Effectiveness of Pelvic Physiotherapy in Children With Functional Constipation Compared With Standard Medical Care

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• 作者：Marieke L. van Engelenburg-van Lonkhuyzen¹ ; ^{m.vanengelenburg@maastrichtuniversity.nl} ; Esther M.J. Bols¹ ; Marc A. Benninga² ; Wim A. Verwijs³ ; Rob A. de Bie¹
• 关键词：Defecation ; Musculoskeletal ; Pediatrician ; Pelvic Floor
• 刊名：Gastroenterology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：152
• 期：1
• 页码：82-91
• 全文大小：704 K
• 卷排序：152

文摘

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.MethodsWe 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).ResultsTreatment 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).ConclusionsIn 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.