Physiotherapy for Children with Functional Constipation: A Pragmatic Randomized Controlled Trial in Primary Care - 13/12/19
, Gea A. Holtman, PhD 1, Boudewijn J. Kollen, PhD 1, Yvonne Lisman-van Leeuwen, PhD 1, Alice H.C. van Ulsen-Rust, BSc 2, Merit M. Tabbers, MD, PhD 3, Janny H. Dekker, MD, PhD 1, Marjolein Y. Berger, MD, PhD 1Abstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : primary care, children, gastroenterology, physiotherapy, functional constipation
Abbreviations : aRR, PCP, RCT, RR
Plan
| Funded by The Netherlands organization for Health Research and Development (ZonMw) (837001409). The funding organization had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The authors declare no conflicts of interest. |
Vol 216
P. 25 - janvier 2020 Retour au numéro
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