title: Effectiveness of Pelvic Physiotherapy in Children With Functional Constipation Compared With Standard Medical Care.
abstract: Functional constipation (FC) is a common childhood problem often related to pelvic floor muscle dysfunction. We compared the effectiveness of pelvic physiotherapy (PPT) vs standard medical care (SMC) in children with FC.
  
  
  
  We performed a multicenter randomized controlled trial of 53 children (age, 5-16 y) with FC according to the Rome III criteria, at hospitals in The Netherlands from December 2009 to May 2014. Group allocation was concealed using a central computer system. SMC consisted of education, toilet training, and laxatives (n = 26), whereas PPT included SMC plus specific physiotherapeutic interventions (n = 27). Results were obtained from written reports from the subjects' pediatricians and parents. The primary outcome was absence of FC, according to Rome III criteria, after a 6-month follow-up period. Secondary outcomes were global perceived effect (range, 1-9; success was defined as a score ≥ 8), numeric rating scales assessing quality of life (parent and child; scale, 1-10), and the strengths and difficulties questionnaire (SDQ).
  
  
  
  Treatment was effective for 92.3% of the children receiving PPT and for 63.0% of the children receiving SMC (adjusted odds ratio for success of PPT, 11.7; 95% confidence interval, 1.8-78.3) (P = .011). Significantly more children undergoing PPT stopped using laxatives (adjusted odds ratio, 6.5; 95% confidence interval, 1.6-26.4) (P = .009). Treatment success (based on global perceived effect) was achieved for 88.5% of subjects receiving PPT vs 33.3% of subjects receiving SMC) (P < .001). PPT also produced larger adjusted mean differences, before vs after treatment, in numeric rating scales to assess quality of life: an increase of 1.8 points for parents (P = .047) and 2.0 points for children (P = .028). Results from the SDQ did not differ significantly between groups (P = .78).
  
  
  
  In a randomized controlled trial of children with FC, PPT was more effective than SMC on all outcomes measured, with the exception of findings from the SDQ. PPT should be considered as a treatment option for FC in children 5-16 years old. Dutch Clinical Trial Registration no: NL30551.068.09.
authors.affiliation: Department of Epidemiology, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: m.vanengelenburg@maastrichtuniversity.nl.
authors.forename: Marieke L
authors.initials: ML
authors.lastname: van Engelenburg-van Lonkhuyzen
authors.affiliation: Department of Epidemiology, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Esther M J
authors.initials: EM
authors.lastname: Bols
authors.affiliation: Department of Paediatric Gastroenterology, Emma Children's Hospital/Amsterdam Medical Centre, Amsterdam, The Netherlands.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.affiliation: Department of Paediatrics, Zuwe Hofpoort Hospital, Woerden, The Netherlands.
authors.forename: Wim A
authors.initials: WA
authors.lastname: Verwijs
authors.affiliation: Department of Epidemiology, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Rob A
authors.initials: RA
authors.lastname: de Bie
mesh_terms: D000293:Adolescent; D001945:Breathing Exercises; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003248:Constipation / Q000503:physiopathology* / Q000628:therapy*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D010353:Patient Education as Topic; D017773:Pelvic Floor / Q000503:physiopathology*; D010388:Pelvis; D026741:Physical Therapy Modalities; D004856:Postural Balance; D011788:Quality of Life; D012064:Relaxation Therapy; D016037:Single-Blind Method; D014039:Toilet Training
chemical_list: D054368:Laxatives
keywords: Defecation; Musculoskeletal; Pediatrician; Pelvic Floor