Analysis of virtually delivered biofeedback for bowel dysfunction and implications for future practice

Objective Biofeedback is an established therapy for faecal incontinence (FI) and chronic constipation, but availability of services is limited and related to the need for face-to-face sessions at specialist units. The COVID-19 pandemic necessitated a move to virtual healthcare delivery; however, there are limited data to support its efficacy. We report an equivalence study comparing virtual to inperson therapy. Design/method Over a 9-month period, consecutive patients undergoing virtual Biofeedback during the COVID-19 pandemic (n=254, 84% women, mean age 41.4 years) were compared with a time-matched prepandemic group treated in person (n=221, 82% women, mean age 39.7). The two groups were similar in terms of aetiology, symptom type and severity. Results Treatment completion rates were similar in both groups (74% vs 76%, virtual vs inperson). In patients with FI, there were similar reductions in mean weekly stool frequency in both groups (3.3 vs 4.2, p<0.05) and use of medications (22% vs 30%, p<0.01). In patients with constipation, there was a similar increase in mean weekly stool frequency in both groups (1.3 vs 2.2, p<0.01) and similar reduction in medication use (24% vs 32%, p<0.01). Overall, 58% vs 54% of patients (p>0.05) were discharged at treatment end. Conclusion Biofeedback therapy delivered virtually is an effective treatment option, representing a potentially more cost-effective possibility. Virtual biofeedback could reduce access inequality by opening the therapy to a geographically wider patient population. Further research is needed to identify subgroups who may need inperson therapy, allowing development of more streamlined pathways.