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Unal B, Pisirici P, Koseoglu Kurt A, Tugtepe H. Comparison of the efficiency of transcutaneous electrical nerve stimulation and manual therapy in children with cerebral palsy with lower urinary system dysfunction- a randomized prospective trial. J Pediatr Urol 2024:S1477-5131(24)00181-5. [PMID: 38641452 DOI: 10.1016/j.jpurol.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Neurological defects in children with cerebral palsy (CP) not only affect their motor skills but also lead to bladder and bowel problems. Although most children with CP have achieved urinary control, more than 50% of cases experience lower urinary tract symptoms (LUTS). Common LUTS complaints observed in CP include delayed toilet training, urinary incontinence, increased frequency of urination, urgency, urinary hesitancy, and recurrent urinary tract infections. OBJECTIVE This study aimed to prospectively evaluate and compare the effectiveness of two different physiotherapy approaches, sacral Transcutaneous Electrical Nerve Stimulation (TENS) and massage, on lower urinary tract dysfunction in children with CP. METHOD A total of 54 children with CP who had the Dysfunctional Voiding Scoring System (DVISS) of 8.5 or higher were included in the study. Children were randomized to the TENS (TG; n = 27) and Manual Therapy (MG; n = 27) groups. TENS application was performed 2 sessions in a week for 20 min for a total of 12 weeks. The electrodes used during the application were adhered bilaterally to the parasacral region (S2-S4). 4 electrodes of 5 × 5 cm were used. Classical bowel massage was applied to the MG with the friction massage technique twice a week for 12 weeks. Manual therapy applications were performed in the form of abdominal, colon, and friction massage, twice a week for 20 min by the physiotherapist. Massage was applied to the abdominal region between the lower subcostal border and the anterior superior iliac spine. Questionnaires were applied before and after treatment interventions: DVISS, functional bladder capacity (FBC), frequency of voiding, and urinary incontinence episodes evaluated by bladder diary, Bristol Gaita Scale, and Pediatric Incontinence Quality of Life Scale (PIN-Q) used. RESULTS The decrease in the episodes of incontinence was higher in the TG (p = 0.037; p < 0.05). FBC increased after treatment in both groups, but there was no statistically significant difference between the groups (p = 0.683; p > 0.05). Manual therapy was more effective in improving constipation symptoms. In both groups, DVISS and PIN-Q values decreased after treatment, but the decrease in TG was statistically significant in the evaluation made between groups (p = 0.001; p < 0.01). CONCLUSION Both parasacral TENS and massage provided a significant improvement in LUTS, constipation, and quality of life but TENS showed a bigger improvement. We suggest adding these interventions to the treatment of bladder and bowel problems in CP children.
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Affiliation(s)
- Betul Unal
- Bahçeşehir University, Graduate Education Institute, Physiotherapy and Rehabilitation Doctoral Program, Istanbul, Turkiye
| | - Pelin Pisirici
- Bahçeşehir University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkiye.
