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Todhunter-Brown A, Booth L, Campbell P, Cheer B, Cowie J, Elders A, Hagen S, Jankulak K, Mason H, Millington C, Ogden M, Paterson C, Richardson D, Smith D, Sutcliffe J, Thomson K, Torrens C, McClurg D. Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis. Health Technol Assess 2024; 28:1-266. [PMID: 38343084 PMCID: PMC11017632 DOI: 10.3310/pltr9622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Up to 30% of children have constipation at some stage in their life. Although often short-lived, in one-third of children it progresses to chronic functional constipation, potentially with overflow incontinence. Optimal management strategies remain unclear. Objective To determine the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation, and understand how they can best be implemented. Methods Key stakeholders, comprising two parents of children with chronic functional constipation, two adults who experienced childhood chronic functional constipation and four health professional/continence experts, contributed throughout the research. We conducted pragmatic mixed-method reviews. For all reviews, included studies focused on any interventions/strategies, delivered in any setting, to improve any outcomes in children (0-18 years) with a clinical diagnosis of chronic functional constipation (excluding studies of diagnosis/assessment) included. Dual reviewers applied inclusion criteria and assessed risk of bias. One reviewer extracted data, checked by a second reviewer. Scoping review: We systematically searched electronic databases (including Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature) (January 2011 to March 2020) and grey literature, including studies (any design) reporting any intervention/strategy. Data were coded, tabulated and mapped. Research quality was not evaluated. Systematic reviews of the evidence of effectiveness: For each different intervention, we included existing systematic reviews judged to be low risk of bias (using the Risk of Bias Assessment Tool for Systematic Reviews), updating any meta-analyses with new randomised controlled trials. Where there was no existing low risk of bias systematic reviews, we included randomised controlled trials and other primary studies. The risk of bias was judged using design-specific tools. Evidence was synthesised narratively, and a process of considered judgement was used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic synthesis: Included studies (any design, English-language) detailed intervention-related costs. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit, and reporting quality evaluated using the consensus health economic criteria checklist. Systematic review of implementation factors: Included studies reported data relating to implementation barriers or facilitators. Using a best-fit framework synthesis approach, factors were synthesised around the consolidated framework for implementation research domains. Results Stakeholders prioritised outcomes, developed a model which informed evidence synthesis and identified evidence gaps. Scoping review 651 studies, including 190 randomised controlled trials and 236 primary studies, conservatively reported 48 interventions/intervention combinations. Effectiveness systematic reviews studies explored service delivery models (n = 15); interventions delivered by families/carers (n = 32), wider children's workforce (n = 21), continence teams (n = 31) and specialist consultant-led teams (n = 42); complementary therapies (n = 15); and psychosocial interventions (n = 4). One intervention (probiotics) had moderate-quality evidence; all others had low to very-low-quality evidence. Thirty-one studies reported evidence relating to cost or resource use; data were insufficient to support generalisable conclusions. One hundred and six studies described implementation barriers and facilitators. Conclusions Management of childhood chronic functional constipation is complex. The available evidence remains limited, with small, poorly conducted and reported studies. Many evidence gaps were identified. Treatment recommendations within current clinical guidelines remain largely unchanged, but there is a need for research to move away from considering effectiveness of single interventions. Clinical care and future studies must consider the individual characteristics of children. Study registration This study is registered as PROSPERO CRD42019159008. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Booth
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Brenda Cheer
- ERIC, The Children's Bowel and Bladder Charity, Bristol, UK
| | - Julie Cowie
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Charlotte Paterson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | | | | | | | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
- Department of Occupational Therapy, Human Nutrition and Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Claire Torrens
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
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Trzpis M, Sun G, Chen JH, Huizinga JD, Broens P. Novel insights into physiological mechanisms underlying fecal continence. Am J Physiol Gastrointest Liver Physiol 2023; 324:G1-G9. [PMID: 36283962 DOI: 10.1152/ajpgi.00313.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The machinery maintaining fecal continence prevents involuntary loss of stool and is based on the synchronized interplay of multiple voluntary and involuntary mechanisms, dependent on cooperation between motor responses of the musculature of the colon, pelvic floor, and anorectum, and sensory and motor neural pathways. Knowledge of the physiology of fecal continence is key toward understanding the pathophysiology of fecal incontinence. The idea that involuntary contraction of the internal anal sphincter is the primary mechanism of continence and that the external anal sphincter supports continence only by voluntary contraction is outdated. Other mechanisms have come to the forefront, and they have significantly changed viewpoints on the mechanisms of continence and incontinence. For instance, involuntary contractions of the external anal sphincter, the puborectal muscle, and the sphincter of O'Beirne have been proven to play a role in fecal continence. Also, retrograde propagating cyclic motor patterns in the sigmoid and rectum promote retrograde transit to prevent the continuous flow of content into the anal canal. With this review, we aim to give an overview of primary and secondary mechanisms controlling fecal continence and evaluate the strength of evidence.
