Predictors of a favorable outcome of physiotherapy in fecal incontinence: secondary analysis of a randomized trial

Abstract

Aims: It is unclear which patients with fecal incontinence (FI) are likely to benefit from physiotherapy treatment, which is relevant for medical decision making and patient counseling. This study aimed to identify patient characteristics predicting a favorable outcome of physiotherapy.

Methods: Eighty patients with FI, with a mean age of 59.3 (SD ± 11.9), were recruited at the Maastricht University Medical Centre and enrolled in a randomized controlled trial, which assessed the effect of adding rectal balloon training to pelvic floor muscle training. Treatment groups were combined for prediction modeling. Candidate predictors were obtained from demographics, medical history, physical examination, baseline tests, questionnaires, and physiotherapy diagnostics. Favorable outcome was defined as a combination of: (i) Vaizey score reduction ≥ 5 points, and (ii) "slightly" to "very much improved" on the nine-point global perceived effect score. Predictors were identified by univariable and multivariable logistic regression analysis.

Results: Thirty-seven patients (46.3%) had a favorable outcome. Multivariable analysis showed that longer time since FI onset appeared to be associated with an unfavorable outcome (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.47-1.00; P = 0.05), whereas the use of constipating medication (OR, 3.79; CI, 0.99-14.51; P = 0.05), any obstetric factor (OR, 2.15; CI, 0.94-4.89; P = 0.07), and experiencing minor embarrassment (OR, 2.12; CI, 1.10-4.09; P = 0.03) predicted a favorable outcome.

Conclusions: The small subset of identified predictors for a favorable outcome may be relevant in patient counseling and targeting physiotherapy treatment more efficiently, especially as they are available early in the diagnostic process.