| | - Aygul Koseoglu Kurt
- Bahçeşehir University, Graduate Education Institute, Physiotherapy and Rehabilitation Doctoral Program, Istanbul, Turkiye
| | - Halil Tugtepe
- Private Tugtepe Pediatric Urology Center, Division of Bladder and Bowel Dysfunction, Istanbul, Turkiye
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Eskici İlgin V, Özer N. The Effect of Abdominal Massage on Discharge and Ventilator-Associated Pneumonia in Enterally Fed Patients Connected to Mechanical Ventilation: A Randomized Controlled Study. Dimens Crit Care Nurs 2023; 42:104-14. [PMID: 36720035 DOI: 10.1097/DCC.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE The present research was conducted to reveal the impact of abdominal massage on enteral nutrition-induced ventilator-associated pneumonia and the gastrointestinal system in mechanically ventilated patients. MATERIALS AND METHODS The present research is a prospective, randomized, controlled clinical trial. This study was completed with 63 patients (31 in the experimental group and 32 in the control group). Data collection was performed using a patient information form, a patient follow-up form, and the Bristol Stool Scale. After patients were under mechanical ventilation for 48 hours, the data collection tools were filled out twice a day for 3 days by visiting the mechanical ventilation patients. The experimental group received 15 minutes of abdominal massage twice a day before nursing care was delivered in the morning and the evening. RESULTS According to the intergroup evaluations, the experimental group had lower gastric residual volume and abdominal distension, types of stool closer to normal, and higher defecation frequency. Differences between the groups were statistically significant (P < .05). In accordance with the intragroup evaluations, the experimental group had lower gastric residual volume, abdominal distension, and ventilator-associated pneumonia. The difference between the groups was revealed to be statistically significant (P < .05). CONCLUSION Abdominal massage reduces ventilator-associated pneumonia development to a statistically significant degree. Furthermore, it decreases gastric residual volume and abdominal distension, causes stools to be closer to the normal/ideal stool, increases defecation frequency, and regulates bowel movements and excretion (P < .05).
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Miget G, Tan E, Pericolini M, Chesnel C, Haddad R, Turmel N, Amarenco G, Hentzen C. The Neurogenic Bowel Dysfunction score (NBD) is not suitable for patients with multiple sclerosis. Spinal Cord 2022; 60:1130-1135. [PMID: 35859189 DOI: 10.1038/s41393-022-00837-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Bowel and anorectal dysfunctions are common in patients with multiple sclerosis (pwMS). The use of validated questionnaires is recommended in the initial assessment and patient's follow-up. The Neurogenic Bowel Dysfunction (NBD) score is the most used questionnaire but has been developed in spinal cord injured patients and has never been validated in other neurological diseases. We aimed to assess NBD's relevance in pwMS. SETTINGS Monocentric study in a tertiary neuro-urology department. METHODS A retrospective study in pwMS consulting for the first time in our department, that fulfilled the NBD questionnaire between 2010 and 2021 was performed. Qualitative and quantitative answers for each question were analyzed. Content validity and internal consistency were evaluated. RESULTS One hundred thirty-five pwMS (mean age 47.1, 58% of women) fulfilled the NBD questionnaire. Mean NBD score was 6.0 (SD 6.1) and 75% of patients had a score <9. Content validity analysis revealed 4 items not appropriate, 1 item with irrelevant calibration, and omission of some treatment widely used in pwMS. Internal consistency was appreciated with Cronbach's alpha = 0.48 IC 95% [0.31; 0.6]. CONCLUSION NBD questionnaire lacks content validity and presents a weak internal consistency in pwMS. A specific questionnaire is therefore required in pwMS to optimize bowel management and follow-up.
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Affiliation(s)
- Gabriel Miget
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France. .,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France.
| | - Eliane Tan
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Martina Pericolini
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France.,Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma "Tor Vergata", 00133, Rome, Italy
| | - Camille Chesnel
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Rebecca Haddad
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Nicolas Turmel
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Gérard Amarenco
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Claire Hentzen
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
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Hasanshahi N, Mirzaei T, Ravari A. Comparative Study of the Effect of Acupressure and Abdominal Massage on Constipation in Elderly Women: A Clinical Trial Study. Gastroenterol Nurs 2022. [PMID: 35533322 DOI: 10.1097/SGA.0000000000000660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/02/2021] [Indexed: 12/19/2022] Open
Abstract
Constipation is a common complaint and challenge in the elderly. Methods such as acupressure and abdominal massage can be considered for the treatment of constipation in the elderly. This study aimed to compare the effect of abdominal massage and acupressure on constipation in healthy elderly women. In this study, 60 elderly women with constipation participated in two groups. The first group underwent acupressure for 3 minutes every day for 5 days, and the other group underwent classical abdominal massage for 15-20 minutes every day for 5 days. The two groups were followed for a month. Data collection tools included a demographic characteristics questionnaire, Rome III criteria, and constipation assessment scale. The data were analyzed by SPSS18 software. Following the intervention, there was no significant difference between the two groups (p > .05). But in the first month, the mean scores of constipation in the abdominal massage and acupressure groups were 6.30 ± 3.47 and 9.03 ± 3.84, respectively, which showed a significant difference between the two groups for that time period (p = .005). Although there was no significant difference between the two methods during the intervention, the severity of constipation did decrease in each group. Also, in the first month after individual intervention, a significant difference was observed between the two groups. We conclude that abdominal massage can be suggested as an applicable and simple method in the treatment of constipation for elderly women.