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Affiliation(s)
- Monika Trzpis
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Ge Sun
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Ji-Hong Chen
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Canada
| | - Jan D Huizinga
- Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Canada
| | - Paul Broens
- Department of Surgery, Anorectal Physiology Laboratory, University of Groningen, University Medical Center, Groningen, The Netherlands.,Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center, Groningen, The Netherlands
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Correll CU, Cortese S, Croatto G, Monaco F, Krinitski D, Arrondo G, Ostinelli EG, Zangani C, Fornaro M, Estradé A, Fusar-Poli P, Carvalho AF, Solmi M. Efficacy and acceptability of pharmacological, psychosocial, and brain stimulation interventions in children and adolescents with mental disorders: an umbrella review. World Psychiatry 2021; 20:244-275. [PMID: 34002501 PMCID: PMC8129843 DOI: 10.1002/wps.20881] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Top-tier evidence on the safety/tolerability of 80 medications in children/adolescents with mental disorders has recently been reviewed in this jour-nal. To guide clinical practice, such data must be combined with evidence on efficacy and acceptability. Besides medications, psychosocial inter-ventions and brain stimulation techniques are treatment options for children/adolescents with mental disorders. For this umbrella review, we systematically searched network meta-analyses (NMAs) and meta-analyses (MAs) of randomized controlled trials (RCTs) evaluating 48 medications, 20 psychosocial interventions, and four brain stimulation techniques in children/adolescents with 52 different mental disorders or groups of mental disorders, reporting on 20 different efficacy/acceptability outcomes. Co-primary outcomes were disease-specific symptom reduction and all-cause discontinuation ("acceptability"). We included 14 NMAs and 90 MAs, reporting on 15 mental disorders or groups of mental disorders. Overall, 21 medications outperformed placebo regarding the co-primary outcomes, and three psychosocial interventions did so (while seven outperformed waiting list/no treatment). Based on the meta-analytic evidence, the most convincing efficacy profile emerged for amphetamines, methylphenidate and, to a smaller extent, behavioral therapy in attention-deficit/hyperactivity disorder; aripiprazole, risperidone and several psychosocial interventions in autism; risperidone and behavioral interventions in disruptive behavior disorders; several antipsychotics in schizophrenia spectrum disorders; fluoxetine, the combination of fluoxetine and cognitive behavioral therapy (CBT), and interpersonal therapy in depression; aripiprazole in mania; fluoxetine and group CBT in anxiety disorders; fluoxetine/selective serotonin reuptake inhibitors, CBT, and behavioral therapy with exposure and response prevention in obsessive-compulsive disorder; CBT in post-traumatic stress disorder; imipramine and alarm behavioral intervention in enuresis; behavioral therapy in encopresis; and family therapy in anorexia nervosa. Results from this umbrella review of interventions for mental disorders in children/adolescents provide evidence-based information for clinical decision making.
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Affiliation(s)
- Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | | | - Gonzalo Arrondo
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | | | - Caroline Zangani
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Michele Fornaro
- Department of Psychiatry, Federico II University, Naples, Italy
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Clinical and Health Psychology, Catholic University, Montevideo, Uruguay
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Marco Solmi
- Neurosciences Department, University of Padua, Padua, Italy
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Bolia R, Safe M, Southwell BR, King SK, Oliver MR. Paediatric constipation for general paediatricians: Review using a case-based and evidence-based approach. J Paediatr Child Health 2020; 56:1708-1718. [PMID: 33197982 DOI: 10.1111/jpc.14720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/13/2022]
Abstract
Constipation is a common problem in childhood. The most common type of constipation is functional, accounting for 90-95% of all cases. The aim of this review is to provide clinical scenarios with treatment using evidence-based information, and management strategies and a clinical algorithm to guide the management of constipation in children. Recent guidelines and online information sites are detailed. Clinical red flags and organic causes of constipation are included. Four clinical scenarios are presented: case (1) 4-month-old child with constipation since birth and likely Hirschsprung disease; case (2) 6-month-old infant with infant dyschezia; case (3) 4-year old with functional constipation; and; case (4) 9-year old with treatment resistant constipation. Children with functional constipation need a thorough history and physical exam to rule out the presence of any 'red flags' but do not require laboratory investigations. Management includes education and demystification, disimpaction followed by maintenance therapy with oral laxatives, dietary counselling and toilet training. Treatment options differ between infants and children. Disimpaction and maintenance regimens for common laxatives are presented. On treatment failure or on suspicion of organic disease the patient should be referred for further evaluation. The radionuclide intestinal transit study (scintigraphy) is a useful modality for evaluation and planning of management in treatment-resistant children. Treatment options for treatment-resistant patients are presented. High-level evidence (meta-analyses) for pharmalogical and non-pharmalogical treatment modalities are reviewed and an algorithm for assessment and treatment are presented.
