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Zakaryaei SA, Ravanbakhsh M, Javaherizadeh H, Hakimzadeh M, Shaterzadeh-Yazdi MJ. EFFECT OF VISCERAL MANIPULATION ON CHILDREN WITH REFRACTORY CHRONIC FUNCTIONAL CONSTIPATION: A RANDOMIZED CONTROLLED TRIAL. ARQUIVOS DE GASTROENTEROLOGIA 2024; 61:e23146. [PMID: 39046000 DOI: 10.1590/s0004-2803.24612023-146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/11/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Functional constipation (FC) is a common global high prevalence issue in children. OBJECTIVE The purpose of the present study is to evaluate the effect of visceral manipulation (VM) on children with chronic interacble FC unresponsive to the standard treatment. METHODS This study was conducted as a randomized, single-blind controlled trial. Fifty-two children with refractory chronic functional constipation unresponsive to the standard medical treatment were randomly allocated to two groups of 26 control (standard medical care (SMC)) and 26 intervention (SMC with VM) for 4 weeks. Abdominal pain, painful defecation, stool consistency, defecation frequency, and the dose of oral laxative were evaluated before and after the treatment period using the Pain Rating Scale, Bristol stool form scale, and patient/parents report. RESULTS At the end of treatment, except for the dose of oral laxative in the control group, all of the results showed a significant difference in both groups (P<0.05). The dose of oral laxative in the intervention group decreased significantly (P<0.05), however, no significant change was observed in the control group (P>0.05). In the intervention group comparison, statistically significant differences were found in all va-riables except the Bristol stool form scale (P<0.05). The Bristol stool form scale after treatments was not different when the groups were compared (P=0.32), but the number of subjects who had normal stool consistency was significantly increased in the intervention group than in the control group (P<0.05). CONCLUSION VM can be considered as a possible treatment without side effects besides SMC for the management of chronic FC. Further studies are needed to investigate the long-term effect of VM.
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Affiliation(s)
- Seyed Arman Zakaryaei
- Student Research Committee, School of Rehabiliatation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Ravanbakhsh
- Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hazhir Javaherizadeh
- Alimentary Tract Tesearch Center, Clinical Science Research Institute, Rehabilitation Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehran Hakimzadeh
- Alimentary Tract Tesearch Center, Clinical Science Research Institute, Rehabilitation Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Soliman A, AboAli SEM, Abdel Karim AE, Elsamahy SA, Hasan J, Hassan BAA, Mohammed AH. Effect of adding telerehabilitation home program to pharmaceutical treatment on the symptoms and the quality of life in children with functional constipation: a randomized controlled trial. Eur J Pediatr 2024:10.1007/s00431-024-05639-8. [PMID: 38922435 DOI: 10.1007/s00431-024-05639-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/29/2024] [Accepted: 06/02/2024] [Indexed: 06/27/2024]
Abstract
Painful defecation, the passage of hard stools, unpleasant or irregular bowel deviation/movements from regular rate, and/or the feeling of not enough elimination of stool are common symptoms of functional constipation. The goals in treating constipation are to produce soft, painless stools and to prevent the re-accumulation of feces. This study looked at how the telerehabilitation home program (TRP) affected the symptoms of FC and the children who were constipated in terms of their quality of life. A randomized controlled trial included 400 children aging 4-18 years with functional constipation distributed in two groups: control group consisted of 200 children receiving pharmaceutical treatment and the intervention group consisted of 200 children receiving the telerehabilitation home program in addition to pharmaceutical treatment. Both groups received the interventions for 6 months. The outcomes in terms of functional constipation symptoms and quality of life are measured and compared pre- and post-interventions. Adding the telerehabilitation home program to pharmaceutical treatment of functional constipation in children results in prominent improvement in the condition; there is a significant difference between the intervention and control group in all Rome criteria which assess symptoms of functional constipation except rush to the bath-room to poop which showed non-significant difference; there is also a significant difference between the intervention and control group in all domains of the SF-36 questionnaire which assess quality of life except the mental health domain which showed non-significant difference. CONCLUSION Adding the telerehabilitation home program to pharmaceutical treatment of functional constipation in children results in prominent improvement in symptoms of functional constipation and quality of life. TRIAL REGISTRATION Our study was registered retrospectively with Clinicaltrials.gov under the identifier NCT06207721 on 5 January 2024. WHAT IS KNOWN • Painful defecation, passage of hard stools, unpleasant or irregular bowel movements, feeling of incomplete stool elimination are common symptoms of functional constipation. • Goals in treating constipation include producing soft, painless stools and preventing re-accumulation of feces. WHAT IS NEW • Adding telerehabilitation home program to pharmaceutical treatment resulted in significant improvement in functional constipation symptoms and quality of life. • Significant differences between intervention group (200 children receiving telerehabilitation home program in addition to pharmaceutical treatment) and control group (200 children receiving pharmaceutical treatment) were observed in all Rome criteria except for rush to the bathroom to poop, and in all domains of SF36 questionnaire except for the mental health domain.
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Affiliation(s)
- Amir Soliman
- Department of Public Health and Community Medicine, Faculty of Medicine, Delta University for Science and Technology, Gamasa, Egypt
| | - Safy Eldin M AboAli
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, October University for Modern Sciences and Arts, Giza, Egypt
| | - Amel E Abdel Karim
- Department of Physical Therapy for Pediatrics, Misr University for Science and Technology, Giza, Egypt
| | - Sara A Elsamahy
- Basic Science Department, Faculty of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
| | - Judy Hasan
- Dakahlia STEM School, Al-Mansoura, Egypt
| | - Badr Al-Amir Hassan
- Department of Physical Therapy for Internal Medicine and Geriatrics, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt
| | - Amira H Mohammed
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt.
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Garag V, Parmar S, Kalavant BA, Kadam DS. Effectiveness of physiotherapy in children with functional constipation. Pediatr Surg Int 2024; 40:147. [PMID: 38824249 DOI: 10.1007/s00383-024-05733-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE The objective was to compare the immediate effects of pharmacological versus physiotherapy intervention versus a combination of physiotherapy and pharmacological treatment, as well as the quality of life and the recurrence of symptoms in children with functional constipation after 3 months. METHODS A total of 69 children with functional constipation between the ages of 5 and 14 years of either gender were assessed and randomly assigned to one of three groups: Group A, B, and C. Visual Analogue Scale, Bristol Stool Form Scale, frequency of defecation, PedsQL GI symptom scale, and PedsQL Generic Core Scale were used as outcome measures. Pharmacology was used to treat Group A, physiotherapy was used to treat Group B, and a combination of both was used to treat Group C. RESULTS The study revealed statistically significant results on Visual Analogue Scale, Bristol Stool Form Scale, and frequency of defecation in all groups. However, no significant changes were observed on the PedsQL GI symptom scale and the Generic Core scale in Group A, whereas significant changes were observed in Groups B and C. CONCLUSION In this study, we found that there were significant differences in the short- and long-term effects across all groups. More changes occurred in Group C than in Groups A and B.
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Affiliation(s)
- Varsha Garag
- SDM College of Physiotherapy, SDM University, Dharwad, 580009, India
| | - Sanjay Parmar
- SDM College of Physiotherapy, SDM University, Dharwad, 580009, India.
| | - B Akshay Kalavant
- Department of Pediatric Surgery, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
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Ansari Chaharsoghi N, Davoodi M, Reihani H, Haghdel M, Honar N, Asmarian N, Haghighat M, Dehghani SM, Shahramian I, Ataollahi M, Salehi S, Ziyaee F, Imanieh MH. A Comparison of the Effect of Kegel Exercises and Conventional Therapy versus Conventional Therapy Alone in the Treatment of Functional Constipation in Children: A Randomized Clinical Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:286-293. [PMID: 38751876 PMCID: PMC11091270 DOI: 10.30476/ijms.2023.98539.3055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/12/2023] [Accepted: 08/19/2023] [Indexed: 05/18/2024]
Abstract
Background There have been few studies on the effect of Kegel exercises on the treatment of functional constipation in children. Hence, the present study investigated the add-on role of Kegel exercises in children with functional constipation. Methods This clinical trial was conducted on children with functional constipation, according to Rome IV, who were referred to the pediatric department of Imam Reza Clinic (Shiraz, Iran) in 2022. The sample consisted of 64 children who were randomly assigned to either the intervention or the control groups. In the control group, a pediatrician administered conventional therapy, including diet training, defecation training, and polyethylene glycol (PEG) syrup (0.7 g/Kg daily). In the treatment group, in addition to conventional therapy, a pediatrician taught Kegel exercises to the child both verbally and in writing in the presence of their parents. To investigate the effectiveness of the intervention, frequency of defecation, defecation time, assistance used for defecation, incomplete emptying, unsuccessful defecation, abdominal pain, and painful defecation were selected as the outcomes. Independent sample t test was used for continuous variables. Categorical variables were reported as frequency and percentages. To examine the difference in categorical outcome variables, Wilcoxon (pre and post), Chi square, and Fisher exact tests were used. Data were analyzed using SPSS software version 21. P<0.05 were considered statistically significant. Results Twenty-seven (88.4%) patients in the Kegel exercise group reported a defecation time of less than 5 min, while only 12 (37.5%) patients in the control group reached this time, and this difference was statistically significant (P=0.001). Moreover, patients in the treatment group showed significant improvements in terms of incomplete emptying of stool, unsuccessful defecation, abdominal pain, and painless defecation (P=0.001, P=0.001, P=0.001, P=0.037, respectively). After intervention, the use of laxatives, digits, or enemas to assist defecation was not significantly different between the groups (P=0.659). Conclusion Kegel exercise was an effective adjunctive treatment for pediatric functional constipation.Trial Registration Number: IRCT20230424057984N1.
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Affiliation(s)
- Narges Ansari Chaharsoghi
- Department of Pediatrics, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Davoodi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Reihani
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mobin Haghdel
- Department of Tissue Engineering, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naser Honar
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Naeimehossadat Asmarian
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Haghighat
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohsen Dehghani
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iraj Shahramian
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Ataollahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Salehi
- Department of Pediatrics, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fateme Ziyaee
- Department of Pediatrics, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Imanieh
- Department of Pediatrics Gastroenterology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Joshi S, Parmar S, Kalavant A, Shah L, Parmar D. Effectiveness of structured physiotherapy in constipation in children with neurodevelopmental disorders-a randomized trial. Physiother Theory Pract 2024; 40:2-10. [PMID: 35848580 DOI: 10.1080/09593985.2022.2100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Constipation is one of the major issues faced by children with neuro-developmental disorder (NDD). The aims of the study were to: 1) examine the effectiveness of a structured physiotherapy program on constipation in children with NDD; and 2) compare if conventional physiotherapy along with structured physiotherapy intervention has any combined effect on constipation in children with NDD. METHOD Thirty-five children with neurodevelopmental disorder were assessed and randomly allotted into two groups. Twenty-two completed the intervention for 2 weeks and were statistically analyzed at baseline and post 4 weeks at a single tertiary center. The outcome measures used were Pediatric quality of life inventory (PedsQL), Peds QL Gastrointestinal symptoms scale, Bristol stool form scale, and defecation frequency. Group A received the conventional treatment, whereas group B received structured physiotherapy along with the conventional treatment. RESULTS Group A had no significant outcomes, whereas in group B there were statistically significant differences for all outcome measures. Comparatively, a statistically significant change was noted for PedsQL GI symptoms scale (p = .045) and its constipation sub-scale (p = .002) in group B along with change in the Bristol stool form. CONCLUSION Combined effect of structured along with conventional physiotherapy was better in terms of form of stool, constipation, and its associated quality of life factors as compared to conventional physiotherapy alone.
