Int J Surg. 2022 Apr 15;101:106617. doi: 10.1016/j.ijsu.2022.106617. Online ahead of print.

C Paasch ¹, L Bruckert ², S Soeder ³, J Von Frankenberg ⁴, R Mantke ⁵, E Lorenz ⁶, M Andric ⁷, A Wiede ⁸, A Strack ⁹, M Hünerbein ¹⁰, S Croner ¹¹

Author information

¹University Hospital Brandenburg an der Havel, Brandenburg Medical University, Germany; Department of General, Abdominal and Vascular- and Transplant Surgery, Otto-von-Guericke University Hospital, Magdeburg, Germany. Electronic address: Paasch.mhb@klinikum-brandenburg.de.

²Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: bruckert@stanford.edu.

³Physiotherapy Practice Söder, Berlin, Germany. Electronic address: sonjasoeder@gmx.de.

⁴University Hospital Brandenburg an der Havel, Brandenburg Medical University, Germany. Electronic address: j.frankenberg@klinikum-brandenburg.de.

⁵University Hospital Brandenburg an der Havel, Brandenburg Medical University, Germany; Brandenburg Medical School, Faculty of Medicine / Faculty of Health Sciences, Germany. Electronic address: mantke.mhb@klinikum-brandenburg.de.

⁶Visceral Vascular Surgery, Minimally Invasive Surgery Alexianer St. Hedwig Hospital, Berlin, Germany. Electronic address: e.lorenz@alexianer.de.

⁷Department of General, Abdominal and Vascular- and Transplant Surgery, Otto-von-Guericke University Hospital, Magdeburg, Germany. Electronic address: mihailo.andric@med.ovgu.de.

⁸Coordination Center for Clinical Studies Magdeburg, Otto-von-Guericke University Hospital Magdeburg, Germany. Electronic address: antje.wiede@med.ovgu.de.

⁹Practice Hospital Strack, Darmstadt, Germany. Electronic address: info@praxisklinik-strack.de.

¹⁰Department of Surgery, Oberhavel Klinik Oranienburg, Germany. Electronic address: michael.huenerbein@oberhavel-kliniken.de.

¹¹Department of General, Abdominal and Vascular- and Transplant Surgery, Otto-von-Guericke University Hospital, Magdeburg, Germany. Electronic address: roland.croner@med.ovgu.de.

Abstract

Introduction: Fecal incontinence refers to the inability to pass stool in a localized and timely manner resulting in the involuntary loss of intestinal contents such as air, intestinal mucus or stool. The prevalence of fecal incontinence in the general population is approximately 2-21%. Women are more frequently affected than men. Physiotherapeutically guided pelvic floor training, otherwise known as Kegel exercise, is the mainstay of treatment for fecal incontinence. The objective of this study was to evaluate the feasibility and potential benefits of a new biofeedback training, which uses a non-insertable pelvic floor sensor with digital interface, called ACTICORE1.

Methods: From January 2020 to April 2021, we conducted a prospective non-randomized multicentric clinical pilot study at the Alexianer St. Hedwig Hospital Berlin (Germany), private clinic Strack (Germany) and the University Hospital Magdeburg (Germany). Patients with fecal incontinence, defined as a Wexner score >2, were recruited and asked to either perform biofeedback training with ACTICORE1 (6 min daily for 16 weeks) or daily Kegel exercise (Physiotherapeutic guidance weekly for the first 6 weeks; biweekly for the remaining 10 weeks). The primary outcome was severity of fecal incontinence after 16 weeks of training assessed using the Wexner score. Secondary outcomes were severity of fecal incontinence after 12 weeks and patients' quality of life assessed using the EQ-5D-3L questionnaire after 16 weeks of training. The two-one-sided t-tests (TOST) procedure was used to determine if training with ACTICORE1 has equivalent or noninferior efficacies compared to Kegel exercise.

Results: A total of 40 individuals were included. Dropout occurred in 4 cases. The final sample included 19 patients who performed the ACTICORE1 training (ACTICORE-group) and 17 patients who performed guideline-based physiotherapy (PHYSIO-group). Univariate analysis of biometric parameters showed no statistically significant differences. Individuals in the ACTICORE-group were younger (M=46,6 (SD=18,9) years vs. M=57,1 (SD=17,3) years, p=0.093). In terms of endpoint evaluation, a non-inferiority of ACTICORE1 compared to the therapy standard (Kegel exercise) was detected. Both groups showed a statistically significant intraindividual improvement in fecal incontinence as measured by Wexner scoring after 16 weeks. The TOST detected a non-inferiority of ACTICORE1 training (98% confidence interval with equivalence bounds 5 for low and high; Results: 1.36, upper 6.75).

Conclusion: Pelvic floor training with ACTICORE1 may enable sufficient pelvic floor training as a digital health application. The study at hand revealed a non-inferiority of ACTICORE1 training compared to Kegel exercise.