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Affiliation(s)
- Rishi Bolia
- Division of Paediatric Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India
| | - Mark Safe
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Bridget R Southwell
- Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Urology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sebastian K King
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia.,Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatric Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mark R Oliver
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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6
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Abstract
Constipation in otherwise healthy infants and children is a common problem despite confusion about how to precisely define constipation and constipation-related disorders. Constipation may, rarely, be a sign or symptom of a more serious disease or a diagnosis defined only by its symptoms and without any structural or biochemical findings. In the latter case it is classified as a functional gastrointestinal disorder (FGID). FGIDs are defined as disorders that cannot be explained by structural or biochemical findings. The Rome Foundation has standardized diagnostic criteria for all FGIDs. The Rome criteria are based on the available research as well as the clinical experience of the Foundation's assembled experts. The most recent report, Rome IV, described clinical criteria and diagnostic tools and encouraged more rigorous research in the area of FGIDs. The true incidence and prevalence of constipation is difficult to know because it may be treated at home using home remedies or diagnosed at a visit to a primary care provider or to a subspecialist pediatric gastroenterologist. The most recent attempts to define the prevalence of all pediatric FGIDs have been made using the Rome IV criteria. The defined FGID entities that may be associated with the complaint of constipation are infant dyschezia, functional constipation, and nonretentive fecal incontinence. The term encopresis, omitted from Rome IV, is defined by the American Psychiatric Association (APA) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition The 3 Rome-defined (constipation-related) entities and the APA entity of encopresis are the focus of this review.
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Affiliation(s)
| | - Sarah Mayer-Brown
- Department of Psychiatry and Human Behavior, Hasbro Children's Hospital/Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, RI
| | | | - Wendy Plante
- Department of Psychiatry and Human Behavior, Hasbro Children's Hospital/Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, RI
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7
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Southwell BR. Treatment of childhood constipation: a synthesis of systematic reviews and meta-analyses. Expert Rev Gastroenterol Hepatol 2020; 14:163-174. [PMID: 32098515 DOI: 10.1080/17474124.2020.1733974] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Constipation occurs in many children and can become chronic. Many grow out of it but for one third, it continues into adulthood. For most patients, there is no identifiable organic disorder and it is classified as functional constipation.Areas covered: In 2016, treatment of childhood constipation was extensively reviewed by Rome IV. This review covers meta-analyses and evidence for treatment of paediatric constipation since 2016 and new emerging treatments.Expert opinion: Since 2016, meta-analyses conclude 1) fibre should be included in a normal diet, but further supplementation does not improve constipation; 2) probiotics may increase stool frequency in children, but evidence from larger RCTs is needed; 3) comparing laxatives, polyethylene glycol (PEG) is superior to placebo, lactulose and milk of magnesia, and 4) appendix stomas are effective and should be considered before surgery. Emerging areas of study include food intolerance, electrical stimulation and faecal microbiota transplant. For research, outcome measures need standardising to allow comparison between studies and allow meta-analyses. To assist this, validated GI instruments have been developed by Rome IV and PedsQl.
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Affiliation(s)
- Bridget R Southwell
- Murdoch Children's Research Institute, Urology Department, Royal Children's Hospital and Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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8
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Group Treatment of Fecal Incontinence: A Description of an Interdisciplinary Intervention. J Pediatr Gastroenterol Nutr 2019; 69:e70-e74. [PMID: 31058779 DOI: 10.1097/mpg.0000000000002372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Approximately 5% of children in the United States have chronic fecal incontinence. Unfortunately, standard medical management of fecal incontinence fails in 20% to 60% of cases. A combined medical-behavioral model is often recommended in these cases. The purpose of this pilot study was to describe an interdisciplinary group-based treatment for fecal incontinence in school-aged children, and to present a description of changes in treatment adherence rates that affect clinical effectiveness. METHOD Poop group employed a developmentally appropriate model of care in which caregivers and children participated in separate but simultaneously held therapy groups. This interdisciplinary 6-week protocol is designed to increase appropriate stooling, decrease soiling events, and increase medication adherence pre- to post-treatment. Group sessions focus on the GI system, medication, toilet sitting posture, hydration, fiber, and behavior contracts. In addition, participant families consult with an Advanced Nurse Practitioner privately at each session discussing symptoms and making medication modifications as needed. RESULTS Nineteen families completed the 6-week protocol. Appropriate stool frequency was improved (P ≤ 0.01), and soiling was reduced (P ≤ 0.00). Medication adherence was also improved (P ≤ 0.04). Treatment results were maintained at 1-month follow-up. DISCUSSION A developmentally targeted intervention and interdisciplinary focus of treatment likely account for treatment successes. CONCLUSION Poop group may be an effective interdisciplinary treatment option for families of children who fail traditional outpatient treatment.
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Fife ST, Hawkins LG. Doctor, Snitch, and Weasel: Narrative Family Therapy With a Child Suffering From Encopresis and Enuresis. Clin Case Stud 2019. [DOI: 10.1177/1534650119866917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children who experience enuresis and encopresis can face many difficulties, including social isolation, shame, embarrassment, anxiety, and depression. Due to the prevalence of enuresis and encopresis, it is essential for mental health professionals to understand the common symptoms and available treatment options for enuresis and encopresis, particularly to assist parents struggling to help their children overcome these challenges. Despite this need, there is very little clinical literature that incorporates a systemic approach for families who have a child diagnosed with enuresis and encopresis. Furthermore, common treatment approaches may unwittingly reinforce children’s perception that these problems are rooted in their identity. In an effort to address these concerns, the present case study aims to illustrate how a narrative therapy approach was utilized to effectively treat a child with enuresis and encopresis. Narrative therapy can uniquely assist children and their parents by helping them externalize the problem, overcome the problem-saturated view of their lives, and create new experiences where the problem is nonexistent.
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Little LM, Benton K, Manuel-Rubio M, Saps M, Fishbein M. Contribution of Sensory Processing to Chronic Constipation in Preschool Children. J Pediatr 2019; 210:141-145. [PMID: 31006491 DOI: 10.1016/j.jpeds.2019.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess differences in sensory processing patterns between children with chronic constipation compared with a matched normative sample as well as to examine the extent to which specific sensory processing patterns and modality scores predicted atypical toileting behaviors. STUDY DESIGN We used a cross-sectional comparative design to evaluate differences between children age 3 and 5 years old with constipation (n = 66) and those in a matched control sample (n = 66). We also examined the contribution of sensory processing patterns to atypical toileting behavior in the clinical sample. RESULTS Children with chronic constipation showed significantly higher sensory scores than a matched normative sample, specifically in oral processing (P < .001), visual processing (P < . 05), sensory avoiding (P < .001), and sensory sensitivity (P < .05). Sensory registration, avoidance, and oral processing significantly predicted toileting behavior over-responsiveness, and attentional difficulties contribute to toileting under-responsiveness. CONCLUSIONS Our findings revealed that children with chronic constipation have underlying sensory characteristics that contribute to toileting behavioral difficulties. By identifying sensory processing patterns of children with chronic constipation, we can optimize behavioral interventions to complement laxative therapy for this population.
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Affiliation(s)
- Lauren M Little
- Department of Occupational Therapy, Rush University, Chicago, IL
| | - Kathryn Benton
- Pediatric Subspecialties Clinic, Northwestern Medicine/Central DuPage Hospital, Winfield, IL; Department of Pediatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL
| | | | - Miguel Saps
- University of Miami Health Care System, Miami, FL; Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL
| | - Mark Fishbein
- Department of Pediatrics, Feinberg School of Medicine at Northwestern University, Chicago, IL; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
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Abstract
PURPOSE To describe the implementation and effectiveness of a multimodal therapeutic approach used to successfully treat a child with encopresis. SUMMARY OF KEY POINTS The child demonstrated chronic constipation, poor pelvic floor muscle awareness, weakness, and incoordination during voiding. He participated in 8 sessions of physical therapy intervention including pelvic floor muscle awareness, strengthening and coordination exercises, behavioral adaptations, diet modification, and use of media, art, and interactive visualization activities. CONCLUSIONS The child improved pelvic floor muscle strength and coordination and became fully continent of bowel in home and community settings. WHAT THIS CASE ADDS TO EVIDENCE-BASED PRACTICE This case report demonstrates that pediatric age-appropriate educational and motivational tools (media, art, and interactive visualization activities) are readily available, economical, and effective when used in conjunction with current practice to decrease impairments and improve active participation and compliance during treatment of retentive encopresis in the pediatric population.
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Beaudry-Bellefeuille I, Lane SJ, Lane AE. Sensory Integration Concerns in Children With Functional Defecation Disorders: A Scoping Review. Am J Occup Ther 2019; 73:7303205050p1-7303205050p13. [PMID: 31120835 DOI: 10.5014/ajot.2019.030387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We examined the literature to identify reports of sensory integration concerns in children with functional defecation issues and to explore whether difficulty processing sensation may be related to their challenging bowel management behaviors. METHOD A scoping review was used to address the research question. We sourced articles from six databases in three languages, searched reference lists of all included articles, and identified additional articles through discussion with experts in the field. RESULTS Twelve articles were included in the final synthesis, identifying 15 challenging behaviors potentially related to sensory integration concerns. CONCLUSION We summarize research documenting sensory integration concerns in children with functional defecation issues, providing researchers and clinicians with an overview of the current state of understanding.
