title: Triple target treatment (3T) is more effective than biofeedback alone for anal incontinence: the 3T-AI study.
abstract: OBJECTIVE
  The efficacy of EMG-biofeedback and low-frequency electrical stimulation for the treatment of anal incontinence has not been proven. Our purpose was to evaluate a novel therapeutic concept, termed triple target treatment, which combines amplitude-modulated medium-frequency stimulation and EMG-biofeedback.
  
  
  METHODS
  Patients with anal incontinence were randomly assigned to the triple target regimen or EMG-biofeedback alone for a 9-month treatment period in a multicenter randomized clinical trial with blinded observers (ClincialTrials.gov registration number NCT00525291). Primary end points were changes in the Cleveland Clinic score and the adapted St. Mark's (Vaizey) score at 9 months compared with baseline. Secondary end points included therapy acceptance and proportion of patients achieving continence or improvement in grade or frequency of incontinence.
  
  
  RESULTS
  We enrolled 158 patients with anal incontinence. The median decrease in the Cleveland Clinic score from baseline to 9 months was 3 points greater for the triple target regimen than for EMG-biofeedback (95% CI, 1-4; P = .0024). The improvement was 8 points for the triple target regimen (95% CI, 7-9) and 5 points for EMG-biofeedback (95% CI, 4-7). Results were similar for the Vaizey score. Of patients treated for at least 3 months, continence was achieved by 50% of patients with the triple target regimen and 25.8% of those with EMG-biofeedback.
  
  
  CONCLUSIONS
  The combination of amplitude-modulated medium-frequency electrostimulation with EMG-biofeedback in the triple target regimen is superior to EMG-biofeedback alone in the treatment of anal incontinence. Therapy programs for fecal incontinence are most effective if patients participate for longer than 2 to 3 months.
authors.affiliation: Clinic for General, Visceral, Thorax, and Transplantation Surgery, Faculty of Medicine, Justus-Liebig-University Giessen, Giessen, Germany.
authors.forename: Thilo
authors.initials: T
authors.lastname: Schwandner
authors.forename: Inke R
authors.initials: IR
authors.lastname: König
authors.forename: Tankred
authors.initials: T
authors.lastname: Heimerl
authors.forename: Walter
authors.initials: W
authors.lastname: Kierer
authors.forename: Michael
authors.initials: M
authors.lastname: Roblick
authors.forename: Ralf
authors.initials: R
authors.lastname: Bouchard
authors.forename: Thorsten
authors.initials: T
authors.lastname: Unglaube
authors.forename: Philipp
authors.initials: P
authors.lastname: Holch
authors.forename: Andreas
authors.initials: A
authors.lastname: Ziegler
authors.forename: Gerd
authors.initials: G
authors.lastname: Kolbert
mesh_terms: D001003:Anal Canal / Q000503:physiopathology*; D001676:Biofeedback, Psychology / Q000379:methods*; D003672:Defecation; D004599:Electric Stimulation Therapy / Q000379:methods*; D004576:Electromyography / Q000379:methods; D005242:Fecal Incontinence / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome