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Improving biofeedback for the treatment of fecal incontinence in women: implementation of a standardized multi-site manometric biofeedback protocol.

Publication ,  Journal Article
Markland, AD; Jelovsek, JE; Whitehead, WE; Newman, DK; Andy, UU; Dyer, K; Harm-Ernandes, I; Cichowski, S; McCormick, J; Rardin, C; Sutkin, G ...
Published in: Neurogastroenterol Motil
January 2017

BACKGROUND: Standardized training and clinical protocols using biofeedback for the treatment of fecal incontinence (FI) are important for clinical care. Our primary aims were to develop, implement, and evaluate adherence to a standardized protocol for manometric biofeedback to treat FI. METHODS: In a Pelvic Floor Disorders Network (PFDN) trial, participants were enrolled from eight PFDN clinical centers across the United States. A team of clinical and equipment experts developed biofeedback software on a novel tablet computer platform for conducting standardized anorectal manometry with separate manometric biofeedback protocols for improving anorectal muscle strength, sensation, and urge resistance. The training protocol also included education on bowel function, anal sphincter exercises, and bowel diary monitoring. Study interventionists completed online training prior to attending a centralized, standardized certification course. For the certification, expert trainers assessed the ability of the interventionists to perform the protocol components for a paid volunteer who acted as a standardized patient. Postcertification, the trainers audited interventionists during trial implementation to improve protocol adherence. KEY RESULTS: Twenty-four interventionists attended the in-person training and certification, including 46% advanced practice registered nurses (11/24), 50% (12/24) physical therapists, and 4% physician assistants (1/24). Trainers performed audio audits for 88% (21/24), representing 84 audited visits. All certified interventionists met or exceeded the prespecified 80% pass rate for the audit process, with an average passing rate of 93%. CONCLUSIONS & INFERENCES: A biofeedback protocol can be successfully imparted to experienced pelvic floor health care providers from various disciplines. Our process promoted high adherence to a standard protocol and is applicable to many clinical settings.

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Published In

Neurogastroenterol Motil

DOI

EISSN

1365-2982

Publication Date

January 2017

Volume

29

Issue

1

Location

England

Related Subject Headings

  • Treatment Outcome
  • Manometry
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Fecal Incontinence
  • Cognitive Behavioral Therapy
  • Biofeedback, Psychology
  • 3209 Neurosciences
  • 3208 Medical physiology
 

Citation

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MLA
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Markland, A. D., Jelovsek, J. E., Whitehead, W. E., Newman, D. K., Andy, U. U., Dyer, K., … Pelvic Floor Disorders Network, . (2017). Improving biofeedback for the treatment of fecal incontinence in women: implementation of a standardized multi-site manometric biofeedback protocol. Neurogastroenterol Motil, 29(1). https://doi.org/10.1111/nmo.12906
Markland, A. D., J. E. Jelovsek, W. E. Whitehead, D. K. Newman, U. U. Andy, K. Dyer, I. Harm-Ernandes, et al. “Improving biofeedback for the treatment of fecal incontinence in women: implementation of a standardized multi-site manometric biofeedback protocol.Neurogastroenterol Motil 29, no. 1 (January 2017). https://doi.org/10.1111/nmo.12906.
Markland AD, Jelovsek JE, Whitehead WE, Newman DK, Andy UU, Dyer K, et al. Improving biofeedback for the treatment of fecal incontinence in women: implementation of a standardized multi-site manometric biofeedback protocol. Neurogastroenterol Motil. 2017 Jan;29(1).
Markland, A. D., et al. “Improving biofeedback for the treatment of fecal incontinence in women: implementation of a standardized multi-site manometric biofeedback protocol.Neurogastroenterol Motil, vol. 29, no. 1, Jan. 2017. Pubmed, doi:10.1111/nmo.12906.
Markland AD, Jelovsek JE, Whitehead WE, Newman DK, Andy UU, Dyer K, Harm-Ernandes I, Cichowski S, McCormick J, Rardin C, Sutkin G, Shaffer A, Meikle S, Pelvic Floor Disorders Network. Improving biofeedback for the treatment of fecal incontinence in women: implementation of a standardized multi-site manometric biofeedback protocol. Neurogastroenterol Motil. 2017 Jan;29(1).
Journal cover image

Published In

Neurogastroenterol Motil

DOI

EISSN

1365-2982

Publication Date

January 2017

Volume

29

Issue

1

Location

England

Related Subject Headings

  • Treatment Outcome
  • Manometry
  • Humans
  • Gastroenterology & Hepatology
  • Female
  • Fecal Incontinence
  • Cognitive Behavioral Therapy
  • Biofeedback, Psychology
  • 3209 Neurosciences
  • 3208 Medical physiology