Table 2.

Summary of randomized controlled trials of biofeedback therapy for Dyssynergic Defecation

	Rao et al (11)	Rao et al (12)	Chiarioni et al (13)	Heymen et al (14)	Chiarioni et al (15)
Trial Design	Biofeedback (manometry pressure) vs. Standard treatment vs. Sham biofeedback	Biofeedback (Manometry pressure) vs Standard therapy	EMG Biofeedback for slow transit vs Dyssynergia	EMG Biofeedback vs Diazepam 5 mg vs placebo	EMG Biofeedback vs PEG 14.6 gms
Subjects and Randomization and Intervention(s)	77 (69 women) 1:1:1 distribution Standard: diet, exercise, laxatives Sham: Progressive muscle relaxation with anorectal probe	52; Short term therapy 26= long term study 12= biofeedback 13= standard therapy Standard: diet, exercise, laxatives (titrated)	52 (49 women) 34 dyssynergia 12 slow transit 6 mixed	84 (71 women) 30 biofeedback 30 diazepam 24 placebo	109 (104 women) 54 biofeedback 55 polyethylene glycol
Duration & Number of biofeedback sessions	3 months, Biweekly, one hour, maximum of six sessions over three months, performed by biofeedback nurse therapist	One year; 6 active therapy sessions and 3 reinforcement sessions at 3 month intervals	5 weekly 30 minute training sessions, performed by physician investigator	6 bi-weekly, one hour sessions	3 months & 1 year, 5 weekly, 30 minute training sessions performed by physician investigator
Primary outcomes	Presence of dyssynergia Balloon expulsion time Number of complete spontaneous bowel movements Global satisfaction	Number of complete spontaneous bowel movements Secondary Outcome;   Presence of dyssynergia   Balloon expulsion time   Global satisfaction	Symptom improvement None=1 Mild=2 Fair=3 Major=4	Global Symptom relief	Global Improvement of symptoms Worse=0 No improvement=1 Mild=2 Fair=3 Major improvement=4
Dyssynergia corrected or symptoms improved	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	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)	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, (p<0.01)	79.6% reported major improvement at 6 and 12 months 81.5% reported major improvement at 24 months
Conclusions	Biofeedback was superior to sham feedback and standard therapy	Biofeedback is superior to standard therapy	Biofeedback benefits dyssynergia and not slow transit constipation	Biofeedback is superior to placebo and diazepam	Biofeedback was superior to laxatives