{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "General/Upper GI Surgery, Broomfield Hospital, Chelmsford, UK"
      ],
      "name": "Jeyam J Emmanuel"
    },
    {
      "affiliations": [
        "Department of Colorectal Surgery, Royal Berkshire NHS Foundation Trust, Reading, UK"
      ],
      "name": "Alison Wallace"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, University College London, London, UK"
      ],
      "name": "Julie Storrie"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, University College London, London, UK"
      ],
      "name": "Concetta Brugaletta"
    },
    {
      "affiliations": [
        "Sir Alan Parks Physiology Unit, St Mark’s Hospital, Harrow, Middlesex, UK",
        "Imperial College London, London, UK"
      ],
      "name": "Jonathan D Hodgkinson"
    },
    {
      "affiliations": [
        "Department of Colorectal Surgery, Royal Berkshire NHS Foundation Trust, Reading, UK"
      ],
      "name": "Kumaran Thiruppathy"
    }
  ],
  "title": "Analysis of virtually delivered biofeedback for bowel dysfunction and implications for future practice",
  "uid": "b41ecb34-6c0a-59df-b889-87f12cd00bf4"
}