Table 2.

Summary of the randomized controlled trials of biofeedback therapy for Dyssynergic Defecation

	Chiaironi et al (18)	Rao et al (11)	Chiaironi et al (10)	Heymen et al (13)	Rao et al 912)
Trial Design	Biofeedback vs PEG 14.6 gms	Biofeedback vs. standard vs. sham biofeedback	Biofeedback for slow transit vs Dyssynergia	Biofeedback vs Diazepam 5 mg vs placebo	Biofeedback vs Standard therapy
Subjects and Randomization	104 women 54 biofeedback 55 polyethylene glycol	77 (69 women) 1:1:1 distribution	52 (49 women) 34 dyssynergia 12 slow transit 6 mixed	84 (71 women) 30 biofeedback 30 diazepam 24 placebo	52; Short term therapy 26= long term study 12= biofeedback 13= standard therapy
Duration & Number of biofeedback sessions	3 months & 1 year, 5 weekly, 30 minute training sessions performed by physician investigator	3 months, Biweekly, one hour, maximum of six sessions over three months, performed by biofeedback nurse therapist	5 weekly 30 minute training sessions, performed by physician investigator	6 bi-weekly, one hour sessions	One year; 6 active therapy sessions and 3 reinforcement sessions at 3 month intervals
Primary outcomes	Global Improvement of symptoms Worse=0 No improvement=1 Mild=2 Fair=3 Major improvement=4	Presence of dyssynergia Balloon expulsion time Number of complete spontaneous bowel movements Global satisfaction	Symptom improvement None=1 Mild=2 Fair=3 Major=4	Global Symptom relief	Number of complete spontaneous bowel movements Secondary Outcome;  Presence of dyssynergia  Balloon expulsion time  Global satisfaction
Dyssynergia corrected or symptoms improved	79.6% reported major improvement at 6 and 12 months 81.5% reported major improvement at 24 months	Dyssynergia corrected at 3 months in 79% with biofeedback vs 4% sham and 6% in Standard group ; CSBM= Biofeedback group vs Sham or Standard, p<0.05	71 % with dyssynergia and 8% with slow transit alone reported fair improvement in symptoms	70% improved with biofeedback compared to 38% with placebo and 30 % with diazepam	No of CSBM/week increased significantly in biofeedback 9p<0.001 Dyssynergia pattern normalized 9p<0.0010 Balloon expulsion improved (p<0.001) Colonic transit normalized (p<0.01)
Conclusions	Biofeedback was superior to laxatives	Biofeedback was superior to sham feedback and standard therapy	Biofeedback benefits dyssynergia and not slow transit constipation	Biofeedback is superior to placebo and diazepam	Biofeedback is superior to standard therapy