***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Despite its high prevalence in stroke survivors , there is little clinical research on bowel dysfunction in this population . This is the first r and omized controlled trial to evaluate treatment of constipation and fecal incontinence in stroke survivors . Methods — Stroke patients with constipation or fecal incontinence were identified by screening question naire ( 122 community , 24 stroke rehabilitation in patients ) and r and omized to intervention or routine care ( 73 per group ) . The intervention consisted of a 1-off structured nurse assessment ( history and rectal examination ) , leading to targeted patient/carer education with booklet and provision of diagnostic summary and treatment recommendations ( after consultation with geriatrician ) to patient ’s general practitioner (GP)±ward physician . Results — Percentage of bowel movements ( BMs ) per week grade d as “ normal ” by participants in a prospect i ve 1-week stool diary was significantly higher in intervention versus control patients at 6 months ( 72 % versus 55 % ; P=0.027 ) , as was mean number of BMs per week ( 5.2 versus 3.6 ; P=0.005 ) . There was no significant reduction in fecal incontinence , although numbers were small . At 12 months , intervention patients were more likely to be modifying their diets ( odds ratio [ OR ] , 3.1 [ 1.2 to 8.0 ] ) and fluid intake ( OR , 4.2 [ 1.4 to 12.2 ] ) to control their bowels and to have visited their GP for their bowel problem ( OR , 5.0 [ 1.4 to 17.5 ] ) . GP prescribing of laxatives and suppositories was significantly influenced at 12 months . Conclusions — A single clinical /educational nurse intervention in stroke patients  effectively improved symptoms of bowel dysfunction up to 6 months later , changed bowel-modifying lifestyle behaviors up to 12 months later , and influenced patient – GP interaction and physician prescribing patterns Objective : To investigate whether additional early physiotherapy after stroke improved functional recovery in stroke patients . Design : A prospect i ve , r and omized , controlled study . Setting : One stroke ward and an acute stroke unit in a large teaching hospital , southern China . Subjects : Patients with first-onset stroke consecutively admitted to the stroke centre . Interventions : One group ( n = 78 ) received additional early physiotherapy ( AEP ) for 45 minutes , five days a week for four weeks starting within the first week since stroke onset ; the routine therapy ( RT ) group ( n = 78 ) received no professional rehabilitation therapy . Main outcome measures : Glasgow Coma Scale , Mini-Mental State Examination , Fugl-Meyer Assessment of Motor Recovery , Clinical Neurological Deficit Scale and Modified Barthel Index ( MBI ) . Results : Patients from the AEP group had a high drop-out rate ( n = 28 ) , but those remaining made relatively better functional recovery at 30 days than those from the RT group if measured by MBI . Multiple linear regression analysis revealed that cognitive disturbance , aphasia , double incontinence , site of lesion and sensory impairment might affect functional recovery after stroke . Conclusions : Additional early physiotherapy might improve independence of patients after stroke but failed to show benefit in other aspects in our study . Cognitive disturbance , aphasia , double incontinence , site of lesion as well as sensory impairment might affect functional outcome after stroke OBJECTIVES To examine skin health outcomes of an exercise and incontinence intervention . DESIGN R and omized controlled trial with blinded assessment s of outcomes at three points over 8 months . SETTING Four nursing homes ( NHs ) . PARTICIPANTS One hundred ninety incontinent NH residents . INTERVENTION In the intervention group , research staff provided exercise and incontinence care every 2 hours from 8:00 a.m. to 4:30 p.m. ( total of four daily care episodes ) 5 days a week for 32 weeks . The control group received usual care from NH staff . MEASUREMENTS Perineal skin wetness and skin health outcomes ( primarily blanchable erythema and pressure ulcers ) as measured by direct assessment s by research staff , urinary and fecal incontinence frequency , and percentage of behavioral observations with resident engaged in st and ing or walking . RESULTS Intervention subjects were significantly better in urinary and fecal incontinence , physical activity , and skin wetness outcome measures than the control group . However , despite these improvements , differences in skin health measures were limited to the back distal perineal area , which included the sacral and trochanter regions . There was no difference between groups in the incidence rate of pressure ulcers as measured by research staff , even though those residents who improved the most on fecal incontinence showed improvement in pressure ulcers in one area . CONCLUSION A multifaceted intervention improved four risk factors related to skin health but did not translate into significant improvements in most measures