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Affiliation(s)
- Isabelle Beaudry-Bellefeuille
- Isabelle Beaudry-Bellefeuille, MSc, is PhD Candidate, Occupational Therapy, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia, and Private Practitioner, Oviedo, Spain;
| | - Shelly J Lane
- Shelly J. Lane, PhD, OTR/L, FAOTA, is Professor and Discipline Lead, Occupational Therapy, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - Alison E Lane
- Alison E. Lane, PhD, is Associate Professor, School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
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Brain-Gut Therapies for Pediatric Functional Gastrointestinal Disorders and Inflammatory Bowel Disease. Curr Gastroenterol Rep 2019; 21:12. [PMID: 30868282 DOI: 10.1007/s11894-019-0683-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss current knowledge of brain-gut therapies (BGT) in pediatric functional gastrointestinal disorders (FGID) and inflammatory bowel disease (IBD), including their evidence base, the common psychopathology that they address, and the integration of this knowledge into medical settings. RECENT FINDINGS Cognitive behavioral therapy (CBT), hypnotherapy (HT), mindfulness-based therapy (MBT), and exposure-based therapy (EBT) have the most data supporting their use in children, particularly in FGID, more so than in IBD. This difference is most likely because of the increased role of psychological factors in FGID, though these same factors can be seen comorbidly in IBD. Integrative BGT treatment strategies with the collaboration of clinicians across disciplines may provide the most benefit to patients. This review details our current understanding of the evidence for BGT in pediatric FGID and IBD and how they may best be used in treatment strategies.
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Beaudry-Bellefeuille I, Bundy A, Lane A, Ramos Polo E, Lane SJ. The toileting habit profile questionnaire: Examining construct validity using the Rasch model. Br J Occup Ther 2018. [DOI: 10.1177/0308022618813266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction Preliminary reports support the hypothesis that sensory issues may be related to atypical defecation habits in children. Clinical practice in this area is limited by the lack of validated measures. The toileting habit profile questionnaire was designed to address this gap. Methods This study included two phases of validity testing. In phase 1, we used Rasch analysis of existing data to assess item structural validity, directed content analysis of recent literature to determine the extent to which items capture clinical concerns, and expert review to validate the toileting habit profile questionnaire. Based on phase 1 outcomes, we made adjustments to toileting habit profile questionnaire items. In phase 2, we examined the item structural validity of the revised toileting habit profile questionnaire. Results Phase 1 resulted in a 17-item questionnaire: 15 items designed to identify habits linked to sensory over-reactivity and two designed to identify sensory under-reactivity and/or poor perception items. The analysis carried out in phase 2 supported the use of the sensory over-reactivity items. Remaining items can be used as clinical observations. Conclusion Caregiver report of behaviour using the revised toileting habit profile questionnaire appears to adequately capture challenging defecation behaviours related to sensory over-reactivity. Identifying challenging behaviours related to sensory under-reactivity and/or perception issues using exclusively the revised toileting habit profile questionnaire is not recommended.
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Affiliation(s)
| | - Anita Bundy
- Professor and Department Head (Occupational Therapy), Colorado State University, Fort Collins, USA
| | - Alison Lane
- Associate Professor (Occupational Therapy, School of Health Sciences), University of Newcastle, Callaghan, Australia
| | | | - Shelly J Lane
- Professor and Discipline Lead (Occupational Therapy, School of Health Sciences), University of Newcastle, Callaghan, Australia
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Standard urotherapy as first-line intervention for daytime incontinence: a meta-analysis. Eur Child Adolesc Psychiatry 2018; 27:949-964. [PMID: 28948380 DOI: 10.1007/s00787-017-1051-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
According to the International Children's Continence Society (ICCS) guidelines for the treatment of daytime urinary incontinence (DUI) in children and adolescents, the first-line intervention for all types of DUI is standard urotherapy (SU). Despite this recommendation there is still no meta-analysis available on the effectiveness of SU. The aim of this study is to provide a meta-analytic evaluation of the intervention. This meta-analysis is based on Odds Ratios (OR) and consists of 26 patient samples out of 19 studies (N = 1609), collected from well-established medical databases. Remission rates after SU are compared to spontaneous remission rates, which are matched to the individual follow-up period. The meta-analysis shows that SU is an effective treatment of DUI. Compared to a spontaneous remission rate of 15.40% per year, urotherapy increases the probability to recover by a factor of 7.27 (6.57 if corrected for publication bias). After exclusion of three outlying samples this effect can be generalized for all types of SU and all patient populations. Moderator analyses cannot identify variables which significantly influence the variance of effect sizes. However, RCTs seem to be associated with lower effects, even when the control group is not considered for effect size calculation. Based on the present meta-analysis, SU is an effective intervention for treating DUI in children and adolescents. Of 100 patients in 1 year, approximately 56 patients (54 if corrected for publication bias) remit after being treated with SU, while only 15 out of 100 remit spontaneously. However, to further quantify the effect size of SU in comparison to spontaneous remission rates and other treatments, additional RCTs are still needed.
