title: Is electromyography a predictive test of patient response to biofeedback in the treatment of fecal incontinence?
abstract: OBJECTIVE
  Biofeedback is effective in more than 70% of patients with fecal incontinence. However, reliable predictors of successful treatment have not been identified. The aim was to identify clinical variables and diagnostic tests, particularly electromyography, that could predict a successful outcome.
  
  
  METHODS
  We included 135 consecutive women with fecal incontinence treated with biofeedback. Clinical evaluation, manometry, ultrasonography, electromyography, and pudendal nerve terminal motor latency were performed before therapy. Treatment outcome was assessed using a symptoms diary, Wexner incontinence score and the patient's subjective perception.
  
  
  RESULTS
  According to the symptoms diaries, 106 (78.5%) women had a good clinical result and 29 (21.5%) had a poor result. There were no differences in age, severity and type of fecal incontinence. Maximum resting pressure (39.3 ± 19.1 mmHg vs. 33.7 ± 20.2 mmHg; P = 0.156) and maximum squeeze pressure (91.8 ± 33.2 mmHg vs. 79.8 ± 31.2 mmHg; P = 0.127) were higher in patients having good clinical outcome although the difference was not significant. There were no differences in the presence of sphincter defects or abnormalities in electromyographic recordings. Logistic regression analysis found no independent predictive factor for good clinical outcome.
  
  
  CONCLUSIONS
  Biofeedback is effective in more than 75% of patients with fecal incontinence. Clinical characteristics of patients and results of baseline tests have no predictive value of response to therapy. Specifically, we found no association between severity of electromyographic deficit and clinical response.
authors.affiliation: Gastrointestinal Surgery Department, Digestive and Metabolic Diseases Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Catalonia, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: Lacima
authors.affiliation: Section of Colon and Rectal Surgery, Department of Surgery, Hospital del Mar Medical Research Institute (IMIM), Hospital del Mar, Barcelona, Catalonia, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pera
authors.affiliation: Gastrointestinal Surgery Department, Digestive and Metabolic Diseases Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Catalonia, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: González-Argenté
authors.affiliation: Biostatistics and data Management Platform, Hospital Clínic. IDIBAPS, Barcelona, Catalonia, Spain.
authors.forename: Abiguei
authors.initials: A
authors.lastname: Torrents
authors.affiliation: Neurology Deparment, Hospital Clínic. IDIBAPS, Barcelona, Catalonia, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Valls-Solé
authors.affiliation: Urogynecology Unit, Clinical Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic, Barcelona, Catalonia, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Espuña-Pons
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000294:innervation / Q000503:physiopathology*; D001676:Biofeedback, Psychology; D003672:Defecation; D004576:Electromyography; D005242:Fecal Incontinence / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011237:Predictive Value of Tests; D011312:Pressure; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome
keywords: biofeedback; electromyography; fecal incontinence; predictive factors