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Affiliation(s)
- Sayali Joshi
- SDM College of Physiotherapy, SDM University, Dharwad, India
| | - Sanjay Parmar
- SDM College of Physiotherapy, SDM University, Dharwad, India
| | - Akshay Kalavant
- Department of Pediatric Surgery, SDM College of Medical Sciences and Hospital, Dharwad, India
| | - Lakshita Shah
- SDM College of Physiotherapy, SDM University, Dharwad, India
| | - Disha Parmar
- SDM College of Physiotherapy, SDM University, Dharwad, India
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Todhunter-Brown A, Booth L, Campbell P, Cheer B, Cowie J, Elders A, Hagen S, Jankulak K, Mason H, Millington C, Ogden M, Paterson C, Richardson D, Smith D, Sutcliffe J, Thomson K, Torrens C, McClurg D. Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis. Health Technol Assess 2024; 28:1-266. [PMID: 38343084 PMCID: PMC11017632 DOI: 10.3310/pltr9622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Up to 30% of children have constipation at some stage in their life. Although often short-lived, in one-third of children it progresses to chronic functional constipation, potentially with overflow incontinence. Optimal management strategies remain unclear. Objective To determine the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation, and understand how they can best be implemented. Methods Key stakeholders, comprising two parents of children with chronic functional constipation, two adults who experienced childhood chronic functional constipation and four health professional/continence experts, contributed throughout the research. We conducted pragmatic mixed-method reviews. For all reviews, included studies focused on any interventions/strategies, delivered in any setting, to improve any outcomes in children (0-18 years) with a clinical diagnosis of chronic functional constipation (excluding studies of diagnosis/assessment) included. Dual reviewers applied inclusion criteria and assessed risk of bias. One reviewer extracted data, checked by a second reviewer. Scoping review: We systematically searched electronic databases (including Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature) (January 2011 to March 2020) and grey literature, including studies (any design) reporting any intervention/strategy. Data were coded, tabulated and mapped. Research quality was not evaluated. Systematic reviews of the evidence of effectiveness: For each different intervention, we included existing systematic reviews judged to be low risk of bias (using the Risk of Bias Assessment Tool for Systematic Reviews), updating any meta-analyses with new randomised controlled trials. Where there was no existing low risk of bias systematic reviews, we included randomised controlled trials and other primary studies. The risk of bias was judged using design-specific tools. Evidence was synthesised narratively, and a process of considered judgement was used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic synthesis: Included studies (any design, English-language) detailed intervention-related costs. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit, and reporting quality evaluated using the consensus health economic criteria checklist. Systematic review of implementation factors: Included studies reported data relating to implementation barriers or facilitators. Using a best-fit framework synthesis approach, factors were synthesised around the consolidated framework for implementation research domains. Results Stakeholders prioritised outcomes, developed a model which informed evidence synthesis and identified evidence gaps. Scoping review 651 studies, including 190 randomised controlled trials and 236 primary studies, conservatively reported 48 interventions/intervention combinations. Effectiveness systematic reviews studies explored service delivery models (n = 15); interventions delivered by families/carers (n = 32), wider children's workforce (n = 21), continence teams (n = 31) and specialist consultant-led teams (n = 42); complementary therapies (n = 15); and psychosocial interventions (n = 4). One intervention (probiotics) had moderate-quality evidence; all others had low to very-low-quality evidence. Thirty-one studies reported evidence relating to cost or resource use; data were insufficient to support generalisable conclusions. One hundred and six studies described implementation barriers and facilitators. Conclusions Management of childhood chronic functional constipation is complex. The available evidence remains limited, with small, poorly conducted and reported studies. Many evidence gaps were identified. Treatment recommendations within current clinical guidelines remain largely unchanged, but there is a need for research to move away from considering effectiveness of single interventions. Clinical care and future studies must consider the individual characteristics of children. Study registration This study is registered as PROSPERO CRD42019159008. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Booth
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Brenda Cheer
- ERIC, The Children's Bowel and Bladder Charity, Bristol, UK
| | - Julie Cowie
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Charlotte Paterson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | | | | | | | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
- Department of Occupational Therapy, Human Nutrition and Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Claire Torrens
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
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Vasconcellos LSD, Silva RS, Pachêco TB, Nagem DA, Sousa CDO, Ribeiro TS. Telerehabilitation-based trunk exercise training for motor symptoms of individuals with Parkinson's disease: A randomized controlled clinical trial. J Telemed Telecare 2023; 29:698-706. [PMID: 34142896 DOI: 10.1177/1357633x211021740] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Poor gait and static balance performance may be associated with trunk muscles in individuals with Parkinson's disease. AIM The study aims at evaluating the effects of a home-based trunk exercise program on gait and balance performance in Parkinson's disease. METHODS A randomized controlled trial was conducted with 28 individuals with Parkinson's disease with Hoehn & Yahr stage II-IV. The control group (n = 14) performed upper and lower limb exercises, while the experimental group (n = 14) engaged in a trunk exercise program. Both groups performed home-based exercises three times daily for 3 weeks. At the end of interventions (post-training) and 4 weeks after post-training (follow-up), static balance (force plate) and gait (motion capture system) were evaluated. Mixed analysis of variance compared time × group interaction (α = 5%). RESULTS No time × group interaction was observed in the center of pressure displacement, center of pressure mean velocity, and anteroposterior and mediolateral center of pressure range during bipedal support with eyes opened and closed; and gait speed, hip, knee, and ankle range of motion during gait analysis. No intragroup differences were found. CONCLUSION Trunk strengthening exercises did not improve gait and balance compared with upper and lower limb exercises. The non-adherence rate (33%) to the remote intervention may have also hindered our results.
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Affiliation(s)
| | - Raquel S Silva
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Thaiana Bf Pachêco
- Faculty of Health Sciences of Trairi (FACISA), Federal University of Rio Grande do Norte, Natal, Brazil
| | - Danilo Ap Nagem
- Biomedical Engineering Department, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Catarina de O Sousa
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Tatiana S Ribeiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
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Gu X, Zhang L, Yuan H, Zhang M. Analysis of the efficacy of abdominal massage on functional constipation: A meta-analysis. Heliyon 2023; 9:e18098. [PMID: 37496907 PMCID: PMC10366436 DOI: 10.1016/j.heliyon.2023.e18098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 07/28/2023] Open
Abstract
Background Constipation is a digestive disorder with a high global prevalence, with approximately 20-25% of the population suffering from constipation, and the majority of constipated patients experience functional constipation (FC). Although abdominal massage is an effective intervention, there is a lack of analysis of the efficacy of abdominal massage in the treatment of functional constipation. Objective: To evaluate the clinical efficacy of abdominal massage in the treatment of functional constipation. Methods A computerized retrieval of randomized controlled trials on abdominal massage for functional constipation was conducted on China National Knowledge Infrastructure (CNKI), Wanfang, VIP Chinese Science and Technology Periodical Database, Chinese BioMedical Literature Database, Cochrane Database, PubMed, Embase, and Web of Science until October 1, 2022. Meta-analysis was performed using RevMan 5.3 software after the initial screening and re-screening of the literature. Results A total of 13 papers involving 830 patients were included. The results of the meta-analysis showed that abdominal massage had better efficacy in the treatment of functional constipation. Constipated patients in the treatment group showed greater improvement in the frequency of defecation, difficulty in defecation, stool properties, and PAC-QOL scores than those in the control group. The SMD/MD values and 95% CI of each score were: SMD = 1.05, 95%CI (0.63,1.46); SMD = -1.51, 95%CI (-2.35,-0.68); SMD = 0.95, 95%CI (0.31,1.59); MD = -13.24, 95%CI (-25.83, -0.65). Conclusion Abdominal massage can increase the frequency of defecation, reduce the symptoms of difficulty in defecation, improve stool properties, and positively affect the quality of life of patients with constipation. Hence, abdominal massage therapy shows definite therapeutic efficacy for functional constipation, providing a more specific plan for clinical treatment.
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Affiliation(s)
- Xinxin Gu
- College of Acupuncture and Massage, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Lei Zhang
- College of Acupuncture and Massage, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Haiguang Yuan
- Department of Treatment and Prevention of Disease, The Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Min Zhang
- College of Acupuncture and Massage, Shaanxi University of Chinese Medicine, Xianyang, China
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Zeng X, He J, Li X, Chen P, Zuo J, Cai X, Fan Z, Qu J. Clinical efficacy of one-finger meditation massage on IBS-C based on the "gut-brain axis" theory: study protocol for a randomized controlled trial. BMC Complement Med Ther 2023; 23:185. [PMID: 37280574 PMCID: PMC10245512 DOI: 10.1186/s12906-023-04019-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND As a common disorder of the gastrointestinal tract, irritable bowel syndrome (IBS) can have negative effects on patients and society, with irritable bowel syndrome with constipation(IBS-C) accounting for a large proportion of these effects. The main clinical manifestations of IBS-C are constipation, abdominal pain, and abdominal distension, which seriously impact the quality of life of patients. The mechanisms of IBS are complex, and the gut-brain axis has been an emerging and recognized theoretical system in recent years. Based on the theory of the gut-brain axis and the theory of Chinese medicine, we designed this study to evaluate the efficacy of one-finger meditation massage in treating IBS-C. METHODS/DESIGN This is a randomized controlled trial. Eligible patients with irritable bowel syndrome (IBS-C) wererandomized 1:1 to a test group (massage plus probiotics) and a control group (probiotics). Patients in the test group weretreated once every 10 days for three consecutive courses of treatment (i.e., three months) and weregiven Bifidobacterium trifolium capsules 630 mg/dose three times daily 30 min after meals every day during the treatment period, with follow-up observations at the end of the third and sixth months of the treatment period. The control group weregiven Bifidobacterium trifolium capsules 630 mg/dose, 3 times a day for 3 months, with follow-up observations at the end of the third and sixth months of the treatment period. The primary outcome indicators are the concentrations of 5-HT and substance P and the IBS Severity Scale (IBS-SSS) assessment. Secondary outcomes are the Bristol Rating Scale (BRSA) score, the IBS Quality of Life Questionnaire (IBS-QOL scale) score, and the assessment of the effectiveness of the evidence. The results wereassessed at the pretreatment, posttreatment, and follow-up stages. Any side effects weresubject to assessment. DISCUSSION The aim of this trial is to provide a new method of treatment based on pharmacological treatment that is easy to use, easy to promote and has proven efficacy and to establish the efficacy and safety of treating IBS-C through this trial. REGISTRATION FOR TRIAL Chinese Clinical Trial Registry ChiCTR2200066417 on 5 December 2022. https://www.chictr.org.cn/bin/project/edit?pid=183461.
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Affiliation(s)
- Xiayang Zeng
- Tui Na Department, Zhejiang Hospital, Hangzhou, China
| | - Jingjing He
- Surgical Department, The Third Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
| | - Xiaoyu Li
- Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
| | - Peng Chen
- Tui Na Department, Zhejiang Hospital, Hangzhou, China
| | - Jinhong Zuo
- Tui Na Department, Zhejiang Hospital, Hangzhou, China
| | - Xinlei Cai
- Tui Na Department, Zhejiang Hospital, Hangzhou, China
| | - Zhenyu Fan
- Tui Na Department, Zhejiang Hospital, Hangzhou, China
| | - Jianpeng Qu
- Tui Na Department, Zhejiang Hospital, Hangzhou, China.
