{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T19:27:53Z","timestamp":1790969273852,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pelvic floor biofeedback therapy (BFT) is the mainstay treatment for dyssynergic defecation, a condition defined by the Rome criteria. This retrospective study compares outcomes between patients referred for EMG\u2010based BFT after anorectal manometry and balloon expulsion testing (ARM group) and those referred directly without prior ARM (DR group).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Records of 466 patients who underwent BFT by a single therapist between 2019 to 2023 were reviewed. Inclusion criteria of referral for constipation, no opioid use, and \u2265\u20092 BFT sessions yielded 208 patients: 137 in the ARM group and 71 in the DR group. Outcomes were assessed using the Colorectal\u2010Anal Distress Inventory\u20108 (CRADI\u20108), abdominal pain and quality\u2010of\u2010life impact scores, and therapist\/patient ratings. Statistical analysis included Fisher's exact and Wilcoxon rank\u2010sum tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Results<\/jats:title>\n                    <jats:p>\n                      Of the 208 patients meeting criteria, 50% achieved successful outcomes and 50% were unsuccessful, including those lost to follow\u2010up. Success rates did not differ significantly between the ARM and DR groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.393), although the ARM group had worse baseline symptoms (CRADI\u20108, strain, and empty scores). A successful outcome was associated with significant improvements in the strain and emptying subscores of the CRADI\u20108, and in quality\u2010of\u2010life limitation scores in both groups. Higher body weight and the absence of documentation of anxiety\/depression were associated with success. ARM diagnoses and balloon expulsion test results were not associated with outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions &amp; Inferences<\/jats:title>\n                    <jats:p>Similar outcomes to BFT were seen in both ARM and DR groups. BFT should be initiated based on clinical assessment when ARM access is limited.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70373","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T05:41:32Z","timestamp":1780465292000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Outcome of\n                    <scp>EMG<\/scp>\n                    \u2010Based Pelvic Floor Biofeedback in Patients With Constipation\u2014Impact of Prior Anorectal Manometry\/Balloon Expulsion Test for Patient Selection. A Retrospective Study"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0682-7258","authenticated-orcid":false,"given":"Smriti","family":"Kochhar","sequence":"first","affiliation":[{"name":"Department of Medicine Penn State Health Milton S. Hershey Medical Center  Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theja","family":"Channapragada","sequence":"additional","affiliation":[{"name":"Department of Medicine Penn State Health Milton S. Hershey Medical Center  Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinayak","family":"Shenoy","sequence":"additional","affiliation":[{"name":"Department of Medicine Penn State Health Milton S. Hershey Medical Center  Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Murone","sequence":"additional","affiliation":[{"name":"Department of Medicine Penn State Health Milton S. Hershey Medical Center  Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Low","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy Penn State Health Milton S. Hershey Medical Center  Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjia","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Penn State College of Medicine  Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Ouyang","sequence":"additional","affiliation":[{"name":"Department of Medicine Penn State Health Milton S. Hershey Medical Center  Hershey Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2023.03.214"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.12520"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2006.12.023"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10484\u2010020\u201009476\u2010x"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2017.10.027"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003267"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.05.015"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.13679"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.12.025"},{"key":"e_1_2_11_13_1","unstructured":"\u201cR: A Language and Environment for Statistical Computing\u201d."},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0b013e318266f43a"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.14174"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2023.05.025"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620\u2010021\u201007094\u2010z"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.20934"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000001529"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620\u2010023\u201008246\u2010z"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/nmo.14948"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.05.014"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/1019652"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572\u20100241.2002.07113.x"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.00000000000013"}],"container-title":["Neurogastroenterology &amp; Motility"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.70373","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/nmo.70373","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nmo.70373","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T08:54:49Z","timestamp":1784364889000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nmo.70373"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/nmo.70373"],"URL":"https:\/\/doi.org\/10.1111\/nmo.70373","archive":["Portico"],"relation":{},"ISSN":["1350-1925","1365-2982"],"issn-type":[{"value":"1350-1925","type":"print"},{"value":"1365-2982","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2025-06-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70373"}}