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16
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Klages KL, Berlin KS, Silverman AH, Mugie S, Di Lorenzo C, Nurko S, Ponnambalam A, Sanghavi R, Sood MR. Empirically Derived Patterns of Pain, Stooling, and Incontinence and Their Relations to Health-Related Quality of Life Among Youth With Chronic Constipation. J Pediatr Psychol 2017; 42:325-334. [PMID: 27474732 DOI: 10.1093/jpepsy/jsw068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/30/2016] [Indexed: 12/22/2022] Open
Abstract
Objective Chronic constipation is associated with pain, stress, and fecal incontinence, which negatively impact health-related quality of life (HRQoL); however, it is unclear if patterns of pain, stool frequency, and incontinence are differentially associated with HRQoL in youth with chronic constipation. Methods 410 caregivers completed a demographics and symptoms form, the Parental Opinions of Pediatric Constipation, Pediatric Symptom Checklist, and the Functional Disability Inventory. Results Stooling patterns were derived using Latent Variable Mixture Modeling. A three-class model emerged: withholding/avoiding ( WA ), pain , and fecal incontinence ( FI ). The pain class reported the greatest amount of disease burden/distress, greatest impairments in illness-related activity limitations, more psychosocial problems, and, along with the FI class, elevated levels of family conflict. The FI class reported the greatest amount of parental worry of social impact. Conclusions Youth with chronic constipation who experience pain or fecal incontinence may be at a greater risk for specific HRQoL problems such as illness-related activity limitations, psychosocial issues, disease burden and worry, and family conflict.
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Affiliation(s)
- Kimberly L Klages
- Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis, Memphis, TN, USA
- University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Alan H Silverman
- Department of Gastroenterology, Children's Hospital of Wisconsin, Milwaukee, USA
- Department of Gastroenterology, Medical College of Wisconsin, Milwaukee, USA
| | - Suzanne Mugie
- Department of Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Carlo Di Lorenzo
- Department of Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Samuel Nurko
- Department of Gastroenterology, Boston Children's Hospital, Boston, MA, USA
| | - Ananthasekar Ponnambalam
- Department of Gastroenterology, Children's and Women's Hospital at University of South Alabama, USA
| | - Rina Sanghavi
- Department of Gastroenterology, University of Texas Southwest Medical Center, Dallas, TX, USA
| | - Manu R Sood
- Department of Gastroenterology, Medical College of Wisconsin, Milwaukee, USA
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Levy EI, Lemmens R, Vandenplas Y, Devreker T. Functional constipation in children: challenges and solutions. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2017; 8:19-27. [PMID: 29388621 PMCID: PMC5774595 DOI: 10.2147/phmt.s110940] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This review intends to update what is known about and what is still a challenge in functional constipation (FC) in children regarding epidemiology, pathophysiology, diagnosis, and management. Although FC is a common childhood problem, its global burden remains unknown as data from parts of the world are missing. Another problem is that there is a large variation in prevalence due to differences in study methods and defining age groups. The pathophysiology of FC remains unclear to date but is probably multifactorial. Withholding behavior is likely to be the most important factor in toddlers and young children. Genetics may also play a role since many patients have positive family history, but mutations in genes associated with FC have not been found. Over the past years, different diagnostic criteria for FC in infants and children have been proposed. This year, Rome IV criteria have been released. Compared to Rome III, it eliminates two diagnostic criteria in children under the age of 4 who still wear diapers. Physical examination and taking a thorough medical history are recommended, but other investigations such as abdominal radiography, transabdominal recto-ultrasonography, colonic transit time, rectal biopsies, and colon manometry are not routinely recommended. Regarding treatment, guidelines recommend disimpaction and maintenance therapy with polyethylene glycol (PEG) with or without electrolytes. But experience shows that acceptability, adherence, and tolerance to PEG are still a challenge. Counseling of parents and children about causes of FC is often neglected. Recent studies suggest that behavior therapy added to laxative therapy improves the relief of symptoms. Further homogeneous studies, better-defined outcomes, and studies conducted in primary care are needed.
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Affiliation(s)
- Elvira Ingrid Levy
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Roel Lemmens
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yvan Vandenplas
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Thierry Devreker
- Kidz Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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18
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Beaudry-Bellefeuille I, Booth D, Lane SJ. Defecation-Specific Behavior in Children with Functional Defecation Issues: A Systematic Review. Perm J 2017; 21:17-047. [PMID: 29035187 PMCID: PMC5638627 DOI: 10.7812/tpp/17-047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
CONTEXT Atypical defecation habits are common and distressing for children and families and can have a major impact on quality of life. Often, no underlying factor can be identified, and the defecation disorder is considered functional. Current interventions are not successful for up to 50% of children. We suggest this high failure rate may be caused by lack of consistency in descriptors of behavioral indicators for functional defecation problems. Most investigations and descriptors focus on general behavior. There are fewer reports concerning defecation-specific behaviors. OBJECTIVE To develop a thorough inventory of defecation-specific behaviors, providing a more informed foundation for assessment and intervention. DESIGN A systematic review of six common databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Reference lists of retained articles were screened for additional studies. MAIN OUTCOME MEASURES Content analysis was used to classify defecation-specific behaviors into 17 categories. RESULTS Our search yielded 2677 articles; 98 peer-reviewed publications were retained for full-text review, and 67 articles were included in the final qualitative synthesis. Although there is inconsistency in reported diagnostic criteria, stool withholding and manifesting pain on defecation are the most commonly reported defecation-specific behaviors. In the studies that included children with autism or attention-deficit/hyperactivity disorder, the defecation-specific behaviors were not unique to the diagnostic group. CONCLUSION Consistent use of established diagnostic criteria, along with use of behaviors identified through this review, lay a foundation for more effective interventions.