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Osborn H, Reek S, Anderson B. Interdisciplinary Occupational and Physical Therapy Approach to Treating Constipation and Fecal Incontinence in Children. Phys Occup Ther Pediatr 2023; 43:243-256. [PMID: 36229926 DOI: 10.1080/01942638.2022.2131499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS This case series was completed to determine the effectiveness of an interdisciplinary (occupational and physical therapy) approach to treating constipation and fecal incontinence in children. Non-pharmacological therapies for treating constipation and incontinence are showing potential benefits, especially for children not responding to standard medical treatment, which involves oral laxatives for fecal dis-impaction (cleanout) and maintenance dosing to prevent further impaction. METHODS A retrospective chart review, surface electromyography (sEMG) biofeedback, and parent and child reports of progress was completed for two children ages 4 and 10 years old. Progress toward goals was measured using a therapy plan of care and progress updates every 60 days. Focus of goals included, pelvic floor muscle coordination and activation, education of anatomy and physiology of digestive system, emotional regulation, functional training in the bathroom, and hygiene. RESULTS Notable improvements in pelvic floor function, emotional regulation, and defecation dynamics contributed to decreased constipation and fecal incontinence as well as improved emotional regulation and confidence in both participants over a 6-month period. CONCLUSION A coordinated physical therapy and occupational therapy approach to treating children with constipation and fecal incontinence can be successful in reaching full continence and support children have not responded to standard medical treatment.
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Affiliation(s)
- Holly Osborn
- Beyond Boundaries Therapy Services, Fargo, North Dakota, USA
| | - Stacey Reek
- Beyond Boundaries Therapy Services, Fargo, North Dakota, USA
| | - Brittany Anderson
- University of Jamestown Physical Therapy Program, University of Jamestown, Fargo, North Dakota, USA
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Liu J, Lv C, Wang W, Huang Y, Wang B, Tian J, Sun C, Yu Y. Slow, deep breathing intervention improved symptoms and altered rectal sensitivity in patients with constipation-predominant irritable bowel syndrome. Front Neurosci 2022; 16:1034547. [PMID: 36408402 PMCID: PMC9673479 DOI: 10.3389/fnins.2022.1034547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/24/2022] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND AND AIM Limited treatment options have been shown to alter the natural course of irritable bowel syndrome (IBS). Slow, deep breathing (SDB) is a common pain self-management intervention. This pilot study aimed to explore the impact of SDB on measures of autonomic and anorectal functions as well as patient-reported symptoms in constipation-predominant IBS (IBS-C). METHODS Eighty-five IBS-C patients were enrolled in this study and randomly assigned to the experimental group (Group A, n = 42) and the control group (Group B, n = 43). SDB was conducted at six breathing cycles per minute with an inhalation for 4 s and exhalation for 6 s at a ratio of 2:3 and repeated for 30 min during the intervention. All subjects underwent high-resolution anorectal manometry (HRAM) and completed the standardized IBS symptom severity system (IBS-SSS) questionnaire. Meanwhile, changes in stool consistency, weekly frequency of complete spontaneous bowel movements (CSBMs), and weekly frequency of spontaneous bowel movements (SBMs) were recorded. All IBS-C patients received electrocardiogram (ECG) recordings for heart rate variability (HRV) analysis at baseline, weeks 3, 6. RESULTS At baseline, no differences were found between Groups A and B. The IBS-SSS score and its five sub-scores of Group B patients were significantly higher at week 6 than those of Group A patients (all p < 0.001). Furthermore, compared with Group B patients, Group A patients had a significantly higher threshold volume for the first sensation (p < 0.001), desire to defecate (p = 0.017), and maximum tolerable volume (p = 0.018) at week 6 of the SDB treatment. We also noted significant improvements in stool consistency (p = 0.002), weekly SBM frequencies (p < 0.001), and weekly CSBM frequencies (p = 0.018) of Group A patients at week 6 when compared with Group B patients. Finally, the corrected high frequency (HF) of Group A patients was significantly higher than the HF of Group B patients at week 3 (p < 0.001) and at week 6 (p < 0.001). Likewise, patients in Group A had a significantly higher root mean square of the successive differences (RMSSD) than that of patients in Group B at week 3 (p < 0.001) and at week 6 (p < 0.001). CONCLUSION We found that a 6-week SDB intervention improved symptoms and altered rectal sensation in IBS-C patients. Moreover, SDB enhanced vagal activity. These findings suggest that the effect of SDB on IBS-C may be due to mechanisms involving autonomic responses.
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Affiliation(s)
- Jie Liu
- Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Chaolan Lv
- Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wei Wang
- Department of Gastroenterology, Affiliated Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Yizhou Huang
- Graduate School of Bengbu Medical College, Bengbu, China
| | - Bo Wang
- Graduate School of Bengbu Medical College, Bengbu, China
| | - Jiashuang Tian
- Department of Gastroenterology, Affiliated Anhui Provincial Hospital, Anhui Medical University, Hefei, China
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Yue Yu
- Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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12
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Abdominal massage: A review of clinical and experimental studies from 1990 to 2021. Complement Ther Med 2022; 70:102861. [PMID: 35907436 DOI: 10.1016/j.ctim.2022.102861] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/10/2022] [Accepted: 07/20/2022] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE To systematically review the current state and holistic application of abdominal massage (AM). DESIGN A systematic review of qualitative evidence was conducted. All English articles exploring the topic of AM that had been published until the end of June 2021 were retrieved. DATA SOURCES The PubMed, Cochrane library, and Embase databases were accessed. Some original texts were obtained from Google Scholar. DATA EXTRACTION AND SYNTHESIS Two authors independently evaluated all search data to identify relevant studies. Disagreements were settled by discussion with a third author. Results were independently extracted into standardized sheets and checked for accuracy. MAIN RESULTS A total of 107 full-text reports were eligible for inclusion. Adult digestive disorders, pediatric disorders, gynecological disorders, obstetric disorders, metabolic disorders, psychological disorders, the side effects of AM, and animal experiments accounted for 49.53%, 14.02%, 7.48%, 7.48%, 4.67%, 4.67%, 5.61%, and 6.54% of all these papers, respectively, with most reports focusing on clinical studies. CONCLUSION The variety of diseases treated with AM is gradually increasing, and the treatment programs of AM for many diseases are being gradually optimized. Different forms of AM, especially mechanical AM, have been widely studied; the side effects of AM have also been considered; and the possible mechanisms of AM therapy continue to be discovered. In general, AM is an effective and safe therapy and can be widely used in various diseases, but further studies are necessary to clarify the mechanism of AM for different diseases. In the future, AM could become an even safer, more popular, and more modern therapy.
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van Summeren JJGT, Holtman GA, Lisman-van Leeuwen Y, van Ulsen-Rust AHC, Vermeulen KM, Tabbers MM, Kollen BJ, Dekker JH, Berger MY. Cost-effectiveness of physiotherapy in childhood functional constipation: a randomized controlled trial in primary care. Fam Pract 2022; 39:662-668. [PMID: 35018413 DOI: 10.1093/fampra/cmab147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Health care expenditures for children with functional constipation (FC) are high, while conservative management is successful in only 50% of the children. The aim is to evaluate whether adding physiotherapy to conventional treatment (CT) is a cost-effective strategy in the management of children with FC aged 4-18 years in primary care. METHODS A cost-effectiveness analysis was performed alongside a randomized controlled trial (RCT) with 8-month follow-up. Costs were assessed from a societal perspective, effectiveness included both the primary outcome (treatment success defined as the absence of FC and no laxative use) and the secondary outcome (absence of FC irrespective of laxative use). Uncertainty was assessed by bootstrapping and cost-effectiveness acceptability curves (CEACs) were displayed. RESULTS One hundred and thirty-four children were randomized. The incremental cost-effectiveness ratio (ICER) for one additional successfully treated child in the physiotherapy group compared with the CT group was €24,060 (95% confidence interval [CI] €-16,275 to €31,390) and for the secondary outcome €1,221 (95% CI €-12,905 to €10,956). Subgroup analyses showed that for children with chronic laxative use the ICER was €2,134 (95% CI -24,975 to 17,192) and €571 (95% CI 11 to 3,566), respectively. At a value of €1,000, the CEAC showed a probability of 0.53 of cost-effectiveness for the primary outcome, and 0.90 for the secondary outcome. CONCLUSIONS Physiotherapy added to CT as first-line treatment for all children with FC is not cost-effective compared with CT alone. Future studies should consider the cost-effectiveness of physiotherapy added to CT in children with chronic laxative use. TRIAL REGISTRATION The RCT is registered in the Netherlands Trial Register (NTR4797), on the 8th of September 2014. The first child was enrolled on the 2nd of December 2014. https://www.trialregister.nl/trial/4654.
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Affiliation(s)
- Jojanneke J G T van Summeren
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
| | - Gea A Holtman
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
| | - Yvonne Lisman-van Leeuwen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
| | | | - Karin M Vermeulen
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Merit M Tabbers
- Emma Children's Hospital/Amsterdam UMC-location AMC, Department of Pediatric Gastroenterology and Nutrition, Amsterdam, The Netherlands
| | - Boudewijn J Kollen
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
| | - Janny H Dekker
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
| | - Marjolein Y Berger
- University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
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Doğan İG, Gürşen C, Akbayrak T, Balaban YH, Vahabov C, Üzelpasacı E, Özgül S. Abdominal Massage in Functional Chronic Constipation: A Randomized Placebo-Controlled Trial. Phys Ther 2022; 102:6585154. [PMID: 35554601 DOI: 10.1093/ptj/pzac058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/22/2021] [Accepted: 03/28/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of abdominal massage on the severity of constipation, bowel function, and quality of life (QoL) in patients with functional chronic constipation in a randomized placebo-controlled design. METHODS Seventy-four patients diagnosed with functional constipation according to the Rome IV diagnostic criteria were included. Patients were randomly assigned to the intervention group (abdominal massage plus lifestyle advice) or the control group (placebo therapeutic ultrasound plus lifestyle advice). Abdominal massage or placebo ultrasound was applied for 4 weeks. The primary outcome measure was the Constipation Severity Instrument score. Bowel diary data and the Patient Assessment of Constipation Quality of Life Questionnaire score were used as secondary outcome measures. Differences in outcome measures within and between groups were analyzed by repeated-measures analysis of variance. RESULTS Although constipation severity, bowel function indicators (defecation frequency and duration and stool consistency), and QoL were found to improve significantly over time in both groups, improvements in both primary and secondary outcomes were much more significant in the abdominal massage group. In addition, group × time interaction effects were found to be significant for constipation severity, bowel function findings, and QoL. There were approximately 70% and 28% reductions in constipation severity, 56% and 38% improvement rates in QoL, and 70% and 43% increases in defecation frequency in the intervention and placebo groups, respectively. CONCLUSION Abdominal massage should be one of the first-line conservative approaches in the management of functional chronic constipation. Further randomized placebo-controlled studies with long-term follow-up are needed. IMPACT For functional constipation, which is a common gastrointestinal problem, abdominal massage should be considered as an option in first-line therapy because of its effect beyond the placebo effect. LAY SUMMARY If you have functional constipation, your physical therapist may be able to provide abdominal massage to help reduce your symptoms.
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Affiliation(s)
- İrem Gül Doğan
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Ceren Gürşen
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Türkan Akbayrak
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Yasemin Hatice Balaban
- Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterology, Ankara, Turkey
| | - Cavanşir Vahabov
- Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Gastroenterology, Ankara, Turkey
| | - Esra Üzelpasacı
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Serap Özgül
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
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15
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Anorectal Manometry in Children: The Update on the Indications and the Protocol of the Procedure. J Pediatr Gastroenterol Nutr 2022; 74:440-445. [PMID: 35001039 DOI: 10.1097/mpg.0000000000003379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Anorectal disorders are common in children. They are related to structural and/or functional abnormalities of the anorectum or pelvic floor with a variety of symptoms. Therefore, diagnostic tests to evaluate anorectal function can help to better understand the underlying pathophysiology and aetiology as well as facilitate patient management. During the past decades, substantial efforts have been made to improve anorectal function testing; however, more advanced investigations might lead to difficulties in interpretation. Additionally, a great diversity of equipment and protocols are used among centres, which may lead to heterogeneous interpretation of results. More studies to standardize methods of testing and validate reference values are strongly recommended in children. This review updates on the current indications and the protocol of anorectal manometry.
