Gastroenterology

Gastroenterology

Volume 152, Issue 1, January 2017, Pages 82-91
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
Effectiveness of Pelvic Physiotherapy in Children With Functional Constipation Compared With Standard Medical Care

https://doi.org/10.1053/j.gastro.2016.09.015Get rights and content

Background & Aims

Functional constipation (FC) is a common childhood problem often related to pelvic floor muscle dysfunction. We compared the effectiveness of pelvic physiotherapy (PPT) vs standard medical care (SMC) in children with FC.

Methods

We performed a multicenter randomized controlled trial of 53 children (age, 5–16 y) with FC according to the Rome III criteria, at hospitals in The Netherlands from December 2009 to May 2014. Group allocation was concealed using a central computer system. SMC consisted of education, toilet training, and laxatives (n = 26), whereas PPT included SMC plus specific physiotherapeutic interventions (n = 27). Results were obtained from written reports from the subjects’ pediatricians and parents. The primary outcome was absence of FC, according to Rome III criteria, after a 6-month follow-up period. Secondary outcomes were global perceived effect (range, 1–9; success was defined as a score ≥ 8), numeric rating scales assessing quality of life (parent and child; scale, 1–10), and the strengths and difficulties questionnaire (SDQ).

Results

Treatment was effective for 92.3% of the children receiving PPT and for 63.0% of the children receiving SMC (adjusted odds ratio for success of PPT, 11.7; 95% confidence interval, 1.8–78.3) (P = .011). Significantly more children undergoing PPT stopped using laxatives (adjusted odds ratio, 6.5; 95% confidence interval, 1.6–26.4) (P = .009). Treatment success (based on global perceived effect) was achieved for 88.5% of subjects receiving PPT vs 33.3% of subjects receiving SMC) (P < .001). PPT also produced larger adjusted mean differences, before vs after treatment, in numeric rating scales to assess quality of life: an increase of 1.8 points for parents (P = .047) and 2.0 points for children (P = .028). Results from the SDQ did not differ significantly between groups (P = .78).

Conclusions

In a randomized controlled trial of children with FC, PPT was more effective than SMC on all outcomes measured, with the exception of findings from the SDQ. PPT should be considered as a treatment option for FC in children 5–16 years old. Dutch Clinical Trial Registration no: NL30551.068.09.

Section snippets

Trial Design and Participants

A pragmatic, single-blind, multicenter RCT was conducted in children aged between 5 and 16 years, who attended regular schools and had been referred to district hospitals.37 Children were diagnosed by the patient’s pediatrician with FC, according to the diagnostic Rome III criteria.7, 38 The study duration was 6 months from randomization.

Exclusion criteria were as follows: (1) prior physiotherapy because of bladder or bowel complaints, (2) urotherapy by another professional at inclusion, (3)

Participants

Figure 2 shows the trial flow and Table 2 lists the baseline characteristics of the allocated children. From December 2009 to May 2014, 111 children were considered eligible. In 31 cases, the parents refused to participate. Of the remaining 80 children, 27 (24.3%) were excluded before randomization, and 53 children were assigned randomly to the PPT (n = 26) or SMC (n = 27) group. At baseline, the children in both treatment groups were comparable in terms of clinical characteristics. Based on

Discussion

This multicenter RCT evaluating the effectiveness of PPT compared with SMC in children with FC showed that PPT performed better than SMC on all primary and secondary outcomes, with the exception of the SDQ. Furthermore, significantly more children receiving PPT were able to stop using laxative medication.

Our results are in accordance with those of Silva and Motta,36 who studied the effect of combined SMC and physiotherapy vs SMC alone in 72 children, age 4–18 years, affected by FC according to

Conclusion

This study found that children receiving PPT had significant improvements in symptom reduction, reduced PEG use, and improved quality of life compared with children receiving SMC only. These results suggest that PPT might be a valuable treatment option for FC in children, aged 5–16 years, and an early intervention may prevent chronicity. Further well-designed studies are necessary to assess whether all children or only specific subgroups with FC would benefit from PPT.

Acknowledgements

The authors would like to thank all of the children and their parents for participating in this trial. In addition, the authors would like to express their gratitude to all the health care providers who contributed, for their cooperation and support, in particular Elisabeth Blokhuis, Charlotte Dorrepaal, Ineke de Gee-de Ridder, Patricia van Gelderen, and Lilian Smeets.

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    Conflicts of interest The authors disclose no conflicts.

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