Wake Forest University, School of Medicine Winston-Salem, NC
Ella M. LePage, MD1, Elizabeth Jensen, MPH, PhD2, Hiral S. Patel, MD1, Nyree Thorne, MD1; 1Wake Forest University, School of Medicine, Winston-Salem, NC; 2Wake Forest School of Medicine, Pfafftown, NC
Introduction: Pelvic floor dyssynergia (PFD), the inability to coordinate and relax pelvic floor muscles, is a common cause of constipation. Biofeedback therapy is used to treat dyssynergia and has been shown to be up to 80% effective in patient satisfaction with results lasting years after completing treatment (1). Despite this effectiveness, patients often do not adhere to treatment recommendations, which generally requires at least 6 visits. We sought to characterize the proportion of patients adhering to treatment and to evaluate patient factors associated with poor adherence. Methods: We conducted a retrospective cohort study of patients at our medical center that met study inclusion criteria of having a diagnosis of constipation, undergoing anorectal manometry (ARM) procedure from January 1, 2017 to June 30, 2019 (n=421), and receiving a diagnosis of PFD (n=324). Patients less than 18 at the time of ARM were excluded. Among those referred for biofeedback therapy (n=245), we determined the proportion of patients completing biofeedback therapy in those diagnosed with constipation due to PFD and patient factors associated with lack of completion of biofeedback therapy. For analyses, we assessed for differences (chi-square for proportions and t-test for means) in distribution of possible explanatory factors by those who did and did not complete therapy. Results: Of the 245 patients referred to biofeedback therapy, only 51 (20.8%) successfully completed treatment per physical therapy’s requirements. The only factor associated with failure to complete treatment was patient sex (p = 0.02) (see Table 1), with a 134% increased odds of not completing therapy for females, relative to males (OR: 2.34; 95% CI [1.12, 4.89]. Of note, none of the patients without insurance (n=11) completed biofeedback therapy. Discussion: Biofeedback therapy is a proven effective treatment for PFD; however, the completion rate is low. Interestingly, 83.3% of the patients referred to biofeedback therapy were female; however, males were statistically more likely to complete biofeedback therapy. With a low adherence rate to biofeedback therapy, further patient assessments after appointments to address personal progress and adherence to therapy could be beneficial to increase the completion rate of therapy. 1. Chiarioni G, Whitehead WE, Pezza V, et al. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006 Mar;130(3):657-64.
Disclosures: Ella LePage indicated no relevant financial relationships. Elizabeth Jensen indicated no relevant financial relationships. Hiral Patel indicated no relevant financial relationships. Nyree Thorne indicated no relevant financial relationships.