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The effect of pelvic physiotherapy on reduction of functional constipation in children: design of a multicentre randomised controlled trial.

van Engelenburg-van Lonkhuyzen ML, Bols EM, Benninga MA, Verwijs WA, Bluijssen NM, de Bie RA - BMC Pediatr (2013)

Bottom Line: Standard medical care in paediatric practice is often based on clinical experience and mainly consists of a behavioural approach and toilet training, along with the prescription of laxatives.Web-based baseline and follow-up measurements, scheduled at 3 and 6 months after inclusion, consist of the numeric rating scale in relation to the perceived severity of the problem, the Strength and Difficulties Questionnaire and subjective improvement post-intervention (global perceived effect).It also addresses difficulties when interpreting the literature with regard to the effectiveness of biofeedback, potential confounding, and future research indications.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands. m.vanengelenburg@maastrichtuniversity.nl

ABSTRACT

Background: Functional constipation is a common disorder worldwide and is found in all paediatric age groups. Functional constipation can be caused by delayed colonic transit or dysfunction of the pelvic floor muscles. Standard medical care in paediatric practice is often based on clinical experience and mainly consists of a behavioural approach and toilet training, along with the prescription of laxatives. Evidence to evaluate the effectiveness of pelvic physiotherapy for this complaint is lacking.

Methods/design: A two-armed multicentre randomised controlled trial has been designed. We hypothesise that the combination of pelvic physiotherapy and standard medical care will be more effective than standard medical care alone for constipated children, aged 5 to 17 years. Children with functional constipation according to the Rome III will be included. Web-based baseline and follow-up measurements, scheduled at 3 and 6 months after inclusion, consist of the numeric rating scale in relation to the perceived severity of the problem, the Strength and Difficulties Questionnaire and subjective improvement post-intervention (global perceived effect). Examination of the pelvic floor muscle functions, including digital testing and biofeedback, will take place during baseline and follow-up measurements at the physiotherapist. The control group will only receive standard medical care, involving at least three contacts during five months, whereas the experimental group will receive standard medical care plus pelvic physiotherapy, with a maximum of six contacts. The physiotherapy intervention will include standard medical care, pelvic floor muscle training, attention to breathing, relaxation and awareness of body and posture. The study duration will be six months from randomisation, with a three-year recruitment period. The primary outcome is the absence of functional constipation according to the Rome III criteria.

Discussion: This section discusses the relevance of publishing the study design and the development of the presented physiotherapy protocol. It also addresses difficulties when interpreting the literature with regard to the effectiveness of biofeedback, potential confounding, and future research indications. To our knowledge, this article is the first to describe the design of a randomised controlled trial among children with constipation to assess the effect of pelvic physiotherapy as an add-on to standard medical care.

Trial registration: Current Controlled Trials NL30551.068.09.

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Related in: MedlinePlus

Dutch pelvic physiotherapy protocol’*.
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Figure 4: Dutch pelvic physiotherapy protocol’*.

Mentions: In order to standardise pelvic physiotherapy (PPT) for these children, a survey was first held among 63 Dutch specialised physiotherapists. Extensive agreement existed on providing information, the use of diaries, toilet training, pelvic floor muscle training and biofeedback. On the basis of the survey a provisional PPT protocol was designed in consultation with 25 physiotherapists who were experienced in treating constipated children, using the data from the survey and the literature (Figure 3). Next, the Delphi method was used to discuss, improve and practise the interim protocol during three meetings with all participating physiotherapists. The resulting Dutch pelvic physiotherapy protocol (DPPP) (Figure 4) provides standardisation of intake and intervention.


The effect of pelvic physiotherapy on reduction of functional constipation in children: design of a multicentre randomised controlled trial.

van Engelenburg-van Lonkhuyzen ML, Bols EM, Benninga MA, Verwijs WA, Bluijssen NM, de Bie RA - BMC Pediatr (2013)

Dutch pelvic physiotherapy protocol’*.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750818&req=5

Figure 4: Dutch pelvic physiotherapy protocol’*.
Mentions: In order to standardise pelvic physiotherapy (PPT) for these children, a survey was first held among 63 Dutch specialised physiotherapists. Extensive agreement existed on providing information, the use of diaries, toilet training, pelvic floor muscle training and biofeedback. On the basis of the survey a provisional PPT protocol was designed in consultation with 25 physiotherapists who were experienced in treating constipated children, using the data from the survey and the literature (Figure 3). Next, the Delphi method was used to discuss, improve and practise the interim protocol during three meetings with all participating physiotherapists. The resulting Dutch pelvic physiotherapy protocol (DPPP) (Figure 4) provides standardisation of intake and intervention.

Bottom Line: Standard medical care in paediatric practice is often based on clinical experience and mainly consists of a behavioural approach and toilet training, along with the prescription of laxatives.Web-based baseline and follow-up measurements, scheduled at 3 and 6 months after inclusion, consist of the numeric rating scale in relation to the perceived severity of the problem, the Strength and Difficulties Questionnaire and subjective improvement post-intervention (global perceived effect).It also addresses difficulties when interpreting the literature with regard to the effectiveness of biofeedback, potential confounding, and future research indications.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands. m.vanengelenburg@maastrichtuniversity.nl

ABSTRACT

Background: Functional constipation is a common disorder worldwide and is found in all paediatric age groups. Functional constipation can be caused by delayed colonic transit or dysfunction of the pelvic floor muscles. Standard medical care in paediatric practice is often based on clinical experience and mainly consists of a behavioural approach and toilet training, along with the prescription of laxatives. Evidence to evaluate the effectiveness of pelvic physiotherapy for this complaint is lacking.

Methods/design: A two-armed multicentre randomised controlled trial has been designed. We hypothesise that the combination of pelvic physiotherapy and standard medical care will be more effective than standard medical care alone for constipated children, aged 5 to 17 years. Children with functional constipation according to the Rome III will be included. Web-based baseline and follow-up measurements, scheduled at 3 and 6 months after inclusion, consist of the numeric rating scale in relation to the perceived severity of the problem, the Strength and Difficulties Questionnaire and subjective improvement post-intervention (global perceived effect). Examination of the pelvic floor muscle functions, including digital testing and biofeedback, will take place during baseline and follow-up measurements at the physiotherapist. The control group will only receive standard medical care, involving at least three contacts during five months, whereas the experimental group will receive standard medical care plus pelvic physiotherapy, with a maximum of six contacts. The physiotherapy intervention will include standard medical care, pelvic floor muscle training, attention to breathing, relaxation and awareness of body and posture. The study duration will be six months from randomisation, with a three-year recruitment period. The primary outcome is the absence of functional constipation according to the Rome III criteria.

Discussion: This section discusses the relevance of publishing the study design and the development of the presented physiotherapy protocol. It also addresses difficulties when interpreting the literature with regard to the effectiveness of biofeedback, potential confounding, and future research indications. To our knowledge, this article is the first to describe the design of a randomised controlled trial among children with constipation to assess the effect of pelvic physiotherapy as an add-on to standard medical care.

Trial registration: Current Controlled Trials NL30551.068.09.

Show MeSH
Related in: MedlinePlus