Biofeedback for treatment of irritable bowel syndrome

• Published in: Cochrane database of systematic reviews 2019-11, Vol.2019 (11)
• Main Authors: Goldenberg, Joshua Z, Brignall, Matthew, Hamilton, Michelle, Beardsley, Jennifer, Batson, Richard D, Hawrelak, Jason, Lichtenstein, Brad, Johnston, Bradley C
• Format: Article
• Language: English
• Subjects: Adult; Child; Complementary & alternative medicine; Feedback, Physiological - physiology; Feedback, Psychological - physiology; Gastroenterology & hepatology; Humans; Irritable Bowel Syndrome; Irritable Bowel Syndrome - therapy; Randomized Controlled Trials as Topic; Treatment Outcome
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD012530.pub2

Irritable bowel syndrome (IBS) is a prevalent condition that currently lacks highly effective therapies for its management. Biofeedback has been proposed as a therapy that may help individuals learn to exert conscious control over sympatho-vagal balance as an indirect method of symptom management. Our primary objective was to assess the efficacy and safety of biofeedback-based interventions for IBS in adults and children. We searched the Cochrane Inflammatory Bowel Disease (IBD) Group Specialized Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Allied and Complementary Medicine Database (AMED) from inception to 24 July 2019. We also searched reference lists from published trials, trial registries, device manufacturers, conference proceedings, theses, and dissertations. We judged randomized controlled trials to be eligible for inclusion if they met the Association for Applied Psychophysiology and Biofeedback definition of biofeedback, and if they compared a biofeedback intervention to an active, sham, or no-treatment control for the management of IBS. Two authors independently screened trials for inclusion, extracted data, and assessed risk of bias. Primary outcomes were IBS global or clinical improvement scores and overall quality of life measures. Secondary outcome measures were adverse events, assessments of stool frequency and consistency, changes in abdominal pain, depression, and anxiety. For dichotomous outcomes, we calculated the risk ratio (RR) and 95% confidence interval (CI). For continuous outcomes, we calculated the mean difference (MD) and 95% CI. We used GRADE criteria to assess the overall certainty of the evidence. We identified eight randomized trials with a total of 300 adult participants for our analysis. We did not identify any trials in children. Four trials assessed thermal biofeedback. One trial assessed rectosigmoidal biofeedback. Two trials assessed heart rate variability biofeedback. Two trials assessed electrocutaneous biofeedback. Comparators were: no treatment (symptom monitoring group; three studies), attention control (pseudomeditation; two studies), relaxation control (one study), counseling (two studies), hypnotherapy (one study), standard therapy (one study), and sham biofeedback (one study). We judged all trials to have a high or unclear risk of bias. Global/Clinical improvement The clinical benefit of