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Cordeiro Santos ML, da Silva Júnior RT, de Brito BB, França da Silva FA, Santos Marques H, Lima de Souza Gonçalves V, Costa dos Santos T, Ladeia Cirne C, Silva NOE, Oliveira MV, de Melo FF. Non-pharmacological management of pediatric functional abdominal pain disorders: Current evidence and future perspectives. World J Clin Pediatr 2022; 11:105-119. [PMID: 35433299 PMCID: PMC8985495 DOI: 10.5409/wjcp.v11.i2.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/19/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
Functional abdominal pain disorders (FAPDs) are an important and prevalent cause of functional gastrointestinal disorders among children, encompassing the diagnoses of functional dyspepsia, irritable bowel syndrome, abdominal migraine, and the one not previously present in Rome III, functional abdominal pain not otherwise specified. In the absence of sufficiently effective and safe pharmacological treatments for this public problem, non-pharmacological therapies emerge as a viable means of treating these patients, avoiding not only possible side effects, but also unnecessary prescription, since many of the pharmacological treatments prescribed do not have good efficacy when compared to placebo. Thus, the present study provides a review of current and relevant evidence on non-pharmacological management of FAPDs, covering the most commonly indicated treatments, from cognitive behavioral therapy to meditation, acupuncture, yoga, massage, spinal manipulation, moxibustion, and physical activities. In addition, this article also analyzes the quality of publications in the area, assessing whether it is possible to state if non-pharmacological therapies are viable, safe, and sufficiently well-based for an appropriate and effective prescription of these treatments. Finally, it is possible to observe an increase not only in the number of publications on the non-pharmacological treatments for FAPDs in recent years, but also an increase in the quality of these publications. Finally, the sample selection of satisfactory age groups in these studies enables the formulation of specific guidelines for this age group, thus avoiding the need for adaptation of prescriptions initially made for adults, but for children use.
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Affiliation(s)
- Maria Luísa Cordeiro Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Hanna Santos Marques
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45083-900, Bahia, Brazil
| | | | - Talita Costa dos Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Carolina Ladeia Cirne
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Natália Oliveira e Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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Wegh CAM, Baaleman DF, Tabbers MM, Smidt H, Benninga MA. Nonpharmacologic Treatment for Children with Functional Constipation: A Systematic Review and Meta-analysis. J Pediatr 2022; 240:136-149.e5. [PMID: 34536492 DOI: 10.1016/j.jpeds.2021.09.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of nonpharmacologic interventions for the treatment of childhood functional constipation. STUDY DESIGN Randomized controlled trials (RCTs) evaluating nonpharmacologic treatments in children with functional constipation which reported at least 1 outcome of the core outcome set for children with functional constipation. RESULTS We included 52 RCTs with 4668 children, aged between 2 weeks and 18 years, of whom 47% were females. Studied interventions included gut microbiome-directed interventions, other dietary interventions, oral supplements, pelvic floor-directed interventions, electrical stimulation, dry cupping, and massage therapy. An overall high risk of bias was found across the majority of studies. Meta-analyses for treatment success and/or defecation frequency, including 20 RCTs, showed abdominal electrical stimulation (n = 3), Cassia Fistula emulsion (n = 2), and a cow's milk exclusion diet (n = 2 in a subpopulation with constipation as a possible manifestation of cow's milk allergy) may be effective. Evidence from RCTs not included in the meta-analyses, indicated that some prebiotic and fiber mixtures, Chinese herbal medicine (Xiao'er Biantong granules), and abdominal massage are promising therapies. In contrast, studies showed no benefit for the use of probiotics, synbiotics, an increase in water intake, dry cupping, or additional biofeedback or behavioral therapy. We found no RCTs on physical movement or acupuncture. CONCLUSIONS More well-designed high quality RCTs concerning nonpharmacologic treatments for children with functional constipation are needed before changes in current guidelines are indicated.
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Affiliation(s)
- Carrie A M Wegh
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Amsterdam, the Netherlands; Laboratory of Microbiology, Wageningen University & Research, Wageningen, the Netherlands.
| | - Desiree F Baaleman
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Amsterdam, the Netherlands
| | - Merit M Tabbers
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Amsterdam, the Netherlands
| | - Hauke Smidt
- Laboratory of Microbiology, Wageningen University & Research, Wageningen, the Netherlands
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Amsterdam, the Netherlands
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Koppen IJN, Benninga MA. Functional Constipation and Dyssynergic Defecation in Children. Front Pediatr 2022; 10:832877. [PMID: 35252068 PMCID: PMC8890489 DOI: 10.3389/fped.2022.832877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/06/2022] [Indexed: 12/22/2022] Open
Abstract
Defecation is a complex physiological process, which relies on intricate mechanisms involving the autonomic and somatic nervous system, the pelvic floor muscles, and the anal sphincter complex. Anorectal dysfunction may result in constipation, a bothersome defecation disorder that can severely affect daily lives of children and their families. In this review, we focus on different mechanisms underlying anorectal dysfunction and specific treatment options aimed at improving defecation dynamics in children with functional constipation.
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Affiliation(s)
- Ilan J N Koppen
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marc A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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The Effect of Aromatherapy and Abdominal Massage Applied to Infants on Constipation and Maternal Anxiety Level. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.884363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Choi YI, Kim KO, Chung JW, Kwon KA, Kim YJ, Kim JH, Park DK. Effects of Automatic Abdominal Massage Device in Treatment of Chronic Constipation Patients: A Prospective Study. Dig Dis Sci 2021; 66:3105-3112. [PMID: 33001346 DOI: 10.1007/s10620-020-06626-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 09/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Manual abdominal massage has been shown to effectively treat slow-transit constipation, but it is labor-intensive. To offer an alternative treatment option for constipation, the Bamk-001 automatic abdominal massage device was developed. The aim of this study was to assess the effect of the Bamk-001 device on symptom profiles and colon transit time (CTT) in patients with chronic constipation. METHODS Thirty-seven patients with chronic functional constipation diagnosed using the Rome IV criteria were enrolled prospectively from December 2018 to February 2019. All patients received device-assisted automatic abdominal massage for 15 min twice daily, once in the morning before breakfast and once at night, for 14 days. CTT was measured before and at the end of the study period. Slow-transit constipation and very-slow-transit constipation were defined as CTT ≥ 48 h and ≥ 72 h, respectively. Patients' symptom profiles regarding overall defecation satisfaction and device-related adverse events were analyzed. RESULTS Among the 37 patients, the mean age was 40.1 ± 11.8, and 5.4% (n = 2) were men. The Bamk-001 device significantly improved CTT from 54.0 (33.6-75.6) to 28.8 (18.0-52.8) h (p = 0.001) in patients with chronic constipation. In subgroup analysis, CTT improved significantly from 54.0 (33.6-75.6) to 28.8 (18.0-52.8) h (p = 0.003) and from 88.2 (74.4-124.8) to 45.6 (27.3-74.1) h (p = 0.005) in the slow-transit and very-slow-transit constipation groups, respectively (p = 0.001). Moreover, all patient symptoms were alleviated after treatment. No serious adverse events were reported. CONCLUSION The Bamk-001 automatic abdominal massage device showed significant care efficacy, including the improvement in CTT and symptom profiles in patients with slow-transit constipation. The use of an automatic abdominal massage device as an adjunct in the management of constipation is a potentially beneficial intervention for patients with slow-transit constipation.
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Affiliation(s)
- Youn I Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Kyoung Oh Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea.
| | - Jun-Won Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Kwang An Kwon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Yoon Jae Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Jung Ho Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Dong Kyun Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
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21
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Santucci NR, Chogle A, Leiby A, Mascarenhas M, Borlack RE, Lee A, Perez M, Russell A, Yeh AM. Non-pharmacologic approach to pediatric constipation. Complement Ther Med 2021; 59:102711. [PMID: 33737146 DOI: 10.1016/j.ctim.2021.102711] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/12/2021] [Indexed: 01/24/2023] Open
Abstract
Functional constipation (FC) is a pervasive problem in pediatrics. Although pharmaceuticals are commonly used for FC, parents and patients show reluctance or find dissatisfaction with available medications at times. Further, patients often have interest in utilizing nutraceutical supplements and botanicals that are available over the counter. This literature review aims to summarize research studies performed on non-pharmacologic approaches to constipation and to evaluate the safety and efficacy of these modalities. Overall data on non-pharmacologic treatments for childhood constipation were sparse, and though some studies were available for adult populations, pediatrics studies were generally limited, lacking or flawed. Certain supplements, such as prebiotics, probiotics and fiber, are safe and are without significant side effects. Though fiber supplements such as glucomannan, green banana mass, cocao husk and various fiber blends have emerging evidence in children, evidence for psyllium, cellulose and flaxseed only have supportive studies in adults. Other than senna, studies of botanicals indicate significant safety concerns (in particular with Aloe vera with aloin and Cascara sagrada) and insufficient evidence. For patients with a significant behavioral or anxiety component to their FC and exhibit dyssynergia, mind-body interventions (e.g. diaphragmatic breathing, biofeedback, cognitive behavioral therapy, and behavioral modifications) are certainly safe and effective. Finally, movement and manipulative interventions such as abdominal massage, reflexology, acupuncture and transcutaneous nerve stimulation show promise in the field of pediatric constipation, and data is accumulating for efficacy. These modalities require further study to determine mechanisms of action and which populations may benefit the most from these therapies.
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Affiliation(s)
- Neha R Santucci
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, OH, USA
| | - Ashish Chogle
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Orange County, Orange, CA, USA
| | - Alycia Leiby
- Division of Gastroenterology, Hepatology and Nutrition, Goryeb Children's Hospital/ Atlantic Health System, Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, NJ, USA
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel E Borlack
- Division of Gastroenterology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | - Amanda Lee
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Oregon Health and Science University, OR, USA
| | - Maria Perez
- Division of Gastroenterology, Hepatology and Nutrition, Goryeb Children's Hospital/ Atlantic Health System, Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, NJ, USA
| | - Alexandra Russell
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ann Ming Yeh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA, USA.
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22
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Abdominal Stiffness Evaluation in Massage for Constipation. SENSORS 2021; 21:s21041192. [PMID: 33567621 PMCID: PMC7915621 DOI: 10.3390/s21041192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022]
Abstract
According to the experience of nurses and physiotherapists, the abdomen of constipated people becomes softer after abdominal massage. However, the relationship between the decrease in abdominal stiffness and the benefits of abdominal massage has not been examined quantitatively and is unclear. Furthermore, devices for measuring stiffness have been designed to measure relatively hard areas such as the shoulders and do not take into account the lateral outflow of the target tissue, which can be a problem when measuring the stiffness of soft areas such as the abdomen. To address these issues, this study presents a stiffness sensor suitable for measuring abdominal stiffness and investigates the relationship between the reduction in abdominal stiffness and the benefits of abdominal massage. The solution to prevent the lateral outflow of the target is the realization of a stopper, including a contact detection device, which enables a wide-area contact around the targeted area. The sensor consists of a stopper, probe, spring, and time-of-flight (ToF) sensors. The probe and spring provide appropriate pressure and deformation to the abdomen, whereas the stopper prevents the probe from being pushed into the abdomen more than necessary. The ToF sensor measures the deformation length when the deformation is stopped by the stopper. The abdominal stiffness can be derived from the deformation length. The investigation results indicate that the reduction in abdominal stiffness corresponds to the improvement of the stool condition or the maintenance of a healthy stool condition, whereas the maintenance of abdominal stiffness indicates the maintenance or deterioration of the stool condition.
