A report from #BlueJC: can home biofeedback physiotherapy prevent fecal incontinence after third-degree tears?
Article first published online: 11 SEP 2013
© 2013 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 120, Issue 11, page 1443, October 2013
How to Cite
(2013), A report from #BlueJC: can home biofeedback physiotherapy prevent fecal incontinence after third-degree tears?. BJOG: An International Journal of Obstetrics & Gynaecology, 120: 1443. doi: 10.1111/1471-0528.12250
- Issue published online: 11 SEP 2013
- Article first published online: 11 SEP 2013
Paper discussed: Peirce C et al. Randomised controlled trial comparing early home biofeedback physiotherapy with pelvic floor exercises for the treatment of third-degree tears (EBAPT Trial). BJOG 2013;120:1240–1247.
Location: Twitter and the RCOG World Congress 2013.
Date of journal club: 25 June 2013.
Number of participants: 35.
Number of tweets: 150.
|Participants||Primiparous women who sustained primary third-degree tears during childbirth|
|Intervention||Early biofeedback physiotherapy (using a portable machine)|
|Comparison||Pelvic floor exercise education|
|Outcomes||Primary: differences in anorectal manometry at 3 months postpartum. Secondary: Cleveland clinic continence scores and Rockwood faecal incontinence qualify-of-life scale scores|
|Study design||Randomised trial (1 : 3 ratio)|
|Findings||No additional benefit with early biofeedback physiotherapy|
Randomisation in 1 : 3 ratio: unequal randomisation was a reasonable method when only a limited number of biofeedback machines were available. However, this was not detailed in the initial registered protocol, when ideally it should have been.
Choice of primary outcome
Anorectal manometry measurements can be subjective, which might confer measurement bias in an unblinded trial. Although using faecal incontinence as the primary outcome has direct clinical relevance, this may inflate the required sample size as this symptom is relatively uncommon.
The use of patient-reported outcome measures (PROMs)
The quality of the PROMs used in this trial was not consistent. Appraisal of health measurement instruments (COSMIN, http://www.cosmin.nl) should be an integral element of study design.
Length of follow-up and compliance to treatment
Although results of longer follow-up would be desirable, the current study showed that even at 3 months postpartum treatment compliance was suboptimal. Treatment compliance is likely to be poorer outside clinical trial settings, which would further compromise any potential benefits of biofeedback physiotherapy.
Early home biofeedback physiotherapy did not prevent adverse sequelae of third-degree tears. Compliance with treatment was poor even during the early postpartum period.
We are grateful for all tweets. For the Storify summary and the list of contributors, please go to http://bit.ly/11MOcmp.
Women's Health Research Unit, Queen Mary, University of London, London, UKAbout #BlueJC: For an introduction to #BlueJC, please refer to BJOG 2013;120:657–660. Further information is available on www.BJOG.org. Follow @BJOGTweets to join the next #BlueJC. Queries should be sent to firstname.lastname@example.org.