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  • Dutch Study Finds Pelvic Floor Physical Therapy Useful in Countering Pediatric Constipation

    New research from the Netherlands has staked out another potential benefit of pelvic floor physical therapy (PPT): help with pediatric constipation. The randomized clinical trial found that children with functional constipation (FC) who received specific physical therapy interventions in addition to standard medical care (SMC) experienced a 92.3% rate of treatment effectiveness, compared with a 63% effectiveness rate among children who received SMC alone.

    The study involved 53 children, aged 5-16 years, who were diagnosed with FC according to Rome III criteria between 2009 and 2014. Of those, 26 were assigned to SMC that consisted of education, toilet training, and laxatives, with the remaining 27 receiving SMC plus no more than 6 physical therapy sessions provided by a physical therapist (PT) who specialized in PPT. Pediatricians from 5 hospitals and PTs from 5 PPT practices provided treatment. The study was e-published ahead of print in Gastroenterology (abstract only available for free).

    The PPT followed the Dutch Pelvic Physiotherapy Protocol, and consisted of exercises, practice in sitting on the toilet, the teaching of effective straining, increasing awareness of bodily sensations, and exercises to strengthen pelvic floor functions. In addition to exercises targeted at abdominal and pelvic floor muscles, interventions included balance and stability training, locomotor exercises to learn proper abdominal breathing, and sensory processing techniques.

    Researchers evaluated participants 6 months after they began treatment, and found a 29 percentage point difference in effectiveness between the children who received PPT and SMC (92.3%) compared with the SMC-only group (63%). The differences were also significant when it came to parent-reported secondary outcomes, which included the disappearance of FC complaints (88.5% of the PPT group versus 33.3% of the SMC group), and quality-of-life ratings on a 10-point numeric rating scale (for parents with children in the PPT group, an average 1.8 difference compared with SMC; for children, an average 2-point difference). The children in the PPT group also reported using laxatives at a lower rate than their SMC counterparts.

    While acknowledging that the study's numbers were relatively small, and that it can't be assumed all PPT would follow the Dutch standards, authors of the study assert that PTs offer a uniquely effective approach to pediatric CF, and that PPT may be a "valuable treatment option" that could prevent chronicity.

    "Physiotherapists are musculoskeletal experts, and there the approach in children with FC differs from SMC," they write. "Given the observed effects of this trial, this comprehensive musculoskeletal approach might explain the effectiveness of PPT."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.

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