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Tang J, Li H, Tang W. Efficacy of Non-pharmacologic Auxiliary Treatments in Improving Defecation Function in Children With Chronic Idiopathic Constipation: A Systematic Review and Network Meta-analysis. Front Pediatr 2021; 9:667225. [PMID: 33987155 PMCID: PMC8110729 DOI: 10.3389/fped.2021.667225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/29/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Non-pharmacologic auxiliary treatments have been considered crucial therapies for treating chronic idiopathic constipation (CIC) during the past decades worldwide. Several treatment patterns are available, but their relative efficacy is obscure because there are no head-to-head randomized controlled trials, especially in children. We conducted this network meta-analysis to evalute the effectiveness of these therapies in improving defecation function based on their direct comparisons with standard medical care. Methods: Medline, Embase, and Cochrane Central were searched for randomized controlled trials (RCTs) published in English from inception to October 2020, assessing the efficacy of auxiliary therapies (behavior therapy, physiotherapy, biofeedback, or anorectal manometry) in children with CIC. We extracted data for endpoints, risk of bias, and evidence quality. Eligible studies in the meta-analysis reported the data of a dichotomous assessment of overall response to treatment (response or not) or defecation frequency per week after treatment. The hierarchical Bayesian network meta-analysis was used in the study. We chose a conservative methodology, random effects model, to pool data which could handle the heterogeneity well. The relative risk (RR) with 95% confidence intervals (CIs) was calculated for dichotomous outcomes. For continuous results, weighted mean difference (WMD) with related CIs was calculated. The included treatments were ranked to define the probability of being the best treatment. Results: Seven RCTs (838 patients) met inclusion and endpoint criteria. Based on an endpoint of the absence of constipation (Rome criteria) with laxatives allowed, physiotherapy plus standard medical care (SMC) had the highest probability (84%) to bethe most effective therapy. When the treatment response was defined as an absence of constipation with not laxatives allowed, biofeedback plus SMC ranked first (probability 52%). Physiotherapy plus SMC ranked first when the endpoint was based on defecation frequency per week with laxatives allowed (probability 86%). Conclusion: Almost all auxiliary therapies are effective complementary therapies for treating CIC, but they needed to be used simultaneously with SMC. Nevertheless, because of the small number of eligible studies and their small sample sizes, the differences in treatment duration and the endpoints, large sample RCTs with long-term follow-up are required for further investigation.
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Affiliation(s)
- Jie Tang
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Huijuan Li
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Weibing Tang
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
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24
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Intrarectal Electromotive Botulinum Toxin Type A Administration in Children With Intractable Constipation: A Randomized Clinical Trial. Am J Gastroenterol 2020; 115:2060-2067. [PMID: 33009066 DOI: 10.14309/ajg.0000000000000940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Children with refractory constipation might not respond to conventional medical treatments. In this study, we assessed the effectiveness of intrarectal botulinum toxin type A/electromotive drug administration (BoNTA/EMDA) on constipation in these children and compared its efficacy with routine intrasphincteric BoNTA injection. METHODS From 2017 to 2019, 60 children aged 5-13 years who fulfilled Rome III criteria for intractable constipation were enrolled and randomly assigned into 2 treatment groups. EMDA group (n = 30) underwent BoNTA/EMDA, whereas the control group (n = 30) received injection of BoNTA into the internal anal sphincter. A complete bowel habit diary (with data on the frequency of defecation per week, stool form, and the number of fecal soiling episodes), a constipation score questionnaire, and a visual pain score were recorded before treatment and at 1 month and 6 months after treatment. In addition, children in both groups were assessed with a constipation-related quality of life questionnaire. RESULTS After 1-month follow-up, treatment reduced the number of patients fulfilling the diagnostic criteria in both EMDA (24/30, 80%) and injection (25/30, 83.3%) groups (P < 0.001). The stool form was normalized in 73.3% (22/30) in EMDA group and 80% (24/30) in injection group after treatment. The median of constipation score and pain score decreased significantly in both groups after treatment (P < 0.001 and P < 0.001, respectively). DISCUSSION BoNTA/EMDA seems to be as effective as intrasphincteric BoNTA injection for treatment of intractable constipation. In addition, this technique is associated with less comorbidity, is less costly, and can be performed in an office-based setting without general anesthesia.
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25
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Gao H, Zhang X, He W, Zhao X, Han J, Li D, Yang H, Li S. To study the intervention mechanism of pediatric massage on intestinal flora and host metabolism in children with anorexia. Medicine (Baltimore) 2020; 99:e23349. [PMID: 33217877 PMCID: PMC7676532 DOI: 10.1097/md.0000000000023349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND As a common and frequent disease in pediatric patients, pediatric anorexia (PN) poses a serious threat to childhood growth and health. In recent years, societal changes in lifestyle and diet have increased the incidence of this PN, which has attracted extensive attention from both the medical community and parents. It has been shown that massage therapy represents an effective intervention for the treatment of anorexia, but investigation on its mechanism(s) of action remains limited. In this study, we will explore the biological mechanism(s) of PN from the perspective of intestinal flora, to further reveal its site of action and therapeutic mechanism(s). METHODS A total of 60 healthy children will be randomly selected for physical examination. According to a random number generated by a computer, children with anorexia who meet the inclusion criteria will be selected. In strict accordance with the time sequence of inclusion, subjects will be randomly assigned to either the massage or control group (n = 60 per group). The blank group will receive no treatment. Children in the massage group will receive a designated massage protocol. The control group will be administered oral Jianweixiaoshi tablets over 4 weeks. Each group will be compared for intestinal flora structure, fecal short chain fatty acids levels, serum trace elements, urine D-xylose-excretion rates, gastric fluid emptying, gastric motility, and hemoglobin levels before and after treatment. RESULTS We will review the clinical trial registry in China (http://www.chictr.org.cn/searchprojen.aspx), peer-reviewed journals and academic conferences. CONCLUSION This study will verify the intervention mechanism(s) of pediatric massage on intestinal flora and host metabolism in children with anorexia. TRIAL REGISTRATION NUMBER ChiCTR2000033274.
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Affiliation(s)
- Hanyuan Gao
- Gansu Provincial Hospital of Traditional Chinese Medicine
| | | | - Wenjie He
- Gansu University of Chinese Medicine
| | - Xia Zhao
- Gansu Provincial Hospital of Traditional Chinese Medicine
| | - Juan Han
- Gansu Institute of Chinese Medicine
| | - Dongmei Li
- Gansu Provincial Hospital of Traditional Chinese Medicine
| | - Hanteng Yang
- Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Shengcai Li
- Gansu Provincial Hospital of Traditional Chinese Medicine
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Hamasaki H. Effects of Diaphragmatic Breathing on Health: A Narrative Review. MEDICINES 2020; 7:medicines7100065. [PMID: 33076360 PMCID: PMC7602530 DOI: 10.3390/medicines7100065] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
Background: Breathing is an essential part of life. Diaphragmatic breathing (DB) is slow and deep breathing that affects the brain and the cardiovascular, respiratory, and gastrointestinal systems through the modulation of autonomic nervous functions. However, the effects of DB on human health need to be further investigated. Methods: The author conducted a PubMed search regarding the current evidence of the effect of DB on health. Results: This review consists of a total of 10 systematic reviews and 15 randomized controlled trials (RCTs). DB appears to be effective for improving the exercise capacity and respiratory function in patients with chronic obstructive pulmonary disease (COPD). Although the effect of DB on the quality of life (QoL) of patients with asthma needs to be investigated, it may also help in reducing stress; treating eating disorders, chronic functional constipation, hypertension, migraine, and anxiety; and improving the QoL of patients with cancer and gastroesophageal reflux disease (GERD) and the cardiorespiratory fitness of patients with heart failure. Conclusions: Based on this narrative review, the exact usefulness of DB in clinical practice is unclear due to the poor quality of studies. However, it may be a feasible and practical treatment method for various disorders.
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Affiliation(s)
- Hidetaka Hamasaki
- Hamasaki Clinic, 2-21-4 Nishida, Kagoshima, Kagoshima 890-0046, Japan
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27
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Orhan C, Özgül S, Baran E, Üzelpasacı E, Akbayrak T. Comparison of Connective Tissue Manipulation and Abdominal Massage Combined With Usual Care vs Usual Care Alone for Chronic Constipation: A Randomized Controlled Trial. J Manipulative Physiol Ther 2020; 43:768-778. [PMID: 32893023 DOI: 10.1016/j.jmpt.2019.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/21/2019] [Accepted: 05/10/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of the present study was to determine and compare the effects of connective tissue manipulation (CTM) and abdominal massage when combined with usual care on the symptoms of constipation and quality of life (QoL) immediately following a 4-week treatment in patients suffering from chronic constipation. METHODS A total of 60 patients with chronic constipation were randomly assigned to CTM, abdominal massage, or control groups. Connective tissue manipulation and abdominal massage were conducted at 5 sessions a week for 4 weeks. Each session was approximately 15 to 20 minutes. The severity of constipation by the Constipation Severity Instrument, symptoms of constipation by a bowel diary and Bristol Stool Scale, and QoL by patient assessment of QoL questionnaire were evaluated at baseline and at the end of 4 weeks. RESULTS There were significant differences in the changes in constipation severity (P < .001), symptoms of constipation (P ≤ .001), and QoL (P < .001) among the 3 groups. However, based on pair-wise analysis, there were no significant differences in the changes of the severity and symptoms of constipation and QoL between the CTM and abdominal massage groups (P > .05). CONCLUSION The findings of the present study revealed that compared to usual care alone, the combination of usual care and CTM or abdominal massage may be more beneficial for chronic constipation. However, the superiority of CTM or abdominal massage was not observed. Further high-quality studies with long-term follow-up are needed to investigate the optimal massage therapy program in patients with chronic constipation.
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Affiliation(s)
- Ceren Orhan
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Serap Özgül
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Emine Baran
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Esra Üzelpasacı
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Türkan Akbayrak
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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28
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The effect of osteopathic manual therapy with breathing retraining on cardiac autonomic measures and breathing symptoms scores: A randomised wait-list controlled trial. J Bodyw Mov Ther 2020; 24:282-292. [PMID: 32826001 DOI: 10.1016/j.jbmt.2020.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/08/2019] [Accepted: 02/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Breathing retraining and manual therapy (MT), delivered independently or together, influence autonomic activity, and improve symptoms in patients with chronic conditions. This study evaluated the effects of breathing retraining and osteopathic MT on cardiac autonomic measures and breathing symptoms during spontaneous breathing in healthy active adults. METHODS Participants (n = 18) received breathing retraining and four, weekly manual therapy sessions, randomised to start immediately, or after 6-week delay. Heart-rate (HR) variability was assessed as a 7-day average of waking 6-min electrocardiograms, using time (logarithm of root-mean-square of successive differences; LnRMSSD) and frequency domain (logarithm of high-frequency; LnHF) measures. Recordings were taken before, one week following intervention or delay, and then following the later intervention for those with delayed starts. Changes were compared between those who received and had yet to receive the intervention, and before and after treatment for the whole cohort. RESULTS Following the intervention, HR-variability measures increased 4% overall (Effect Sizes: 1.0-1.1) for the whole cohort. Between-group analyses showed that the immediate-start group increased more than the delayed start group: LnRMSSD 0.27 (0.02-0.52; 95%CI) ln.ms, and LnHF 0.41 (-0.01-0.84) ln.ms2 for immediate start; compared with LnRMSSD -0.09 (-0.29-0.11) ln.ms, and LnHF -0.19 (-0.59-0.22) ln.ms2 (P = 0.02-0.03 for interaction) for delayed start. Resting HR decreased following intervention in the whole cohort (Effect Size -0.8; P = 0.02). CONCLUSION A 6-week osteopathic treatment consisting of breathing retraining and MT is beneficial in raising HR-variability compared to no treatment, and may induce favourable (parasympathetic over sympathetic) autonomic modulation. TRIAL REGISTRATION ACTRN12614001119684.
