Long-Term Efficacy Of Biofeedback Therapy For Functional Constipation

Background:Functional constipation (FC) is one of the most common clinical chronic functional gastrointestinal diseases. The epidemiological data shows that worldwide populations plagued by constipation ranging from0.7%to79%, an average of about16%, and the incidence rate showed an increasing trend. The traditional medical and surgical treatment do not work well, and course more adverse reactions and complications. Therefore, to find effective treatment of FC, has become an urgent problem.Biofeedback therapy as a new kind of behavior therapy, safe, simple, low cost of treatment, no side effects, has been widely used in clinical treatment of FC. It has been reported that the effective rate of biofeedback was from62.4%t to86%. Its efficacy and patient compliance are closely related. Preliminary studies of our group also confirmed that the total efficiency of BF treatment joint nursing intervention of FC is up to90%. Nursing intervention to improve treatment compliance of patients with BF plays an integral role. FC is a chronic disease, the symptoms continue for at least2years. Researchers concern about the efficacy of BF can be long maintained. However, there are few reports on long-term efficacy of BF in domestic.FC patients received BF pius nursing intervention in May2005to May2010 were followed up in this research. Comprehensive efficacy evaluation from the clinical symptoms, objective physiological parameters, psychological status, quality of life and patient satisfaction of them was studied in order to clear the long-term efficacy and its influencing factors. And then we can establish a follow-up system for efficacy and create a computer software system to manage the process. This research can provide the basis for clinical diagnosis and treatment, follow-up and continuity of nurse intervention of FC. And it also provides a reference for the formulation of the guidelines for the diagnosis and treatment of chronic constipation of the Asia-Pacific region.Objectives:1. To investigate retrospectively the long-term efficacy and the influencing factors of biofeedback treatment for FC patients.2. To establish a management system for managing treatment and follow-up of FC patients and use modern database technology to manage clinical data of FC in order to assist clinical and research work.Materials and Methods:1. From May2005to May2010,120FC patients undergone biofeedback therapy in our hospital were followed up. Long-term efficacy of biofeedback treatment was evaluated by a bowel symptom score, colonic transit test and anorectal manometry. Thirty two independent risk factors of long-term efficacy were analyzed using univariate analysis and multivariable linear regression model.2. Blueprint of the data structure was designed and accomplished based on the resolution of data flow of FC after requirements. Performance test and analysis was carried out for clinical application.Results:1. One hundred and ten patients (91.7%) were able to be followed up and109effective questionnaires were collected. The mean follow-up time was (36.4±12.7) months.2. The score of clinical symptoms and SAS/SDS in follow-up period were significantly lower than that in baseline (P<0.01). The scores of all subcategories of SF-36except physical functioning were higher than those in baseline (P<0.01).45.9%(50/109) of patients were greatly effective,14.7%(16/109) of patients were good effective,14.7%(16/109) of patients were general effective, the total effective rate was70.7%, and the total satisfaction was62.4%.3. The colonic emptying rate of48h and72h was higher than those in baseline (P<0.05).4. The residual pressure of anal was lower than that in baseline (P<0.05), and the number of patient with dyssynergia was significantly reduced (P<0.05).5. The score of clinical symptoms in follow-up period was higher than that after biofeedback (P<0.01), The long-term efficacy of biofeedback therapy for FC was lower than that in short-term (70.7%VS93.6%).6. There were no significant differences in the Clinical symptom scores, the score of SAS/SDS and SF-36at1-2years,2-4years and more than4years after patients received BF (P>0.05).7. The univariate and multivariate analysis showed that the significant influencing factors were treatment compliance, social support and illness duration.8. The database and the application including user defined quering utilities were finished and applied to clinic usage.Conclusion:Biofeedback therapy provided sustained improvement of clinical symptom and anorectal function in constipated subjects. Treatment compliance, social support and illness duration were the most important factors influencing the long-term efficacy. The application system, which can provide support for clinical real-time decision, will increase the efficiency of data management of functional constipation and analysis. It can helpful for clinical doctors and researchers.