic criteria of RomeⅢ for functional gastrointestinal disorders［J］．Chinese Journal of Gastroenterology，2006，11（12）：761-765．DOI：10.3969/j.issn.1008-7125.2006.12.017.
［8］代小松，陈和平，张新星，等．生物反馈训练治疗慢性功能性便秘的临床研究［J］．华西医学，2009，24（10）：2624-2627.
DAI X S，CHEN H P，ZHANG X X，et al．Study on the clinical effect of biofeedback therapy for functional constipation［J］．West China Medical Journal，2009，24（10）：2624-2627.
［9］葛宁，李宾，罗淑萍，等．生物反馈训练治疗功能性便秘效果观察［J］．山东医药，2016，60（22）：90-91．DOI：10.3969/j.issn.1002-266X.2016.22.035.
GE N，LI B，LUO S P，et al．Effect of biofeedback training on functional constipation［J］．Shandong Medical Journal，2016，60（22）：90-91．DOI：10.3969/j.issn.1002-266X.2016.22.035.
［10］陶文雅，王晨.生物反馈训练治疗和灌肠对便秘疗效比较的研究［J］．西南国防医药，2016，26（1）：30-32．DOI：10.3969/j.issn.1004-0188.2016.01.011.
TAO W Y，WANG C.Comparative research on curative effects of biofeedback training and coloclysis on constipation［J］．Medical Journal of National Defending Forces in Southwest China，2016，26（1）：30-32．DOI：10.3969/j.issn.1004-0188.2016.01.011.
［11］吴青眉，张爱群，林婕.生物反馈训练和灌肠治疗便秘的比较研究［J］．中国医药，2014，9（10）：1495-1497．DOI：10.3760/cma.j.issn.1673-4777.2014.10.025.
WU Q M，ZHANG A Q，LIN J.The efficacy evaluation of enema therapy and biofeedback training for constipation［J］．China Medicine，2014，9（10）：1495-1497．DOI：10.3760/cma.j.issn.1673-4777.2014.10.025.
［12］鲍聚喜，张光鑫，张孝通，等．盆底表面肌电生物反馈治疗失迟缓性便秘疗效观察［J］．人民军医，2012，55（12）：1218-1219.
BAO J X，ZHANG G X，ZHANG X T，et al．Effect of pelvic floor electromyographic biofeedback on patients with delayed onset constipation［J］．People's Military Surgeon，2012，55（12）：1218-1219.
［13］HEYMEN S，SCARLETT Y，JONES K，et al．Randomized controlled trial shows biofeedback to be superior to pelvic floor exercises for fecal incontinence［J］．Dis Colon Rectum，2009，52（10）：1730-1737．DOI：10.1007/DCR.0b013e3181b55455.
［14］RAO S S，SEATON K，MILLER M，et al．Randomized controlled trial of biofeedback，sham feedback，and standard therapy for dyssynergic defecation［J］．Clin Gastroenterol Hepatol，2007，5（3）：331-338．DOI：10.1016/j.cgh.2006.12.023.
［15］POURMOMENY A A，EMAMI M H，AMOOSHAHI M，et al．
Comparing the efficacy of biofeedback and balloon-assisted training in the treatment of dyssynergic defecation［J］．Can J Gastroenterol，2011，25（2）：89-92.
［16］SKARDOON G R，KHERA A J，EMMANUEL A V，et al．Review article：dyssynergic defaecation and biofeedback therapy in the pathophysiology and management of functional constipation［J］．Aliment Pharmacol Ther，2017，46（4）：410-423．DOI：10.1111/apt.14174.
［17］VERMA A，MISRA A，GHOSHAL U C.Effect of biofeedback therapy on anorectal physiological parameters among patients with fecal evacuation disorder［J］．Indian J Gastroenterol，2017，36（2）：99-104．DOI：10.1007/s12664-017-0731-y.
［18］RAO S S，TUTEJA A K，VELLEMA T，et al．Dyssynergic defecation：demographics，symptoms，stool patterns，and quality of life［J］．J Clin Gastroenterol，2004，38（8）：680-685.

[1]	WANG Zhe, DONG Zhihao, ZHENG Hao, KONG Wencheng, ZHANG Yukuan, ZHANG Qiuyue, HAN Jing. Construction of Optimized Treatment Plan of Acupuncture for Migraine Based on Entropy Weight-TOPSIS Method [J]. Chinese General Practice, 2023, 26(34): 4336-4342.