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29
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Mokhtare M, Karimi S, Bahardoust M, Sotoudeheian M, Ghazi A, Babaei-Ghazani A. How adding the abdominal massage to polyethylene glycol can improve symptom and quality of life in patients with functional constipation in comparison with each one of the treatment modalities alone: A randomized clinical trial. Complement Ther Med 2020; 52:102495. [PMID: 32951744 DOI: 10.1016/j.ctim.2020.102495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/11/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A variety of medical and non-medical treatments have been introduced for functional constipation relief. Here, we aimed to compare the efficacy of a combination of polyethylene glycol (PEG) and abdominal massage with each one of the treatments alone. MATERIALS AND METHODS Patients with functional constipation based on Rome IV criteria were randomly assigned into the three treatment groups: group A (abdominal massage for 15 min daily), group B (PEG 20 g daily), and group C (PEG 20 g plus abdominal massage for 15 min daily) for 14 days. PAC-QOL questionnaire, Bristol stool scale were evaluated at baseline and two weeks after treatment. Constipation-associated symptom scores were recorded at baseline, two weeks and four weeks after treatment beginning. Descriptive statistics were provided as the mean ± standard deviation or number and percentage. P-value<0.05 was considered statistically significant. RESULTS Forty eight, 47 and 48 patients in group A, B, and C completed the study, respectively. PAC-QOL, Bristol and Constipation-associated symptom scores showed a significant improvement in all study groups two weeks after the treatment compared to the baseline. At the end of treatment, the rate of straining, incomplete evacuation sensation, finger evacuation and the number of defecation was significantly lower in the group C (P < 0.04). Bristol score were significantly improved in group B (P = 0.029) in compare to other groups. The total quality of life score was also significantly improved in the group C (P = 0.028). CONCLUSION A combination of abdominal massage and PEG is safe, tolerable and more effective than each one of the treatments alone.
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Affiliation(s)
- Marjan Mokhtare
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Shahdieh Karimi
- Internal Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Mansour Bahardoust
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Epidemiology, School of Public Health, Iran University of Medical Science, Tehran, Iran.
| | | | - Ayoub Ghazi
- Fellowship of Gastroenterology, Iran University of Medical Sciences, Tehran, Iran.
| | - Arash Babaei-Ghazani
- Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Tehran, Iran; Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Canada.
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30
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Pasin Neto H, Borges RA. Visceral Mobilization and Functional Constipation in Stroke Survivors: A Randomized, Controlled, Double-Blind, Clinical Trial. Cureus 2020; 12:e8058. [PMID: 32537276 PMCID: PMC7286593 DOI: 10.7759/cureus.8058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction Chronic functional constipation is common among stroke survivors. Osteopathy is an effective form of treatment as it acts on the structures surrounding the bowels that may have lost their normal capacity of resilience. The aim of the present study was to evaluate the effect of visceral mobilization on symptoms of functional constipation and static balance in stroke survivors. Materials and methods Thirty stroke survivors met the eligibility criteria and were randomly allocated to a group physical therapy and visceral manipulation or a group physical therapy. Both groups were submitted to conventional physical therapy. The group physical therapy and visceral manipulation was also submitted to visceral mobilization (sphincter inhibition and mobilization of the large intestine), whereas the group physical therapy was submitted to a sham procedure (superficial touching over the intestines). Evaluations were conducted prior to the intervention, immediately after the first intervention session and one week after the end of the five sessions. At each evaluation, the static balance was analyzed using a computerized plantar pressure sensor. Moreover, an intestinal symptoms rating scale was administered during the pre-intervention evaluation, and one week after the end of the intervention. Results Significant improvements were found in intestinal symptoms (frequency of bowel movements, abdominal pain/discomfort, difficulty eliminating stools, sensation of intestinal swelling or distention, difficulty eliminating gas, sensation of incomplete bowel movement and, anal pain during bowel movement) and static balance (anteroposterior sway: F = 82.06, p = 0.0001; velocity of anteroposterior sway: F = 17.6, p = 0.001; and velocity of mediolateral sway: F = 4.41, p = 0.01). Conclusion Visceral mobilization can be part of a neurologic rehabilitation program to improve symptoms of constipation and static balance in stroke survivors.
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Affiliation(s)
- Hugo Pasin Neto
- Osteopathy, Brazilian College of Osteopathy, Sorocaba, BRA
- Physiotherapy, University of Sorocaba, Sorocaba, BRA
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31
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Serra J, Pohl D, Azpiroz F, Chiarioni G, Ducrotté P, Gourcerol G, Hungin APS, Layer P, Mendive JM, Pfeifer J, Rogler G, Scott SM, Simrén M, Whorwell P. European society of neurogastroenterology and motility guidelines on functional constipation in adults. Neurogastroenterol Motil 2020; 32:e13762. [PMID: 31756783 DOI: 10.1111/nmo.13762] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Chronic constipation is a common disorder with a reported prevalence ranging from 3% to 27% in the general population. Several management strategies, including diagnostic tests, empiric treatments, and specific treatments, have been developed. Our aim was to develop European guidelines for the clinical management of constipation. DESIGN After a thorough review of the literature by experts in relevant fields, including gastroenterologists, surgeons, general practitioners, radiologists, and experts in gastrointestinal motility testing from various European countries, a Delphi consensus process was used to produce statements and practical algorithms for the management of chronic constipation. KEY RESULTS Seventy-three final statements were agreed upon after the Delphi process. The level of evidence for most statements was low or very low. A high level of evidence was agreed only for anorectal manometry as a comprehensive evaluation of anorectal function and for treatment with osmotic laxatives, especially polyethylene glycol, the prokinetic drug prucalopride, secretagogues, such as linaclotide and lubiprostone and PAMORAs for the treatment of opioid-induced constipation. However, the level of agreement between the authors was good for most statements (80% or more of the authors). The greatest disagreement was related to the surgical management of constipation. CONCLUSIONS AND INFERENCES European guidelines on chronic constipation, with recommendations and algorithms, were developed by experts. Despite the high level of agreement between the different experts, the level of scientific evidence for most recommendations was low, highlighting the need for future research to increase the evidence and improve treatment outcomes in these patients.
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Affiliation(s)
- Jordi Serra
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain.,Motility and Functional Gut Disorders Unit, University Hospital Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Badalona, Spain
| | - Daniel Pohl
- Division of Gastroenterology, University Hospital Zurich, Zurich, Switzerland.,Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Fernando Azpiroz
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Badalona, Spain.,Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Giuseppe Chiarioni
- Division of Gastroenterology B, AOUI Verona, Verona, Italy.,UNC Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA
| | - Philippe Ducrotté
- Department of Gastroenterology, UMR INSERM 1073, Rouen University Hospital, Rouen, France
| | - Guillaume Gourcerol
- Department of Physiology, UMR INSERM 1073 & CIC INSERM 1404, Rouen University Hospital, Rouen, France
| | - A Pali S Hungin
- General Practice, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Peter Layer
- Department of Medicine, Israelitic Hospital, Hamburg, Germany
| | - Juan-Manuel Mendive
- Sant Adrià de Besòs (Barcelona) Catalan Institut of Health (ICS), La Mina Primary Health Care Centre, Badalona, Spain
| | - Johann Pfeifer
- Department of Surgery, Division of General Surgery, Medical University of Graz, Graz, Austria
| | - Gerhard Rogler
- Division of Gastroenterology, University Hospital Zurich, Zurich, Switzerland.,Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - S Mark Scott
- Neurogastroenterology Group, Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Barts, UK.,The London School of Medicine & Dentistry, Queen Mary University London, London, UK
| | - Magnus Simrén
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Whorwell
- Division of Diabetes, Endocrinology & Gastroenterology, Neurogastroenterology Unit, Wythenshawe Hospital, University of Manchester, Manchester, UK
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van Summeren JJGT, Holtman GA, Kollen BJ, Lisman-van Leeuwen Y, van Ulsen-Rust AHC, Tabbers MM, Dekker JH, Berger MY. Physiotherapy for Children with Functional Constipation: A Pragmatic Randomized Controlled Trial in Primary Care. J Pediatr 2020; 216:25-31.e2. [PMID: 31732133 DOI: 10.1016/j.jpeds.2019.09.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the effectiveness of physiotherapy plus conventional treatment compared with conventional treatment alone for the treatment of functional constipation in children age 4-17 years in primary care. STUDY DESIGN Pragmatic randomized controlled trial with 8 months follow-up. Primary care physicians recruited children diagnosed with functional constipation (n = 234), and pediatricians recruited newly referred children with a diagnosis of functional constipation (n = 11). Conventional treatment comprised toilet training, nutritional advice, and laxative prescribing, whereas physiotherapy focused on resolving dyssynergic defecation. The primary outcome was treatment success over 8 months, defined as the absence of functional constipation (Rome III criteria) without laxative use. Secondary outcomes included the absence of functional constipation irrespective of continuation of laxative use and global perceived treatment effect. RESULTS Children were allocated to conventional treatment plus physiotherapy or conventional treatment alone (67 per group), mean (SD) age was 7.6 (3.5) years. Results of longitudinal analyses in the intention-to-treat population showed that the treatment success percentage was not statistically improved by adding physiotherapy to conventional treatment (adjusted relative risk [aRR] 0.80, 95% CI 0.44-1.30). At 4 months, fewer children receiving physiotherapy had treatment success (17%) than children receiving conventional treatment alone (28%), but this had equalized by 8 months (42% and 41%, respectively). The percentage of children without functional constipation, irrespective of continuation of laxative use, was not statistically different between groups over 8 months (aRR 1.12, 95% CI 0.82-1.34). Notably, parents reported significantly more global symptom improvement after physiotherapy than after conventional treatment (aRR 1.40; 95% CI 1.00-1.73). CONCLUSIONS We find no evidence to recommend physiotherapy for all children with functional constipation in primary care. TRIAL REGISTRATION Netherlands Trial Registry: NTR4797.
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Affiliation(s)
- Jojanneke J G T van Summeren
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, the Netherlands.
| | - Gea A Holtman
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Boudewijn J Kollen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Yvonne Lisman-van Leeuwen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, the Netherlands
| | | | - Merit M Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Amsterdam UMC-Location AMC, Amsterdam, the Netherlands
| | - Janny H Dekker
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, the Netherlands
| | - Marjolein Y Berger
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center, Groningen, the Netherlands
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Paknejad MS, Motaharifard MS, Barimani S, Kabiri P, Karimi M. Traditional, complementary and alternative medicine in children constipation: a systematic review. ACTA ACUST UNITED AC 2019; 27:811-826. [PMID: 31734825 DOI: 10.1007/s40199-019-00297-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This review aims to evaluate the efficacy and safety of complementary and alternative medicine methods for constipation in the pediatric population. EVIDENCE ACQUISITION Medical literature search was performed in several databases for a variety of Traditional, Complementary and Alternative Medicine in childhood constipation. Databases included Web of Science, Scopus, Embase, Cochrane Library, PubMed, ScienceDirect, Google scholar and a number of Persian databases including IranDoc, Magiran and SID. No time limitation was determined. Clinical trials or case series that had evaluated the effectiveness of CAM therapies in functional constipation of 1-18 year old children were included. Papers not in English or Persian language were excluded. Related articles were screened independently by two reviewers according to their titles and abstracts. A data extraction form was filled in for each eligible paper. Quality assessment of eligible documents was also performed. RESULTS 30 studies were included, comprising 27 clinical trials and 3 case series. Ten documents were on herbal medicine, nine on traditional medicine, ten on manual therapies and one on homeopathy. Except for two herbal and one reflexology interventions, all studies reported positive effects on childhood constipation, with the majority being statistically significant. As the number of studies in each method was limited, we could not perform a meta-analysis. CONCLUSION The scarcity of research on the efficacy and safety of different types of complementary and alternative medicine methods in children with constipation necessitates conducting more studies in each field. Graphical abstract.