of skin health . Even if they had adequate staffing re sources , NHs might not be able to improve skin health quality indicators significantly if they attempt to implement preventive interventions on all residents who are judged at risk because of their incontinence status The purpose of this study was to determine whether biofeedback benefits children with dyssynergic defecation and constipation/encopresis  , and whether home biofeedback improves long-term outcomes . Thirty-six patients with chronic constipation who had failed at least 6 months of conventional treatment and demonstrated dyssynergic defecation at anorectal manometry were r and omized to biofeedback in the laboratory alone ( group 1 , n=24 ) or in the laboratory and at home ( group 2 , n=12 ) and followed up at 2 , 4 , and a mean of 44 months . Thirty patients were available for long-term follow-up .  Bowel movements increased in all from a mean of 1.4/week to 5.1 , 5.8 , and 5.1 per week at 2 months , 4 months , and long-term , respectively ( p ≤0.001 ) . Soiling decreased in all from a mean of 5.5/week to 0.6 , 0.1 , and 1 per week at 2 months , 4 months , and long-term , respectively ( p ≤0.001 ) . Laxative use decreased from a mean of 4.1 days/week to 0.6 , 0.3 , and 0.7 per week at 2 months , 4 months , and long-term , respectively ( p ≤0.001 ) . Twenty-seven of 30 parents ranked their satisfaction a mean of 2.2 ( range 1-excellent to 3-good ) . There were no significant differences in outcomes between the laboratory alone group and the laboratory plus home group . Biofeedback is beneficial for some children with  chronic constipation and dyssynergic defecation . Supplemental home biofeedback does not improve long-term outcomes Abstract BACKGROUND : A prospect i ve , three-armed , r and omized , controlled trial was performed to assess whether pelvic floor exercises with biofeedback using anal manometry or transanal ultrasound are superior to pelvic floor exercises with feedback from digital examination alone in terms of continence , quality of life , physiologic sphincter strength , and compliance . Its secondary objectives were to assess whether there are any differences in these outcomes between biofeedback with transanal ultrasound vs. anal manometry and to correlate the physiologic measures with clinical outcome . METHODS : One hundred twenty patients with mild to moderate fecal incontinence were r and omized into one of three treatment groups : biofeedback with anal manometry , biofeedback with transanal ultrasound , or pelvic floor exercises with feedback from digital examination alone . Commencing one week after an initial 45-minute assessment session , patients attended monthly treatments for a total of five sessions . Each session lasted 30 minutes and involved sphincter exercises with biofeedback that involved instrumentation or digital examination alone , and patients were encouraged to perform identical exercises twice per day between outpatient visits . RESULTS : One hundred two patients ( 85 percent ) completed the four-month treatment program . Across all treatment allocations , patients experienced modest but highly significant improvements in all nine outcome measures during treatment , with 70 percent of all patients perceiving improvement in symptom severity and 69 percent of patients reporting improved quality of life . With the possible exception of isotonic fatigue time , there were no significant differences between the three treatment groups in compliance , physiologic sphincter strength , and clinical or quality -of-life measures . Correlations between physiologic measures and clinical outcomes were much stronger with ultrasound-based measures than with manometry . CONCLUSIONS : Although patients in this study who completed pelvic floor exercises with feedback from digital examination achieved no additional benefit from biofeedback and measurement with transanal ultrasound or manometry , it may be that the guidance received through digital examination alone offered patients in the pelvic floor exercise group an effective biofeedback mechanism . Contrary to our hypothesis , the use of transanal ultrasound offered no benefit over manometry , but the use of ultrasound for isotonic fatigue time and isometric fatigue contractions provided potentially important physiologic measures that require further study . This study has confirmed , through a large sample of patients , that pelvic floor retraining programs are an effective treatment for improving physiologic , clinical , and quality -of-life parameters in the short term Background and aims Faecal incontinence is a distressing problem that is often not amenable to surgical correction . Chronic low-frequency electrical stimulation of damaged axons is thought to reduce synaptic resistance , increase the size of motor units by axonal sprouting and increase the rate of conduction of the pudendal nerve . The aim of this study was to prospect ively evaluate the effect of chronic low-frequency endo-anal electrical stimulation on faecal incontinence