title: Factors Associated With Efficacy of Nurse-led Bowel Training of Patients With Chronic Constipation.
abstract: OBJECTIVE
  It is not clear whether nurse-led bowel training (NBT), an individually tailored biofeedback strategy designed to improve the physiological process of defecation by operant conditioning and trial and error learning, is effective for patients with chronic constipation. We assessed the ability of NBT to reduce symptoms and increase quality of life in patients with constipation at a large tertiary medical center.
  
  
  METHODS
  We performed a retrospective analysis of data from 347 patients (median age, 50 years) who underwent a median 3 sessions of NBT for chronic constipation from January 2011 through December 2013 at St Marks Hospital in the United Kingdom. The NBT comprised a combination of sensory retraining, pelvic floor conditioning, and advice on diet and toileting behavior. Data on patient demographics (age, sex, type of constipation) were collected alongside their assessments of constipation, which were based on Patient Assessment of Constipation Quality of Life (PAC-QoL) and patient satisfaction scores. We performed binary logistic regression analysis. Each variable was tested first at the univariate level; those with significance (P < .10) were included in a multivariate model.
  
  
  RESULTS
  At the end of NBT, 62.5% of the patients (217/347) reported reduced symptoms, and 40.2% of the patients (41/102) reported a reduction of at least 1 point on the PAC-QoL score. The mean PAC-QoL scores before and after NBT were 2.42 and 1.41, respectively (P = .001). Multivariate analysis demonstrated that increasing age (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.02-2.87; P = .042), greater number of sessions (OR, 4.14; 95% CI, 2.09-8.20; P < .001), and non-irrigation (OR, 4.39; 95% CI, 1.89-10.19; P = .001) were independent predictors of patient satisfaction.
  
  
  CONCLUSIONS
  Data collected immediately after patients with chronic constipation received NBT indicate that it is an effective treatment for most patients. Older patients with dyssynergic defecation benefit most from at least 4 sessions.
authors.affiliation: Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, United Kingdom.
authors.forename: Fareed
authors.initials: F
authors.lastname: Iqbal
authors.affiliation: Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Askari
authors.affiliation: Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, United Kingdom.
authors.forename: Franklin
authors.initials: F
authors.lastname: Adaba
authors.affiliation: Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, United Kingdom.
authors.forename: Aliya
authors.initials: A
authors.lastname: Choudhary
authors.affiliation: Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, United Kingdom.
authors.forename: Gregory
authors.initials: G
authors.lastname: Thomas
authors.affiliation: Department of Physiology, St Mark's Hospital and Academic Institute, Harrow, United Kingdom.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Collins
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, United Kingdom.
authors.forename: Emile
authors.initials: E
authors.lastname: Tan
authors.affiliation: Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, United Kingdom.
authors.forename: R John
authors.initials: RJ
authors.lastname: Nicholls
authors.affiliation: Department of Surgery, St Mark's Hospital and Academic Institute, Harrow, United Kingdom. Electronic address: cvaizey@nhs.net.
authors.forename: Carolynne J
authors.initials: CJ
authors.lastname: Vaizey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy; D003248:Constipation / Q000473:pathology / Q000628:therapy*; D003672:Defecation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D064797:Physical Conditioning, Human; D011788:Quality of Life; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
keywords: Biofeedback; Constipation; Nurse-led; Outcomes