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Affiliation(s)
- Maryam Sadat Paknejad
- School of Traditional Medicine, Tehran University of Medical Sciences, Building of the Ahmadiyeh, No 27, Corner Alley Tabriz, Sarparast Shomali Str, Taleghani Ave, Tehran, 1416663361, Iran
| | - Monireh Sadat Motaharifard
- School of Traditional Medicine, Tehran University of Medical Sciences, Building of the Ahmadiyeh, No 27, Corner Alley Tabriz, Sarparast Shomali Str, Taleghani Ave, Tehran, 1416663361, Iran
| | - Shahdis Barimani
- Department of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payam Kabiri
- Department of Biostatics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Karimi
- School of Traditional Medicine, Tehran University of Medical Sciences, Building of the Ahmadiyeh, No 27, Corner Alley Tabriz, Sarparast Shomali Str, Taleghani Ave, Tehran, 1416663361, Iran.
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Yang S, Chen J, Guo Y, Teng Y, Liu T, Ying R, He Z, Wu J, Yu SG, Zeng F. Comparison of Taiji and aerobic exercise for functional constipation: study protocol for a randomised controlled neuroimaging trial. BMJ Open 2019; 9:e031089. [PMID: 31471444 PMCID: PMC6719768 DOI: 10.1136/bmjopen-2019-031089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Taiji has been proven to be effective for regulating both the physical and mental state compared with simple aerobic exercise. However, whether the improvement of Taiji for constipation is related to regulate imbalanced brain-gut axis and emotional disorder for functional constipation (FC) remains uncertain. The results of the study will demonstrate the differences in regulation brain-gut balance between Taiji and simply aerobic exercise for patients with FC and provide a potential therapy for clinical treatment of FC, and a new approach for the research of mind-body exercise. METHODS AND ANALYSIS In this randomised controlled neuroimaging trial, 80 patients with FC will be allocated into two groups: Taiji group and aerobic exercise group. The two groups will receive 10 weeks of Taiji exercise or aerobic exercise, respectively. The stool diary, Cleveland Constipation Score and Patient Assessment of Constipation Symptom, Patient Assessment of Constipation Quality of Life Questionnaire will be used to evaluate the clinical efficacy, the Self-rating Depression Scale, Self-rating Anxiety Scale, Eysenck Personality Questionnaires and Mini-Mental State Examinations will be used to assess the mental state at the baseline, the 5-week intervention and the end of intervention. The 24-hour heart rate variability will be used for assessing the autonomic nervous function, functional MRI and positron emission tomography-CT will be performed for detecting the cerebral functional changes at the baseline and the end of the intervention. The clinical data and multimodal imaging data will be analysed, respectively. Correlation analysis will be conducted to investigate the relationship between cerebral functional changes and symptom improvement. ETHICS AND DISSEMINATION The procedures have been approved by the Sichuan Regional Ethics Review Committee on Traditional Chinese Medicine (No. 2018KL-047) and conformed to the Declaration of Helsinki. Results will be disseminated through policy briefs, workshops, peer-reviewed publications and conferences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR1800019781).
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Affiliation(s)
- Sha Yang
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jingwen Chen
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuyi Guo
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuke Teng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Tianyu Liu
- School of Gymnasium, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Rongtao Ying
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhaoxuan He
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jianwei Wu
- School of Chinese Classics, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Shu-Guang Yu
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fang Zeng
- Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Lee TH, Kim SE, Park KS, Shin JE, Park SY, Ryu HS, Kim JW, Lee YJ, Cho YS, Park S. Medical Professionals' Review of YouTube Videos Pertaining to Exercises for the Constipation Relief. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 72:295-303. [PMID: 30642148 DOI: 10.4166/kjg.2018.72.6.295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 12/11/2022]
Abstract
Background/Aims The primary aims of this study were to evaluate the content quality of YouTube videos on exercises to help relieve constipation and to assess whether the video source, exercise types, and popularity affected their quality. Methods Eight gastroenterologists independently evaluated the exercises presented in the constipation YouTube videos for seven items: image quality, usefulness in relieving constipation (quality 1), usefulness for general physical health (quality 2), difficulty in following, activity intensity, fun, and overall quality. Raters were asked open-ended questions to evaluate the strengths and weaknesses of the videos. Five-point ordinal scales were used to score each item aforementioned, with the exception of image quality and overall quality that used a six-point Likert scale. Results The 20 videos had a mean length of 268 seconds and a mean viewership of 32,694. The most common video source was commercial (n=10), and the most common type of physical activity was yoga (n=11). The median values of image quality, quality 1, quality 2, difficulty in following, activity intensity, fun, and overall quality were 3, 2, 2, 2, 2, 2, and 2, respectively. Yoga videos had significantly higher median quality 1 values (3) compared with massage videos (2, adjusted p=0.006) and 'others' videos (2, adjusted p<0.001). A lack of medical evidence was the most common answer to open-ended questions about the weaknesses of each video. Conclusions Overall, YouTube exercise videos presented a low-quality content. This study highlights the need for evidence-based comprehensive educational videos addressing exercises for treating constipation.
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Affiliation(s)
- Tae Hee Lee
- Institute for Digestive Research, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, Ewha Medical Research institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyung Sik Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Jeong Eun Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Han Seung Ryu
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Jung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Young Sin Cho
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital, Seoul, Korea
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Abstract
PURPOSE OF REVIEW Functional constipation (FC) in children is a common health problem with reported worldwide prevalence rates up to 32.2%. The majority of children with constipation respond to oral laxative treatment. After 5 years of intensive treatment, however, approximately 50% of children remain symptomatic. To discuss the evidence for new treatments in these children, including pre- and probiotics, pelvic physiotherapy, prucalopride, sacral nerve stimulation, and surgery, and to highlight the controversies surrounding them. RECENT FINDINGS Pre- and probiotics and prucalopride are not effective in the treatment of childhood constipation. Pelvic physiotherapy and sacral nerve stimulation are promising treatment options but larger trials are needed. Surgery for pediatric constipation is the treatment of last resort. Large, well-designed placebo-controlled trials with proper outcome measures, as suggested by the Rome foundation pediatric subcommittee on clinical trials, are necessary to provide more insight regarding the efficacy of new treatments in childhood constipation.
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Ganesh S, Kumar M. Physiotherapist management of a patient with spastic perineal syndrome and subsequent constipation: a case report. Physiother Theory Pract 2019; 37:242-251. [PMID: 30983479 DOI: 10.1080/09593985.2019.1603259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background and Purpose: The purpose of this case report is to describe the benefits of manual therapy techniques, including mobilization and stretching, in the management of a patient with chronic constipation. Case Description: A 17-year-old male with an 8-month history of constipation and complaint of incomplete evacuation after defecation was referred for therapy. The patient was diagnosed with a spastic perineal syndrome. Isolated puborectalis relaxation exercise was not successful in alleviating constipation. Physical examination showed tightness of left side piriformis, thoracic kyphosis, apparent limb shortening on the left side, and a right-on-right sacrum forward torsion. The patient was treated with stretching of left piriformis and mobilization of thoracic and lumbar vertebrae and sacroiliac joints along with puborectalis relaxation exercises. Outcomes: After 4 weeks of treatment, there was a reduction in Bowel Function Index (BFI) from 74.6 to 27.2. The patient also reported spending less time (<3 minutes) during defecation. The patient maintained his improvement at 7 months. Discussion: A detailed neuromuscular examination assisted in identifying the pathophysiology related to obstructive defecation for this patient. Controlled studies regarding the effectiveness of various physiotherapy interventions in the treatment of obstructive constipation are warranted.
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Affiliation(s)
- Shankar Ganesh
- Department of Physiotherapy, Composite Regional Center for Skill Development, Rehabilitation, and Empowerment of Persons with Disabilities., Composite Regional Centre for Persons with Disabilities , Lucknow, India
| | - Mritunjay Kumar
- PhyWorld Physiotherapy Clinic, Arjun Marg, Defence Colony , New Delhi, India
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Zollars JA, Armstrong M, Whisler S, Williamson S. Visceral and Neural Manipulation in Children with Cerebral Palsy and Chronic Constipation: Five Case Reports. Explore (NY) 2019; 15:47-54. [DOI: 10.1016/j.explore.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/21/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022]
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van Summeren JJGT, Holtman GA, Lisman- van Leeuwen Y, Louer LEAM, van Ulsen-Rust AHC, Vermeulen KM, Kollen BJ, Dekker JH, Berger MY. Physiotherapy plus conventional treatment versus conventional treatment only in the treatment of functional constipation in children: design of a randomized controlled trial and cost-effectiveness study in primary care. BMC Pediatr 2018; 18:249. [PMID: 30064408 PMCID: PMC6069950 DOI: 10.1186/s12887-018-1231-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/19/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Our aim was to design a study to evaluate the effectiveness and cost-effectiveness of adding physiotherapy to conventional treatment for children with functional constipation in primary care. Physiotherapy is focusing on improving the coordination between the pelvic floor and abdominal musculature during bowel movement, while conventional treatment is mainly focusing on symptomatic relief of symptoms, therefore, we expect the effects of physiotherapy will be more sustainable than the effects of conventional treatment. In this paper we describe the final study design and how the design was adapted, to overcome recruitment problems. METHODS We designed a randomized controlled trial of children aged 4-17 years with functional constipation diagnosed by a general practitioner or pediatrician. Children in the intervention group received physiotherapy plus conventional treatment, and those in the control group received conventional treatment only. Follow-up measurements took place at 4 and 8 months. The primary outcome was treatment success defined according to the Rome-III criteria as the absence of functional constipation, with no laxative use. Secondary outcomes were absence of functional constipation irrespective of laxative use, quality of life, global perceived effect, and costs. Children were recruited from September 2014 to February 2017. Initially, we aimed to include children with recent symptom onset. However, in the first phase of enrollment we were confronted with an unforeseen recruitment problem: many children and their parents refused randomization because physiotherapy was considered too burdensome for the stage of disease. Therefore, we decided to also include children with a longer duration of symptoms. In total 134 children were included. DISCUSSION The target number of participants is achieved. Therefore, the results may change thinking about the management of functional constipation in children. TRAIL REGISTRATION Netherlands Trial Register ( NTR4797 ), registered 8 September 2014.
