A308 A PRACTICE AUDIT ON THE EFFECTIVENESS OF BIOFEEDBACK THERAPY IN A TERTIARY CARE CENTRE

Chronic constipation (CC) and fecal incontinence (FI) are common disorders that can often be related to pelvic floor neuromuscular sensory and motor dysfunction. These disorders have been shown to impair patients’ quality of life. Conventional therapies for both conditions include dietary changes, behavioural modification and pharmacologic therapies. However, these are frequently insufficient to achieve satisfactory outcomes in a subset of patients. Biofeedback therapy (BFT) involves training patients to improve the ano-rectal sensory, motor and coordination via verbal and visual feedback. BFT has been shown to be an effective treatment strategy in those patients who have failed conventional therapy with response rates often exceeding 50% of participants. To review the effectiveness of BFT as performed at a tertiary centre in Canada. A secondary aim was to determine the subset of patients who benefit most from BFT in our cohort. A retrospective chart review was performed on all patients who underwent BFT at our institution between January 1, 2008 and August 15, 2016. Demographic information, reason for referral, baseline and post-biofeedback ano-rectal manometry (ARM) data, and patient subjective report of changes in symptoms were collected. A positive response to BFT was defined as an improvement in the patient’s ARM profile (i.e. improvement in sphincter function, normalization of the balloon expulsion time, etc) and/or patient reported improvement of pre-BFT symptoms. Patients who completed a course of BFT were included. Descriptive statistics were used to analyze the data. 130 patients had a complete data set for the analysis. The average age of the patients was 56.1 ± 16.3 yr and 76.8% were female. The average number of completed biofeedback session was 2.9. 43.1% of patients were referred for CC, 37.7% for FI, 16.9% for both CC and FI, and 2.3% for rectal pain. 76.2% of the patients had a positive response to BFT. Amongst those, 27.3% had an improvement in their ARM profile alone, 7.1% reported symptomatic improvement alone, 65.6% demonstrated both manometric and symptomatic improvement. Patients, who responded to both symptom and ARM profile, were more likely to present with FI (65.3%) or both CC and FI (54.5%), as compared to those presenting with CC alone (37.5%). Examining the CC group (n=56), those with dyssynergic defecation (DD, n=53) were more likely to have ARM profile and symptom response than those without (39.6% vs. 0%). This practice audit illustrates that our BFT program achieves a similar overall response rate as compared with previously published reports. Our cohort demonstrates that patients presented with both FI and CC, FI, or CC with DD are more likely to respond. This data will be used to further examine our BFT program and to develop quality improvement initiatives within the program to improve patient outcomes. None

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