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Choi YI, Kim KO, Chung JW, Kwon KA, Kim YJ, Kim JH, Park DK. Effects of Automatic Abdominal Massage Device in Treatment of Chronic Constipation Patients: A Prospective Study. Dig Dis Sci 2021; 66:3105-3112. [PMID: 33001346 DOI: 10.1007/s10620-020-06626-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 09/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Manual abdominal massage has been shown to effectively treat slow-transit constipation, but it is labor-intensive. To offer an alternative treatment option for constipation, the Bamk-001 automatic abdominal massage device was developed. The aim of this study was to assess the effect of the Bamk-001 device on symptom profiles and colon transit time (CTT) in patients with chronic constipation. METHODS Thirty-seven patients with chronic functional constipation diagnosed using the Rome IV criteria were enrolled prospectively from December 2018 to February 2019. All patients received device-assisted automatic abdominal massage for 15 min twice daily, once in the morning before breakfast and once at night, for 14 days. CTT was measured before and at the end of the study period. Slow-transit constipation and very-slow-transit constipation were defined as CTT ≥ 48 h and ≥ 72 h, respectively. Patients' symptom profiles regarding overall defecation satisfaction and device-related adverse events were analyzed. RESULTS Among the 37 patients, the mean age was 40.1 ± 11.8, and 5.4% (n = 2) were men. The Bamk-001 device significantly improved CTT from 54.0 (33.6-75.6) to 28.8 (18.0-52.8) h (p = 0.001) in patients with chronic constipation. In subgroup analysis, CTT improved significantly from 54.0 (33.6-75.6) to 28.8 (18.0-52.8) h (p = 0.003) and from 88.2 (74.4-124.8) to 45.6 (27.3-74.1) h (p = 0.005) in the slow-transit and very-slow-transit constipation groups, respectively (p = 0.001). Moreover, all patient symptoms were alleviated after treatment. No serious adverse events were reported. CONCLUSION The Bamk-001 automatic abdominal massage device showed significant care efficacy, including the improvement in CTT and symptom profiles in patients with slow-transit constipation. The use of an automatic abdominal massage device as an adjunct in the management of constipation is a potentially beneficial intervention for patients with slow-transit constipation.
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Affiliation(s)
- Youn I Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Kyoung Oh Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea.
| | - Jun-Won Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Kwang An Kwon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Yoon Jae Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Jung Ho Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Dong Kyun Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
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Carotenuto A, Costabile T, Moccia M, Falco F, Petracca M, Satelliti B, Russo CV, Sacc F, Lanzillo R, Brescia Morra V. Interplay Between Cognitive and Bowel/Bladder Function in Multiple Sclerosis. Int Neurourol J 2021. [PMID: 33957715 DOI: 10.5213/inj.2040346.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/29/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose The aim of this study was to evaluate the prevalence of bowel/bladder dysfunction in multiple sclerosis (MS) and its associations with cognitive impairment. Methods We prospectively enrolled 150 MS patients. Patients were administered the Symbol Digit Modality Test (SDMT), the Neurogenic Bowel Dysfunction Score (NBDS), and the Actionable Bladder Symptom Screening Tool (ABSST). The associations between bowel/bladder dysfunction and cognitive function were assessed through hierarchical regression models using the SDMT and clinicodemographic features as independent variables and NBDS and ABSST scores as dependent variables. Results The prevalence of bowel/bladder deficits was 44.7%, with 26 patients (17.3%) suffering from bowel deficits and 60 patients (40%) from bladder deficits. The total NBDS and ABSST scores were correlated with the SDMT (β=-0.10, P<0.001 and β=-0.03, P=0.04, respectively) after correction for demographic features and physical disability. Conclusions Bowel/bladder disorders are common in MS and are associated with both physical and cognitive disability burdens. As SDMT is embedded into routine clinical assessments, a lower score may warrant investigating bowel/bladder dysfunction due to the strong interplay of these factors.
