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Open Access Highly Accessed Study protocol

A randomized physiotherapy trial in patients with fecal incontinence: design of the PhysioFIT-study

Esther MJ Bols12*, Bary CM Berghmans3, Erik JM Hendriks124, Rob A de Bie124, Jarno Melenhorst35, Wim G van Gemert35 and Cor GMI Baeten35

Author Affiliations

1 Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands

2 Caphri research institute, Maastricht University, The Netherlands

3 Pelvic care Center Maastricht, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands

4 Centre for Evidence Based Physiotherapy, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands

5 Department of Surgery, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands

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BMC Public Health 2007, 7:355  doi:10.1186/1471-2458-7-355

Published: 20 December 2007

Abstract

Background

Fecal incontinence (FI) is defined as the recurrent involuntary excretion of feces in inappropriate places or at inappropriate times. It is a major and highly embarrassing health care problem which affects about 2 to 24% of the adult population. The prevalence increases with age in both men and women.

Physiotherapy interventions are often considered a first-line approach due to its safe and non-invasive nature when dietary and pharmaceutical treatment fails or in addition to this treatment regime. Two physiotherapy interventions, rectal balloon training (RBT) and pelvic floor muscle training (PFMT) are widely used in the management of FI. However, their effectiveness remains uncertain since well-designed trials on the effectiveness of RBT and PFMT versus PFMT alone in FI have never been published.

Methods/Design

A two-armed randomized controlled clinical trial will be conducted. One hundred and six patients are randomized to receive either PFMT combined with RBT or PFMT alone. Physicians in the University Hospital Maastricht include eligible participants. Inclusion criteria are (1) adults (aged ≥ 18 years), (2) with fecal incontinence complaints due to different etiologies persisting for at least six months, (3) having a Vaizey incontinence score of at least 12, (4) and failure of conservative treatment (including dietary adaptations and pharmacological agents). Baseline measurements consist of the Vaizey incontinence score, medical history, physical examination, medication use, anorectal manometry, rectal capacity measurement, anorectal sensation, anal endosonography, defecography, symptom diary, Fecal Incontinence Quality of Life scale (FIQL) and the PREFAB-score. Follow-up measurements are scheduled at three, six and 12 months after inclusion. Skilled and registered physiotherapists experienced in women's health perform physiotherapy treatment. Twelve sessions are administered during three months according to a standardized protocol.

Discussion

This section discusses the decision to publish a trial protocol, the actions taken to minimize bias and confounding in the design, explains the choice for two treatment groups, discusses the secondary goals of this study and indicates the impact of this trial on clinical practice.

Trial registration

The Netherlands Trial Register ISRCTN78640169.