Pelvic physiotherapy in addition to standard care is more effective than standard medical care alone for children with functional constipation [commentary]

摘要

Summary of: van Engelenburg-van Lonkhuyzen ML, Bols EM, physiotherapists from five primary healthcare pelvic physiotherapy Benninga MA, Verwijs WA, de Bie RA. Effectiveness of pelvic physio- practices delivered the intervention. Outcome measures: The primary therapy in children with functional constipation compared with outcome was absence of functional constipation at 6 months as indi- standard medical care. Gastroenterol. 2017;152:82C91. cated by meeting none or one of six diagnostic criteria (Rome III Question: Does the addition of pelvic physiotherapy to criteria). Secondary outcome measures were parent-reported global standard medi- cal care reduce functional constipation in children? Design: Random- perceived effect (scored from 1 to 9), parent-reported and child- ised, controlled trial with concealed allocation and blinded outcome reported influence on daily life (scored from 1 to 10), behavioural assessment. Setting: Five district hospitals in The Netherlands. Parti- screening (scored from 0 to 40) and laxative use. Results: A total of cipants: Children aged 5 to 16 years with functional constipation, 49 participants completed the study. After the intervention more indicated by the presence of two or more of six children in the intervention group were reported by paediatricians diagnostic criteria (called Rome III criteria). Exclusion criteria were previous physiothera- (OR 7.1, 95% CI 1.4 to 36.4) and by parents (OR 15.3, 95% CI 3.6 to 65.0) to py for continence issues; presence of endocrine, metabolic, neurologi- have been successfully treated. The intervention group also reported cal or psychiatric condition(s); Down syndrome; Hirschsprung s reduced laxative use compared with the control group (OR 3.2, 95% CI disease; drug-induced constipation; score of 14 on a 1.0 to 9.9). Parent-reported and child-reported influence on daily life > behavioural screening questionnaire (range 0 to 40); or previous intestinal surgery. was improved for the intervention group (adjusted mean differences Randomisationof 53participants allocated26 tothe interventiongroup 1.8, 95% CI 0.7 to 3.5 and 2.0, 95% CI 0.2 to 3.8, respectively). The groups and 27 to the control group. Interventions: Both groups received did not significantly differ on behavioural screening. Conclusion: Chil- standard medical care, including education, dietary advice, toilet dren with functional constipation receiving pelvic physiotherapy in train- ing and laxatives for 6 months. In addition, the intervention group addition to standard medical care had significant improvements in received up to six pelvic physiotherapy sessions,which includedmotor symptom reduction, laxative use and influence on daily life compared control training (eg, core stability, balance, pelvic oor muscle exer- with children receiving standard medical care only. fl cises), practising stabilised toilet posture, teaching effective strainingto Provenance: Invited. Not peer reviewed. defecate, optimising pelvic floor muscle function (relaxing while defe- cating, contracting to prevent faecal incontinence) and sensory proces- Nora Shields sing techniques to increase sensory awareness (eg, urge to defecate). School of Allied Health, La Trobe University and Northern Health, Motor training was supported by exercise equipment (eg, Swiss ball, Australia. balance board), myofeedback and rectal balloon training. Pelvic http://dx.doi.org/10.1016/j.jphys.2017.06.002 ? 2017 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).