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Affiliation(s)
| | - Debbie Booth
- Senior Librarian at the University of Newcastle in Callaghan, New South Wales, Australia.
| | - Shelly J Lane
- Professor of Occupational Therapy at the University of Newcastle School of Health Sciences in Callaghan, New South Wales, Australia.
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19
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Shepard JA, Poler JE, Grabman JH. Evidence-Based Psychosocial Treatments for Pediatric Elimination Disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:767-797. [PMID: 27911597 DOI: 10.1080/15374416.2016.1247356] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pediatric elimination disorders are common in childhood, yet psychosocial correlates are generally unclear. Given the physiological concomitants of both enuresis and encopresis, and the fact that many children with elimination disorders are initially brought to their primary care physician for treatment, medical evaluation and management are crucial and may serve as the first-line treatment approach. Scientific investigation on psychological and behavioral interventions has progressed over the past couple of decades, resulting in the identification of effective treatments for enuresis and encopresis. However, the body of literature has inherent challenges, particularly given the multicomponent nature of many of the treatment packages. This review identified 25 intervention studies-18 for nocturnal enuresis and 7 for encopresis-over the past 15 years and classified them according to the guidelines set forth by the Task Force on the Promotion and Dissemination of Psychological Procedures. For nocturnal enuresis, the urine alarm and dry-bed training were identified as well-established treatments, Full Spectrum Home Therapy was probably efficacious, lifting was possibly efficacious, and hypnotherapy and retention control training were classified as treatments of questionable efficacy. For encopresis, only two probably efficacious treatments were identified: biofeedback and enhanced toilet training (ETT). Best practice recommendations and suggestions for future research are provided to address existing limitations, including heterogeneity and the multicomponent nature of many of the interventions for pediatric elimination disorders.
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Affiliation(s)
- Jaclyn A Shepard
- a Department of Psychiatry & Neurobehavioral Sciences , University of Virginia School of Medicine
| | - Joseph E Poler
- a Department of Psychiatry & Neurobehavioral Sciences , University of Virginia School of Medicine
| | - Jesse H Grabman
- a Department of Psychiatry & Neurobehavioral Sciences , University of Virginia School of Medicine
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20
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Davis JL. Identifying Underlying Emotional Instability and Utilizing a Combined Intervention in the Treatment of Childhood Constipation and Encopresis—A Case Report. J Altern Complement Med 2016; 22:489-92. [DOI: 10.1089/acm.2015.0093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Toilet School for Children with Failure to Toilet Train: Comparing a Group Therapy Model with Individual Treatment. J Dev Behav Pediatr 2016; 37:223-30. [PMID: 26950340 DOI: 10.1097/dbp.0000000000000278] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study compared the toileting outcomes of children participating in Toilet School group therapy with children in individual treatment. METHOD All children in this study failed conventional toilet training and were 4 to 6 year, 11 month old. Cases were 63 children who attended a 6-week Toilet School group therapy with their parents. Controls were 62 children who were seen in individual treatment in the same tertiary care program and were matched to cases based on treatment dates. We analyzed the number of toileting benchmarks met for cases and controls. We used a stepwise linear regression model to investigate the contribution of child and family factors in predicting the number of toileting benchmarks met. RESULTS Compared to controls, cases achieved significantly more toileting benchmarks (p < .001) at the end of Toilet School, were more likely to have bowel movements in the toilet (p = .001), and required fewer subsequent visits until completion of toilet training (p = .013). Similarly, at the seventh provider encounter for both controls and cases, the cases continued to achieve significantly more toileting benchmarks (p < .001) and were more likely to have bowel movements in the toilet (p = .002) compared to controls. After adjusting for age, gender, neighborhood poverty level, and number of total clinical visits for fecal incontinence, treatment grouping was the only independent variable that predicted toileting progress. CONCLUSION For children with failure to toilet train, group treatment involving both the child and the family results in greater improvement in toileting outcomes than individual treatment.
