Acupoint thread embedding compared to or in combination with biofeedback for treating anismus: A retrospective cohort study

Biofeedback therapy (BFT) is the first-line treatment for anismus, a constipation-type defecation disorder characterized by pelvic floor muscle dyscoordination during defecation; however, BFT has limited efficacy and is associated with high recurrence. Acupoint thread embedding (ATE) is a traditional Chinese medicine therapy offering sustained stimulation. We aimed to evaluate the short-term efficacy of ATE, BFT, and their combination in treating anismus, and explore the prognostic value of the traditional Chinese medicine syndrome (TCMS) score. This retrospective cohort study included 150 patients with anismus treated at Guilin Hospital of Integrated Traditional Chinese and Western Medicine between January 2019 and December 2024. Patients were divided into ATE (n = 45), BFT (n = 45), and ATE + BFT (n = 60) groups. The primary outcomes were the Cleveland Clinic constipation (CCC) and TCMS scores at 3-month posttreatment. Secondary outcomes included the patient assessment of constipation quality of life (PAC-QOL) score, total effectiveness rate, and safety, evaluated 3-month posttreatment and at the 3- and 6-month follow-ups. Multivariable linear regression was used to identify prognostic factors. Three-month posttreatment, the ATE + BFT group reported significantly lower CCC, TCMS, and PAC-QOL scores compared with the BFT group and significantly lower PAC-QOL scores compared with the ATE group (P < .01). At the 3-month follow-up, the CCC, TCMS, and PAC-QOL scores in the ATE + BFT group were significantly lower than those in the BFT group (P < .05); the TCMS and PAC-QOL scores were significantly lower than those in the ATE group (P < .01). At the 6-month follow-up, all scores had returned to the baseline levels. The total effectiveness rate was the highest in the ATE + BFT group (85.00%), significantly surpassing that in the BFT group (68.89%, P = .03). A ≥5-point reduction in the TCMS score at 3-month posttreatment independently predicted a favorable outcome (P < .01). This study demonstrated that the combination of ATE and BFT is significantly superior to either monotherapy alone in the short-term management of anismus, evidenced by greater reductions in CCC, TCMS, and PAC-QOL scores posttreatment. Furthermore, a ≥5-point reduction in the TCMS score was identified as an independent predictor of a favorable prognosis.