{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T05:49:11Z","timestamp":1791870551762,"version":"4.3.4"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n Neurogenic bowel dysfunction (NBD) after spinal cord injury (SCI) remains difficult to manage in rehabilitation practice. Anorectal biofeedback targets defecatory coordination, whereas electroacupuncture at Baliao points may provide an additional sacral-region intervention. This study evaluated short-term between-group associations when Baliao electroacupuncture was added to anorectal biofeedback; it was not designed to isolate an electroacupuncture-specific effect.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This single-center prospective preference-allocated comparative study enrolled 106 consecutive patients with SCI-related NBD between March 2024 and August 2025. Fifty-two received anorectal biofeedback alone and 54 received Baliao electroacupuncture plus biofeedback. The protocol scheduled 18 treatment sessions over approximately 6\u202fweeks, with assessments at baseline, week 6, and week 12. Week 6 NBD score was the sole primary comparison. Covariate-adjusted models, propensity-score overlap weighting, mixed-effects models, and inverse-probability-of-follow-up weighting were supplemented by\n post-hoc<\/jats:italic>\n model-stability, multiplicity, severity-transition, balloon-expulsion, and injury-completeness sensitivity analyses.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Week 6 assessments were completed by 51\/52 patients in the biofeedback group and 52\/54 in the combined-treatment group. NBD score decreased more in the combined-treatment group (change, \u22125.2\u202f\u00b1\u202f2.9 vs. \u22122.9\u202f\u00b1\u202f1.9 points; adjusted difference, \u22122.1; 95% CI, \u22123.2 to \u22121.1;\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). In a\n post-hoc<\/jats:italic>\n Holm sensitivity analysis at week 6, PAC-QOL, anal relaxation during straining, and RMSSD remained below 0.05 across non-primary outcomes, whereas the small spontaneous-bowel-movement difference did not (Holm-adjusted\n p<\/jats:italic>\n \u202f=\u202f0.085). The primary NBD estimate was similar in baseline-adjusted, parsimonious, full, overlap-weighted, and 2,000-replicate bootstrap analyses. At week 12, only the NBD-score difference remained below 0.05 after Holm adjustment.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In this preference-allocated, non-randomized study, adding Baliao electroacupuncture to biofeedback was associated with a modestly larger short-term reduction in NBD score. Secondary and physiological findings were exploratory, and the design does not establish an electroacupuncture-specific contribution, causal superiority, or durable benefit. Confirmation requires prospectively registered, adequately powered randomized trials with attention-matched controls, blinded outcome assessment, and longer follow-up.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1866886","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:46:01Z","timestamp":1786509961000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Electroacupuncture at Baliao points added to anorectal biofeedback for spinal cord injury\u2013related neurogenic bowel dysfunction: a single-center prospective preference-allocated comparative study"],"prefix":"10.3389","volume":"13","author":[{"given":"Mingxuan","family":"Liao","sequence":"first","affiliation":[{"name":"General Hospital of The Yangtze River Shipping, Wuhan Brain Hospital","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Huang","sequence":"additional","affiliation":[{"name":"General Hospital of The Yangtze River Shipping, Wuhan Brain Hospital","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Mo","sequence":"additional","affiliation":[{"name":"General Hospital of The Yangtze River Shipping, Wuhan Brain Hospital","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1016\/S0140-6736(96)91487-7","article-title":"Bowel dysfunction in spinal-cord-injury patients","volume":"347","author":"Glickman","year":"1996","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1093\/ptj\/82.6.601","article-title":"Neurogenic bladder, neurogenic bowel, and sexual dysfunction in people with spinal cord injury","volume":"82","author":"Benevento","year":"2002","journal-title":"Phys Ther"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"F1000 Faculty Rev-1800.","DOI":"10.12688\/f1000research.20529.1","article-title":"Neurogenic bowel dysfunction","volume":"8","author":"Emmanuel","year":"2019","journal-title":"F1000Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1038\/sc.2008.137","article-title":"Management of neurogenic bowel dysfunction in the community after spinal cord injury: a postal survey in the United Kingdom","volume":"47","author":"Coggrave","year":"2009","journal-title":"Spinal Cord"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.3390\/jpm12071141","article-title":"Neurogenic bowel and management after spinal cord injury: a narrative review","volume":"12","author":"Rodriguez","year":"2022","journal-title":"J Pers Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1038\/sc.2010.14","article-title":"Neurogenic bowel management after spinal cord injury: a systematic review of the evidence","volume":"48","author":"Krassioukov","year":"2010","journal-title":"Spinal Cord"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"75","DOI":"10.46292\/sci2702-75","article-title":"Management of neurogenic bowel dysfunction in adults after spinal cord injury: clinical practice guideline for health care providers","volume":"27","author":"Johns","year":"2021","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"35","DOI":"10.2340\/16501977-0277","article-title":"Relationship between neurogenic bowel dysfunction and health-related quality of life in persons with spinal cord injury","volume":"41","author":"Liu","year":"2009","journal-title":"J Rehabil Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1038\/sj.sc.3102121","article-title":"The pattern of colorectal dysfunction changes with time since spinal cord injury","volume":"46","author":"Faaborg","year":"2008","journal-title":"Spinal Cord"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1016\/j.apmr.2015.01.011","article-title":"Outcomes of neurogenic bowel management in individuals living with a spinal cord injury for at least 10 years","volume":"96","author":"Adriaansen","year":"2015","journal-title":"Arch Phys Med Rehabil"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1186\/s13018-023-03946-8","article-title":"Effect of neurogenic bowel dysfunction symptoms on quality of life after a spinal cord injury","volume":"18","author":"Khadour","year":"2023","journal-title":"J Orthop Surg Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1038\/s41393-022-00786-x","article-title":"Guideline for the