using a home-based unit and hospital-supervised therapy . Material s and methods Forty-eight patients with faecal incontinence completed a prospect i ve r and omised trial . Patients were allocated r and omly to one of two groups ; group 1 was exposed to endo-anal pudendal nerve stimulation daily at home with a portable home unit , group 2 attended the physiotherapy department for endo-anal electrical stimulation under supervision . Results Continence scores improved significantly after treatment in both groups ( p<0.001 ) . Both groups showed improved manometric scores , although only group 1 showed significant improvement in both resting and squeeze pressures ( mean total resting pressure 184–224 mmHg , p<0.001 ; mean total squeeze pressure 253–337 mmHg , p<0.001 ) . This was also reflected by an improvement in quality of life in both groups . Conclusions Low-frequency endo-anal electrical stimulation significantly improves continence scores and quality of life in patients with faecal incontinence not amenable to surgical correction . It leads to improved manometric values when carried out on a daily basis with a portable home unit Background : Prevalence studies of faecal incontinence in the general population are rare and the impact of faecal incontinence on quality of life has not been previously addressed . Aims : To establish the prevalence of faecal incontinence in adults in terms of frequency of leakage , degree of soiling , and level of impact on quality of life . Methods : In a cross sectional postal survey , 15 904 adults aged 40 years or more ( excluding residents of nursing and residential homes ) were selected r and omly by household from the Leicestershire Health Authority patient register . Participants were asked to complete a confidential health question naire . Major faecal incontinence was defined as soiling of underwear or worse with a frequency of several times a month or more . Respondents were also asked if bowel symptoms had an impact on their quality of life . Results : From a total sample of 10 116 respondents , 1.4 % reported major faecal incontinence and 0.7 % major faecal incontinence with bowel symptoms that had an impact on quality of life . Major faecal incontinence was significantly associated with a lot of impact on quality of life ( odds ratio 12.4 , 95 % confidence interval 7.5–20.6 ) . Incontinence was more prevalent and more severe in older people but there was no significant difference between men and women . Conclusions : This study has confirmed that faecal incontinence is a fairly common symptom , particularly in older people . Faecal incontinence in men has received little attention in the past and the results from this study indicate that it is as much of a problem in men as it is in women while the level of unmet need in this group is high . Estimates of need for health care for this symptom should be multidimensional and assess both the severity of symptoms and the impact it has on quality of life In order to evaluate the efficacy of  biofeedback  for childhood encopresis , 50 children with encopresis were prospect ively studied and r and omized to receive biofeedback ( B ) or mineral oil therapy ( M ) . Specificity of  biofeedback  was also evaluated by comparing outcomes of both regimens in children with normal ( n = 32 ) and abnormal ( n = 18 ) defecation patterns . Using a single blinded design , there were no significant differences in clinical outcomes between the 24 children receiving B and the 26 children receiving M at 3 , 6 , and 12 months . However , at 12 months six of nine children with abnormal defecation patterns were in remission or markedly improved after receiving B , compared to only three of nine children receiving M. In contrast , children with normal patterns appeared to respond better to M than did those receiving B ( 71 vs. 40 % at 12 months ) . Biofeedback appears to warrant further evaluation in children with encopresis and abnormal defecation patterns OBJECTIVE Abnormal defecation dynamics often are present in children with chronic constipation and encopresis . Patients who learned normal defecation dynamics with biofeedback treatment had improved short 
    Output:
    
There are suggestions that rectal volume discrimination training improves continence more than sham training and that anal biofeedback combined with exercises and electrical stimulation provides more short-term benefits than vaginal biofeedback and exercises for women with obstetric-related faecal incontinence .
The limited number of identified trials together with their method ological weaknesses do not allow a definitive assessment of the possible role of anal sphincter exercises and biofeedback therapy in the management of people with faecal incontinence .
We found no evidence of biofeedback or exercises enhancing the outcome of treatment compared to other conservative management methods .
While there is a suggestion that some elements of biofeedback therapy and sphincter exercises may have a therapeutic effect , this is not certain .