Home training works as well as hospital training for constipation
Home-based versus office-based biofeedback therapy for constipation with dyssynergic defecation: a randomised controlled trial.
The Lancet - Gastroenterology & Hepatology
Prof Satish S C Rao, Jessica A Valestin, Xuelian Xiang, Prof Shaheen Hamdy, Prof Catherine S Bradley, Prof M Bridget Zimmerman
A randomised controlled trial involving patients with dyssynergic defecation to assess a new portable biofeedback device and probes that can be used at home.
Office-based biofeedback therapy is effective for constipation with dyssynergic defecation, but must be performed by skilled staff, is only available in selected centres and requires multiple visits. The efficacy of home-based biofeedback therapy is unknown.
We compared clinical and subjective outcomes with both approaches in this randomised controlled trial with 100 adult outpatients who met the Rome III criteria for functional constipation, had been referred to a tertiary-care centre after non-response to routine management, and had dyssynergic defecation.
Patients were randomly assigned to receive office-based or home-based biofeedback therapy. Office-based biofeedback comprised therapist-guided pelvic floor training for six sessions over three months. Home-based biofeedback comprised two 20-minute self-training sessions per day.
Patients recorded details of their defecation attempts in a diary from one week before enrolment to the end of follow-up. With the cost of healthcare, treatments must be cost-effective as well as efficacious. For this reason, we additionally did a cost-effectiveness analysis.
Home-based biofeedback therapy was as good as office biofeedback therapy in remedying bowel symptoms associated with constipation and in correcting dyssynergic defecation in around 70% of patients.
Additionally, the overall cost of home-based biofeedback therapy was significantly lower than that for office-based biofeedback therapy.
Given the ease of administering home biofeedback treatment and cost implications, this approach could substantially broaden the availability of biofeedback therapy and should be the preferred setting.
- Treating constipation can be difficult.
- Biofeedback has been shown to be effective.
- Most biofeedback is delivered in hospitals, but is expensive.
- The new finding that home biofeedback is just as good but cheaper might result in a shift in how this condition is managed.
This trial is registered with ClinicalTrials.gov, number NCT03202771.
This study was funded by the National Institutes of Health.