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Affiliation(s)
- Jennifer M Colombo
- Division of Gastroenterology, Children's Mercy Kansas City, University of Missouri at Kansas City School of Medicine, Kansas City, MO
| | - Matthew C Wassom
- Division of Developmental & Behavioral Sciences, Children's Mercy Kansas City, University of Missouri at Kansas City School of Medicine, Kansas City, MO
| | - John M Rosen
- Division of Gastroenterology, Children's Mercy Kansas City, University of Missouri at Kansas City School of Medicine, Kansas City, MO
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23
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Hill SR, Ehrlich PF, Felt B, Dore-Stites D, Erickson K, Teitelbaum DH. Rectal prolapse in older children associated with behavioral and psychiatric disorders. Pediatr Surg Int 2015; 31:719-24. [PMID: 26163086 DOI: 10.1007/s00383-015-3733-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Rectal prolapse (RP) beyond infancy is challenging, and despite surgical correction, recurrences are not uncommon, suggesting that underlying contributing processes may have a role. This study highlights a previously poorly recognized relationship between RP in older children and behavioral/psychiatric disorders (BPD). We describe the incidence of recurrence and use of behavioral, psychological and physical therapeutic tactics in a multidisciplinary approach to pediatric RP. METHODS A retrospective 20-year review of RP in children >3 years of age was adopted. Charts were reviewed for gastrointestinal, connective tissue, and BPD conditions, incidence of recurrence, and therapies employed including surgery, behavioral, and physical therapy. RESULTS 45 patients were included, ranging from 3 to 18 years of age; 29 males. Thirty-seven underwent surgery. Six of the 45 were excluded as they had gastrointestinal or connective tissue conditions placing them at risk for prolapse. Over half (21/39, 53%) had BPD. Slightly more than half of patients had a recurrence, but there was no increased risk in those with associated BPD. While all 21 underwent some therapy for their BPD, over the past 5 years we have enrolled eight of these patients into a program of behavioral and/or physical therapy with all reporting reductions in frequency and severity of prolapse after initiating pelvic floor strengthening, behavior modification, and biofeedback, and avoidance of surgery in three. CONCLUSIONS This study highlights an important group of pediatric patients with RP that may well benefit from a combination of behavioral therapy, physical therapy as well as surgical intervention to obtain the most optimal outcome.
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Affiliation(s)
- Shelley Reynolds Hill
- Section of Pediatric Surgery, Department of Surgery, Mott Children's Hospital, 1540 E. Hospital Dr., SPC 4211, Ann Arbor, MI, 48109-4211, USA
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Melendez-Torres GJ, Bonell C, Thomas J. Emergent approaches to the meta-analysis of multiple heterogeneous complex interventions. BMC Med Res Methodol 2015; 15:47. [PMID: 26032785 PMCID: PMC4455278 DOI: 10.1186/s12874-015-0040-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 05/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple interventions meta-analysis has been recommended in the methodological literature as a tool for evidence synthesis when a heterogeneous set of interventions is included in the same review—and, more recently, when a heterogeneous set of complex interventions is included. However, there is little guidance on the use of this method with complex interventions. This article suggests two approaches to model complexity and heterogeneity through this method. DISCUSSION 'Clinically meaningful units' groups interventions by modality or similar theory of change, whereas 'components and dismantling' separates out interventions into combinations of components and either groups interventions by the combination of components they demonstrate or extracts effects for each identified component and, possibly, interactions between components. Future work in systematic review methodology should aim to understand how to develop taxonomies of components or theories of change that are internally relevant to the studies in these multiple interventions meta-analyses. SUMMARY Despite little meaningful prior guidance to its use in this context, multiple interventions meta-analysis has the potential to be a useful tool for synthesising heterogeneous sets of complex interventions. Researchers should choose an approach in accordance with their specific aims in their systematic review.
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Affiliation(s)
- G J Melendez-Torres
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
| | - Chris Bonell
- Social Science Research Unit, UCL Institute of Education, University College London, University of London, London, UK.
| | - James Thomas
- Social Science Research Unit, UCL Institute of Education, University College London, University of London, London, UK.
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25
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Palermo TM. Evidence-based interventions in pediatric psychology: progress over the decades. J Pediatr Psychol 2014; 39:753-62. [PMID: 24996921 DOI: 10.1093/jpepsy/jsu048] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This introduction to the special issue on Evidence-Based Interventions in Pediatric Psychology provides background on the process used to develop the special issue, a summary of the key findings from the series of reviews, and discussion of the implications for evidence-based practice. Authors followed a three-phase approach to develop their systematic reviews using rigorous systematic review methodology drawn heavily from the Cochrane Collaboration. The strength of the evidence for each pediatric psychology intervention was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The introduction discusses the progress that has been made in the evidence base for pediatric psychology interventions since the first special series published in 1999. Recommendations to stimulate further research and expand and strengthen the quality of the evidence base are described. The introduction concludes with implications from the special issue for pediatric psychology training in evidence-based practice.
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Affiliation(s)
- Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington and Seattle Children's Research Institute
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