{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:39:20Z","timestamp":1785775160948,"version":"3.56.0"},"reference-count":43,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T00:00:00Z","timestamp":1694131200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["RP\u2010PG\u20100612\u201020001"],"award-info":[{"award-number":["RP\u2010PG\u20100612\u201020001"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>The aim was to determine whether specialist\u2010led habit training using Habit Training with Biofeedback (HTBF) is more effective than specialist\u2010led habit training alone (HT) for chronic constipation and whether outcomes of interventions are improved by stratification to HTBF or HT based on diagnosis (functional defaecation disorder vs. no functional defaecation disorder) by radio\u2010physiological investigations (INVEST).<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This was a parallel three\u2010arm randomized single\u2010blinded controlled trial, permitting two randomized comparisons: HTBF versus HT alone; INVEST\u2010 versus no\u2010INVEST\u2010guided intervention. The inclusion criteria were age 18\u201370\u2009years; attending specialist hospitals in England; self\u2010reported constipation for &gt;6\u2009months; refractory to basic treatment. The main exclusions were secondary constipation and previous experience of the trial interventions. The primary outcome was the mean change in Patient Assessment of Constipation Quality of Life score at 6\u2009months on intention to treat. The secondary outcomes were validated disease\u2010specific and psychological questionnaires and cost\u2010effectiveness (based on EQ\u20105D\u20105L).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all, 182 patients were randomized 3:3:2 (target 384): HT <jats:italic>n<\/jats:italic>\u2009=\u200968; HTBF <jats:italic>n<\/jats:italic>\u2009=\u200968; INVEST\u2010guided treatment <jats:italic>n<\/jats:italic>\u2009=\u200946. All interventions had similar reductions (improvement) in the primary outcome at 6\u2009months (approximately \u22120.8 points of a 4\u2010point scale) with no statistically significant difference between HT and HTBF (\u22120.03 points; 95% CI \u22120.33 to 0.27; <jats:italic>P<\/jats:italic>\u2009=\u20090.85) or INVEST versus no\u2010INVEST (0.22; \u22120.11 to 0.55; <jats:italic>P<\/jats:italic>\u2009=\u20090.19). Secondary outcomes showed a benefit for all interventions with no evidence of greater cost\u2010effectiveness of HTBF or INVEST compared with HT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The results of the study at 6\u2009months were inconclusive. However, with the caveat of under\u2010recruitment and further attrition at 6\u2009months, a simple, cheaper approach to intervention may be as clinically effective and more cost\u2010effective than more complex and invasive approaches.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.16738","type":"journal-article","created":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T04:07:06Z","timestamp":1694232426000},"page":"2243-2256","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Habit training versus habit training with direct visual biofeedback in adults with chronic constipation: A randomized controlled trial"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2259-0948","authenticated-orcid":false,"given":"Christine","family":"Norton","sequence":"first","affiliation":[{"name":"Faculty of Nursing Midwifery and Palliative Care, King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sybil","family":"Bannister","sequence":"additional","affiliation":[{"name":"Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry Queen Mary University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley","family":"Booth","sequence":"additional","affiliation":[{"name":"Bowel Research UK, Registered Charity  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve R.","family":"Brown","sequence":"additional","affiliation":[{"name":"Sheffield Teaching Hospitals NHS Trust &amp; University of Sheffield  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0501-0289","authenticated-orcid":false,"given":"Samantha","family":"Cross","sequence":"additional","affiliation":[{"name":"Department Biostatistics and Health Informatics Institute of Psychology, Psychiatry and Neuroscience, King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Eldridge","sequence":"additional","affiliation":[{"name":"Pragmatic Clinical Trials Unit Institute of Population Health Sciences, Barts and the London School of Medicine and dentistry, Queen Mary University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Emmett","sequence":"additional","affiliation":[{"name":"County Durham and Darlington NHS Foundation Trust  Durham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"Grossi","sequence":"additional","affiliation":[{"name":"Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts and the London School of Medicine and Dentistry Queen Mary University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Jordan","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School University of Warwick  Warwick UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Lacy\u2010Colson","sequence":"additional","affiliation":[{"name":"Royal Shrewsbury Hospital Shrewsbury and Telford Hospital NHS Trust  Shrewsbury UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Mason","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School University of Warwick  Warwick UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"McLaughlin","sequence":"additional","affiliation":[{"name":"Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health University of Manchester and Manchester Academic Health Sciences Centre  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rona","family":"Moss\u2010Morris","sequence":"additional","affiliation":[{"name":"Department of Psychology, Institute of Psychology, Psychiatry and Neuroscience King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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