This Critical Reviews of Incontinence Literature section has been established to promote scholarly debate on issues raised in recently published studies and important articles in our field.
Too often articles are presented in an "academic" manner without any acknowledgement of any underlying "conflict of interest" potential that may cloud the results. (To our knowledge, only the APTA's journal publishes a "conflict of interest rating" for each article. We can only hope that someday all journals will do so.)
This problem is especially prevalent in any new field, like incontinence, where most if not all of the specialized instruments and necessary supplies are "donated" to the researcher by the manufacturer. Researchers are always told the be "fair and impartial", and they obviously try. At the same time they are aware that if the results don't come out as expected, they won't be invited back for more research. Often critical facts are simply "omitted" to avoid making a product look bad, or irrelevant comparisons made to make a product look good. "Promising" in a new product research review means "they haven't made it work yet, but they "promise" it will get better!
Because we aim to stimulate intellectual debate on these topics, anyone with a contrary or complimentary view on any opinions expressed here is invited to submit their remarks for publication (Send to the webmaster).
Table of Contents
The Empire Strikes Back Series: We review two major incontinence drugs and two forms of electrical stimulation that -- in spite of enormous advertising budgets -- fail to produce results comparable to those obtained by EMG biofeedback. And check out our recent commentary on a new OAB study comparing Two Drugs with each other; neither comes close to even minimalist treatment with biofeedback
We have just published on this website the complete text of the 1986 masterpiece "From The Ghost in the Box to Successful Biofeedback Training", by Robert Shellenberger and Judith Green. "Ghost" points out the category and methodology errors of attempting to apply "drug research" models to biofeedback therapy. Then, to illustrate the continuing relavance of "Ghost", we drafted a critique of a brand new article by Edward B. Blanchard et al., "Direction of Temperature Control in the Thermal Biofeedback Treatment of Vascular Headache", in the journal Applied Psychophysiology and Biofeedback, 22:4 (December, 1997 -- but distributed in May, 1998!). Our next project will be a "ghost" evaluation of Burns et al (next below), which commited most of the same errors as Blanchard.
P.A. Burns, K. Pranikoff, T.H. Nochajski, E.C. Hadley, K.J. Levy, and M.G. Ory. A Comparison of Effectiveness of Biofeedback and Pelvic Muscle Exercise Treatment of Stress Incontinence in Older Community-Dwelling Woman. Journal of Gerontology, Vol. 48, No. 4, (p. M167-M-174). This is the study that the insurance companies are now using to deny reimbursement for biofeedback. Mistakes in patient selection, biofeedback protocols, and experimental design are pointed out.
Jeanette Tries and Eugene Eisman, Urinary Incontinence: Evaluation and Biofeedback Treatment, Chapter 23 in M. Schwartz, ed., Biofeedback: A Practitioner's Guide (2nd edition). Decidedly a minority viewpoint on the treatment of incontinence, these authors promote non-standard evaluations and their own instruments -- rather than reporting on the state of the art.
The BC/BS TEC Report on Biofeedback in the Treatment of Urinary Incontinence. This originally contained the complete text of the executive summary, but BC/BS demanded that we remove their "copyrighted material" from this website. That, in spite of the fact that the report was submitted to HCFA to make public policy. Why the secrecy? Click on it! You'll see why they didn't want the public to know what's in it.
The 1994 Ætna Life Insurance Company's analysis of biofeedback for incontinence, with critical comments pointing out their errors. The analysis included seven studies (n=219) which showed the superiority of biofeedback; one study [Burns, above (n=122)] in which biofeedback's superiority was not statistitically significant, and concluded, remarkably, that biofeedback did not add to the treatment of incontinence. They also included as evidence against biofeedback two studies (Ferguson and Castledon) which did not utilize and biofeedback training! Extraordinarily badly researched and written -- yet widely used by the insurance industry.
The Florida Medicare B Update (Jan/Feb 1998). Florida Medicare will no longer pay for repeated 51784 (EMG evaluations). Read this gem of bureaucratic reasoning. [They failed to consider that Florida has many more elderly persons than the national average, which is why there were more claims submitted.]
What HCFA already knows about biofeedback. An analysis of the HCFA TAC committee's 1997 minutes dealing with biofeedback in the treatment of incontinence.
What is the Best Treatment for Incontinence? Biofeedback or Electrical Stimulation? Home Trainers or Office instruments? It is difficult to compare research results when authors try to prevent comparisons! We converted a score of research reports to Kathy Burgio's "Symptom Reduction Rate" -- and the results may surprise you!
"Data-Based Evidence Supporting the Effectiveness of Incon Therapy™ Treatment for Urinary Incontinence" Published by ERA III Medical Ltd. A review of the "data" and research supporting Incon Therapy's claims to superiority.
"The Great Estim Hoax" is a review of the AHCPR Guideline on Urinary Incontinence in Adults (Second Edition, 1996) - Section on Electrical Stimulation. Based on the research, estim is vastly inferior to biofeedback in treating incontinence.
The Agency for Health Care Policy and Research (AHCPR) Guideline on Urinary Incontinence in Adults (Second edition, 1996) - Section on Biofeedback contains serious errors.
P. Paul, J. E. Cassisi, & P Larson. Ethical and Practice Considerations for Biofeedback Therapists in the Treatment of Urinary Incontinence. Biofeedback and Self-regulation, Vol. 21, No. 3, 1996 (p. 229-240)
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