Physiotherapy plus usual care is equal to usual care in kids with functional constipation

Reference

van Summeren J, Holtman GA, Kollen BJ, et al. Physiotherapy for children with functional constipation: a pragmatic randomized controlled trial in primary care. J Pediatr 2020;216:25-31.e22.

Synopsis

These researchers conducted a pragmatic trial in which they recruited children with functional constipation from primary care practices in the Netherlands. Functional constipation was diagnosed by the primary care clinician. The authors randomized the children to receive standard care (education, dietary advice, toilet training, and laxatives; n = 54) or standard care plus physiotherapy (n = 61). The physiotherapy consisted of 6 elements: knowledge, toilet behavior and posture, sensing the need to defecate, relaxing while defecating, generating intra-abdominal pressure, and effective straining. The goal was for the children to be able to defecate without the need for laxatives. After 8 months (seems like an odd study interval), slightly more than 40% of children in each group were able to defecate without laxatives. The study was large enough to detect modest differences in the rate of laxative use. The authors also did a bunch of subgroup analyses, but with so few patients and a basically negative trial, it makes little sense to report them.