Electroacupuncture at Baliao points added to anorectal biofeedback for spinal cord injury-related neurogenic bowel...

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.

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 weeks, 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 post-hoc model-stability, multiplicity, severity-transition, balloon-expulsion, and injury-completeness sensitivity analyses.

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, -5.2 ± 2.9 vs. -2.9 ± 1.9 points; adjusted difference, -2.1; 95% CI, -3.2 to -1.1; p < 0.001). In a post-hoc 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 p = 0.085). 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.

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.