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Affiliation(s)
- Jojanneke J. G. T. van Summeren
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gea A. Holtman
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yvonne Lisman- van Leeuwen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lisa E. A. M. Louer
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Karin M. Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Boudewijn J. Kollen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Janny H. Dekker
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y. Berger
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Sharifi-Rad L, Ladi-Seyedian SS, Manouchehri N, Alimadadi H, Allahverdi B, Motamed F, Fallahi GH. Effects of Interferential Electrical Stimulation Plus Pelvic Floor Muscles Exercises on Functional Constipation in Children: A Randomized Clinical Trial. Am J Gastroenterol 2018; 113:295-302. [PMID: 29257143 DOI: 10.1038/ajg.2017.459] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 10/03/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Functional constipation is a common condition in children. We assessed the effectiveness of combined interferential (IF) electrical stimulation and pelvic floor muscle (PFM) exercises on functional constipation in children. METHODS We conducted a single-center, double-blind randomized clinical trial study during 2014-2017 in Tehran, Iran. Ninety children, aged 5-13 years, who fulfilled Rome III criteria were enrolled and randomly assigned into two treatment groups. Case group (n=45) underwent IF electrical stimulation and PFM exercises, whereas the control group (n=45) received PFM exercises plus sham stimulation. A complete bowel habit diary (with concerning data on the frequency of defecation per week, stool form, and the number of fecal soiling episodes), a constipation score questionnaire, and a visual pain score were recorded before, after the treatment and 6 months later for all participants. In addition, children in both groups were assessed with a constipation-related quality-of-life questionnaire before, after the end of treatment sessions, and 6 months after the treatment. RESULTS Treatment success was achieved for 88.4% of children in the case group compared with 43.2% of children in the control group after the treatment (P<0.003). The median constipation score was reduced in both groups, with the cases having significantly lower scores after the treatment (4 vs. 8, P<0.000). Stool form normalized in 75.6% of the cases and 45.5% of the controls after the treatment (P<0.01). CONCLUSIONS Our results showed that using IF electrical stimulation as an adjuvant therapy to the medical and rehabilitation programs significantly boosts the effects of treatment among these patients.
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Affiliation(s)
- Lida Sharifi-Rad
- Pediatric Gastroenterology and Hepatology Research Center, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).,Department of Physical Therapy, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).,Pelvic Floor Rehabilitation and Urotherapy Group (PFRUG), Universal Scientific Education and Research Network (USERN), Tehran, Iran (IRI)
| | - Seyedeh-Sanam Ladi-Seyedian
- Pediatric Gastroenterology and Hepatology Research Center, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).,Pelvic Floor Rehabilitation and Urotherapy Group (PFRUG), Universal Scientific Education and Research Network (USERN), Tehran, Iran (IRI)
| | - Navid Manouchehri
- Pediatric Gastroenterology and Hepatology Research Center, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).,Pelvic Floor Rehabilitation and Urotherapy Group (PFRUG), Universal Scientific Education and Research Network (USERN), Tehran, Iran (IRI)
| | - Hosein Alimadadi
- Pediatric Gastroenterology and Hepatology Research Center, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).,Department of Pediatrics, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Bahar Allahverdi
- Pediatric Gastroenterology and Hepatology Research Center, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).,Department of Pediatrics, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Farzaneh Motamed
- Pediatric Gastroenterology and Hepatology Research Center, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).,Department of Pediatrics, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Gholam-Hossein Fallahi
- Pediatric Gastroenterology and Hepatology Research Center, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).,Department of Pediatrics, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
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Minichiello VJ. Therapeutic Breathing. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Belvaux A, Bouchoucha M, Benamouzig R. Osteopathic management of chronic constipation in women patients. Results of a pilot study. Clin Res Hepatol Gastroenterol 2017; 41:602-611. [PMID: 28215390 DOI: 10.1016/j.clinre.2016.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/28/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Constipation is a common problem in western countries. The aim of this pilot study was to determine the effectiveness of osteopathic manipulative treatment (OMT) for the treatment of constipated women with functional constipation (FC) or defeation disorders (DD). METHODS Twenty-one constipated females referred to a tertiary center were recruited. A course of OMT, weekly for four weeks, was given. Clinical questionnaire, Bristol stool form scale and patients' subjective perception of constipation, bloating and abdominal pain, were recorded. Total and segmental colonic transit time (CTT) were performed before and after OMT. RESULTS Eleven patients had FC and 10 DD, as defined by Rome III criteria. After OMT, the Knowless Eccersley Scott Symptom score (P=0.020), the oro-anal transit time (P=0.002), the right (P=0.005) and left (P=0.009) CTT had decreased while the stool frequency (P=0.005) and the Bristol Stool Form scale (P=0.003) had increased. After OMT, the intensity of constipation, and the Patient assessment of constipation symptoms score did not change but a decrease of abdominal pain, bloating, quality of life score and drug use was found. CONCLUSIONS This study shows OMT has potential benefit for treating functional constipation in women. Further randomised trials are required to confirm these results.
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Affiliation(s)
- Aurélie Belvaux
- Gastroenterology Department, Avicenne Hospital, 93000 Bobigny, France
| | - Michel Bouchoucha
- Gastroenterology Department, Avicenne Hospital, 93000 Bobigny, France; Physiology Department, université René Descartes, Paris V, 75270 Paris, France.
| | - Robert Benamouzig
- Gastroenterology Department, Avicenne Hospital, 93000 Bobigny, France
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van Summeren J, Dekker J, Berger M. Pelvic Physiotherapy in Children With Functional Constipation: Promising But More Research Needed. Gastroenterology 2017; 152:2080-2081. [PMID: 28478145 DOI: 10.1053/j.gastro.2017.02.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/10/2017] [Indexed: 12/02/2022]
Affiliation(s)
| | - Janny Dekker
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marjolein Berger
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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van Engelenburg-van Lonkhuyzen ML, Bols EMJ, Benninga MA, Verwijs WA, de Bie RA. Effectiveness of Pelvic Physiotherapy in Children With Functional Constipation Compared With Standard Medical Care. Gastroenterology 2017; 152:82-91. [PMID: 27650174 DOI: 10.1053/j.gastro.2016.09.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/05/2016] [Accepted: 09/09/2016] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
| | - Esther M J Bols
- Department of Epidemiology, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marc A Benninga
- Department of Paediatric Gastroenterology, Emma Children's Hospital/Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Wim A Verwijs
- Department of Paediatrics, Zuwe Hofpoort Hospital, Woerden, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
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Zivkovic VD, Stankovic I, Dimitrijevic L, Kocic M, Colovic H, Vlajkovic M, Slavkovic A, Lazovic M. Are Interferential Electrical Stimulation and Diaphragmatic Breathing Exercises Beneficial in Children With Bladder and Bowel Dysfunction? Urology 2016; 102:207-212. [PMID: 28040503 DOI: 10.1016/j.urology.2016.12.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/12/2016] [Accepted: 12/20/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the effects of interferential current (IC) stimulation and diaphragmatic breathing exercises (DBEs) in children with bladder and bowel dysfunction. PATIENTS AND METHODS Seventy-nine children with dysfunctional voiding and chronic constipation who were failures of primary care interventions were included in the prospective clinical study. All the children were checked for their medical history regarding lower urinary tract symptoms and bowel habits. Physical examination, including abdominal and anorectal digital examination, was performed. Children kept a bladder and bowel diary, and underwent urinalyses and urine culture, ultrasound examination of bladder and kidneys, and uroflowmetry with pelvic floor electromyography. Eligible children were divided into 3 groups (A, B, and C). All groups were assigned education and behavioral modifications. Additionally, group A underwent DBEs and IC stimulation, whereas group B received only DBEs. The treatment was conducted for 2 weeks in the clinic in all 3 groups,. The behavioral modifications and DBEs were continued at home for 1 month. Clinical manifestations, uroflowmetry parameters, and postvoided residual urine were analyzed before and after 6 weeks of therapy. RESULTS After the treatment, significant improvement in defecation frequency and fecal incontinence was noticed only in group A (P < .001 and P < .05, respectively). These children demonstrated significant improvement in lower urinary tract symptoms and postvoided residual urine (P < .001 and P < .05, respectively). Bell-shaped uroflowmetry curve was observed in 73.3% of group A patients (P < .001). CONCLUSION IC stimulation and DBEs are beneficial in chronically constipated dysfunctional voiders. Further trials are needed to define the long-term effects of this program.
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Affiliation(s)
- Vesna D Zivkovic
- Clinic of Physical Medicine, Rehabilitation and Prosthetics, Clinical Centre Nis, Faculty of Medicine, University of Nis, Nis, Serbia.
| | - Ivona Stankovic
- Clinic of Physical Medicine, Rehabilitation and Prosthetics, Clinical Centre Nis, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Lidija Dimitrijevic
- Clinic of Physical Medicine, Rehabilitation and Prosthetics, Clinical Centre Nis, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Mirjana Kocic
- Clinic of Physical Medicine, Rehabilitation and Prosthetics, Clinical Centre Nis, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Hristina Colovic
- Clinic of Physical Medicine, Rehabilitation and Prosthetics, Clinical Centre Nis, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Marina Vlajkovic
- Department of Nuclear Medicine, Clinical Centre Nis, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Andjelka Slavkovic
- Clinic of Paediatric Surgery, Clinical Centre Nis, Faculty of Medicine, University of Nis, Nis, Serbia
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Orhan C, Kaya Kara O, Kaya S, Akbayrak T, Kerem Gunel M, Baltaci G. The effects of connective tissue manipulation and Kinesio Taping on chronic constipation in children with cerebral palsy: a randomized controlled trial. Disabil Rehabil 2016; 40:10-20. [PMID: 27793072 DOI: 10.1080/09638288.2016.1236412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to investigate the effects of connective tissue manipulation (CTM) and Kinesio Taping® (KT) on constipation and quality of life in children with cerebral palsy (CP). METHOD This study was designed as a randomized controlled trial. Forty children diagnosed with chronic constipation based on Rome III criteria were randomly assigned to CTM group [6 females, 7 males; 8 y 6 mo (SD = 3y 4 mo)], KT group [7 female, 7 male; 8y 7 mo (SD =3y 5 mo)] or control group [6 female, 7 male; 8y 3 mo (SD = 3y 6 mo)]. All patients were assessed with 7-day bowel diaries, Bristol Stool Form Scale (BSFS), Visual Analog Scale (VAS), and Pediatric Quality of Life Inventory (PEDsQL). Kruskal-Wallis, Wilcoxon's signed-rank, and Mann-Whitney U tests were used to determine intra-group and inter-group differences. The level of significance was p < 0.05. RESULTS Among the CTM, KT, and control groups, there were statistically significant differences regarding the changes in defecation frequency (2.46, 3.00, 0.30, ES 1.16, p < 0.001), duration of defecation (5.07, 5.35, 0.15, ES 2.37, p = 0.003), BSFS (1.84, 2.14, 0.07, ES 0.91, p < 0.001), VAS (4.83, 3.87, 0.23, ES 1.98, p < 0.001), and PEDsQL total scores (7, 14, 8.36, -0.85, ES 4.08, p < 0.001). CONCLUSIONS This study revealed that CTM and KT seem equally effective physiotherapy approaches for the treatment of pediatric constipation and these approaches may be added to bowel rehabilitation program. Implications for rehabilitation CTM and KT have similar effectiveness in alleviating the constipation-related symptoms and improving quality of life in children with CP. CTM and KT can be integrated into bowel rehabilitation programs. Considering the characteristics of patients, these treatment options can be used as an alternative of each other by physiotherapists.
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Affiliation(s)
- Ceren Orhan
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Ozgun Kaya Kara
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Serap Kaya
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Turkan Akbayrak
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Mintaze Kerem Gunel
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
| | - Gül Baltaci
- a Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation , Hacettepe University , Ankara , Turkey
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A comprehensive physical therapy approach including visceral manipulation after failed biofeedback therapy for constipation. Tech Coloproctol 2016; 20:603-7. [DOI: 10.1007/s10151-016-1489-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/28/2015] [Indexed: 10/21/2022]
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