management of neurogenic bowel dysfunction in spinal cord injury\/disease","volume":"60","author":"Kurze","year":"2022","journal-title":"Spinal Cord"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"10","DOI":"10.46292\/sci23-00065","article-title":"How can we treat if we do not measure: a systematic review of neurogenic bowel objective measures","volume":"30","author":"Stampas","year":"2024","journal-title":"Topics in Spinal Cord Injury Rehabilitation"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1038\/sj.sc.3101887","article-title":"Neurogenic bowel dysfunction score","volume":"44","author":"Krogh","year":"2006","journal-title":"Spinal Cord"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1038\/sc.2017.82","article-title":"Reliability, validity and sensitivity to change of neurogenic bowel dysfunction score in patients with spinal cord injury","volume":"55","author":"Erdem","year":"2017","journal-title":"Spinal Cord"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1080\/00365520510012208","article-title":"Development and validation of the patient assessment of constipation quality of life questionnaire","volume":"40","author":"Marquis","year":"2005","journal-title":"Scand J Gastroenterol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/j.gtc.2008.06.011","article-title":"Dyssynergic defecation and biofeedback therapy","volume":"37","author":"Rao","year":"2008","journal-title":"Gastroenterol Clin N Am"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"423","DOI":"10.5056\/jnm16060","article-title":"Diagnosis and treatment of Dyssynergic defecation","volume":"22","author":"Rao","year":"2016","journal-title":"J Neurogastroenterol Motil"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1038\/sc.2016.67","article-title":"Anorectal biofeedback for neurogenic bowel dysfunction in incomplete spinal cord injury","volume":"54","author":"Mazor","year":"2016","journal-title":"Spinal Cord"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1007\/BF02054687","article-title":"Biofeedback treatment is ineffective in neurogenic fecal incontinence","volume":"39","author":"van Tets","year":"1996","journal-title":"Dis Colon Rectum"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"364216","DOI":"10.1155\/2013\/364216","article-title":"Acupuncture for spinal cord injury and its complications: a systematic review and meta-analysis of randomized controlled trials","volume":"2013","author":"Heo","year":"2013","journal-title":"Evid Based Complement Alternat Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"543174","DOI":"10.1155\/2013\/543174","article-title":"Electroacupuncture improves bladder and bowel function in patients with traumatic spinal cord injury: results from a prospective observational study","volume":"2013","author":"Liu","year":"2013","journal-title":"Evid Based Complement Alternat Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1007\/s00384-023-04403-y","article-title":"Electroacupuncture at Baliao point alleviates post-operative pain and anal distension after procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy): a prospective randomized clinical trial","volume":"38","author":"Shen","year":"2023","journal-title":"Int J Color Dis"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/s00384-024-04628-5","article-title":"Efficacy of electroacupuncture therapy in patients with functional anorectal pain: study protocol for a multicenter randomized controlled trial","volume":"39","author":"Xue","year":"2024","journal-title":"Int J Color Dis"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e13679","DOI":"10.1111\/nmo.13679","article-title":"The international anorectal physiology working group (IAPWG) recommendations: standardized testing protocol and the London classification for disorders of anorectal function","volume":"32","author":"Carrington","year":"2020","journal-title":"Neurogastroenterol Motil"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1161\/01.CIR.93.5.1043","article-title":"Heart rate variability: standards of measurement, physiological interpretation and clinical use","volume":"93","year":"1996","journal-title":"Circulation"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"258","DOI":"10.3389\/fpubh.2017.00258","article-title":"An overview of heart rate variability metrics and norms","volume":"5","author":"Shaffer","year":"2017","journal-title":"Front Public Health"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.3390\/jpm12071110","article-title":"Autonomic dysfunction and management after spinal cord injury: a narrative review","volume":"12","author":"Henke","year":"2022","journal-title":"J Pers Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"361","DOI":"10.2105\/ajph.94.3.361","article-title":"Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement","volume":"94","author":"Des Jarlais","year":"2004","journal-title":"Am J Public Health"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e1000261","DOI":"10.1371\/journal.pmed.1000261","article-title":"Revised standards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement","volume":"7","author":"MacPherson","year":"2010","journal-title":"PLoS Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"3661","DOI":"10.1002\/sim.6607","article-title":"Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies","volume":"34","author":"Austin","year":"2015","journal-title":"Stat Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"2417","DOI":"10.1001\/jama.2020.7819","article-title":"Overlap weighting: a propensity score method that mimics attributes of a randomized clinical trial","volume":"323","author":"Thomas","year":"2020","journal-title":"JAMA"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1179\/1079026812Z.00000000053","article-title":"International standards to document remaining autonomic function after spinal cord injury","volume":"35","author":"Krassioukov","year":"2012","journal-title":"J Spinal Cord Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e14667","DOI":"10.1111\/nmo.14667","article-title":"Lack of improvement in anorectal manometry parameters after implementation of a pelvic floor\/anal sphincter biofeedback in persons with motor-incomplete spinal cord injury","volume":"35","author":"Aloysius","year":"2023","journal-title":"Neurogastroenterol Motil"}],"updated-by":[{"DOI":"10.3389\/fmed.2026.2008883","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000}}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1866886\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T05:43:34Z","timestamp":1791870214000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1866886\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":34,"alternative-id":["10.3389\/fmed.2026.1866886"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1866886","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]},"article-number":"1866886"}}