[2]	WANG Yue, CHEN Qing, LIU Lurong. Detection Rate of Depression and Its Influencing Factors in Chinese Elderly: a Meta-analysis [J]. Chinese General Practice, 2023, 26(34): 4329-4335.
[3]	JIAN Qiufeng, XU Ronghua, YAO Qian, ZHOU Yuanyuan. A Meta-analysis of the Prevalence and Influencing Factors of Post-stroke Cognitive Impairment in Chinese Elderly Patients [J]. Chinese General Practice, 2023, 26(32): 4070-4079.
[4]	JIA Yu, ZHOU Zitong, CAO Xuehua, HU Wanqin, XIANG Feng, XIONG Langyu, WANG Xiaoxia. Incidence of Perimenopausal Syndrome in Chinese Women Aged 40 to 65 Years: a Meta-analysis [J]. Chinese General Practice, 2023, 26(32): 4080-4088.
[5]	LI Jixin, QIU Linjie, REN Yan, WANG Wenru, LI Meijie, ZHANG Jin. The Correlation of Dietary Inflammatory Index with Overweight, Obesity and Abdominal Obesity: a Meta-analysis [J]. Chinese General Practice, 2023, 26(32): 4089-4097.
[6]	HE Jingyi, WANG Fang, SHUI Xiaoling, LI Ling, LIANG Qian. Efficacy of Non-pharmacological Interventions to Improve Perimenopausal Insomnia Symptoms: a Network Meta-analysis [J]. Chinese General Practice, 2023, 26(31): 3963-3974.
[7]	ZHU Lin, GUO Yankui, GAO Chen, CHEN Xuezhi, WANG Fashuai. Efficacy of Western Medicine, Chinese Patent Medicine and Their Combination on Post-stroke Insomnia: a Network Meta-analysis [J]. Chinese General Practice, 2023, 26(30): 3823-3832.
[8]	ZHANG Dongli, SHEN Chong, ZHANG Weichuan, CHEN Haibin, ZHAO Jianjun. Efficacy and Safety of Programmed Death-1/Programmed Death-1 Ligand Inhibitors in the Treatment of Renal Cell Cancer: a Meta-analysis [J]. Chinese General Practice, 2023, 26(30): 3815-3822.
[9]	HE Li, ZHANG Yifan, SHEN Xuechun, SUN Yan, ZHAO Yang. Prevalence Trends of Multimorbidity among Residents in Mainland China: a Meta-analysis [J]. Chinese General Practice, 2023, 26(29): 3599-3607.
[10]	LIN Yang, WANG Fang, WANG Han, WU Rong, WANG Yao, XU Ziyao, WANG Xu, WANG Yanding. Prevalence of Frailty in Elderly Patients with Comorbidity: a Meta-analysis [J]. Chinese General Practice, 2023, 26(25): 3185-3193.
[11]	GUO Yinning, MIAO Xueyi, JIANG Xiaoman, XU Ting, XU Qin. Effects of Protein Supplementation on Muscle Mass, Strength, and Physical Function in Frail/Pre-frail Older Adults: a Meta-analysis [J]. Chinese General Practice, 2023, 26(23): 2854-2863.
[12]	WANG Xueyan, TIAN Jinhui, ZHANG Li, ZHAI Jinguo. Effects of Different Intervention Measures for Breech Presentation/Transverse Lie Position on Maternal and Neonatal Outcomes: a Network Meta-analysis [J]. Chinese General Practice, 2023, 26(21): 2647-2658.
[13]	WANG Shumin, LI Xuejun, ZHANG Yixing, JIANG Zhiyan, XIAO Zhen. Correlation between Mycoplasma Pneumoniae Infection and Coronary Artery Lesions in Mucocutaneous Lymph Node Syndrome: a Meta-analysis [J]. Chinese General Practice, 2023, 26(20): 2532-2539.
[14]	XUE Shan, LI Laiyou, LIANG Junli, JIN Yinghui, WEI Shuyan. The Efficacy and Safety of Home Enteral Nutrition in Patients with Esophageal Cancer: a Meta-analysis [J]. Chinese General Practice, 2023, 26(20): 2540-2547.
[15]	ZHAI Leilei, ZHAO Shupeng, YAO Ping. Meta-analysis of the Relationship between Dietary Inflammatory Index and Upper Gastrointestinal Cancer Risks [J]. Chinese General Practice, 2023, 26(18): 2286-2292,2300.