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Altun Ugras G, Yüksel S, Isik MT, Tasdelen B, Dogan H, Mutluay O. Effect of abdominal massage on bowel evacuation in neurosurgical intensive care patients. Nurs Crit Care 2020; 27:558-566. [PMID: 33179847 DOI: 10.1111/nicc.12575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are many factors, which affect the bowel evacuation of neurosurgical intensive care unit (NICU) patients, resulting in constipation. AIM AND OBJECTIVES The aim of this study was to investigate effect of abdominal massage on bowel evacuation and the risk of constipation in NICU patients. DESIGN A prospective, randomized-controlled clinical trial. METHODS The sample of this study included 80 NICU patients. The patients were randomly assigned to abdominal massage and control groups. The constipation risk of all the patients was assessed with Constipation Risk Assessment Scale (CRAS). The patients in the abdominal massage group received a total of 30 minutes of massage, 15 minutes every morning and evening, until the first defecation. The bowel sounds of all patients in the abdominal massage and control groups were assessed on a daily basis. The days when bowel sounds were heard and the first defecation took place were recorded in a Bowel Evacuation Form. RESULTS The risk of constipation was higher in the patients in the abdominal massage (CRAS score 19.02 ± 1.81) and control groups (CRAS score 20.45 ± 2.61). The time of return of bowel sounds and the time of the first defecation were earlier in the abdominal massage group, compared to the control group (P < .05). In the control group, there was a weak correlation (P = .004) between the CRAS score and the time of return of bowel sounds, while there was a moderate correlation between the CRAS score and the time of the first defecation (P < .001). CONCLUSION Our study results show that the risk of constipation is high in NICU patients, and abdominal massage is an effective nursing intervention to shorten the time of return of bowel sounds and the time of the first defecation. RELEVANCE TO CLINICAL PRACTICE Nurses can safely apply abdominal massage to improve bowel evacuation in NICU patients.
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Affiliation(s)
- Gulay Altun Ugras
- Nursing Faculty, Department of Surgical Nursing, Mersin University, Mersin, Turkey
| | - Serpil Yüksel
- Nursing Faculty, Department of Surgical Nursing, Necmettin Erbakan University, Konya, Turkey
| | - Meryem Turkan Isik
- Nursing Faculty, Department of Fundamentals Nursing, Mersin University, Mersin, Turkey
| | - Bahar Tasdelen
- Department of Biostatistics and Medical Informatics, Mersin University Medical Faculty, Mersin, Turkey
| | - Havva Dogan
- Surgery Intensive Care Unit, Mersin University Hospital, Mersin, Turkey
| | - Ozum Mutluay
- Surgery Intensive Care Unit, Mersin University Hospital, Mersin, Turkey
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Crowley E, Treweek S, Banister K, Breeman S, Constable L, Cotton S, Duncan A, El Feky A, Gardner H, Goodman K, Lanz D, McDonald A, Ogburn E, Starr K, Stevens N, Valente M, Fernie G. Using systematic data categorisation to quantify the types of data collected in clinical trials: the DataCat project. Trials 2020; 21:535. [PMID: 32546192 PMCID: PMC7298750 DOI: 10.1186/s13063-020-04388-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data collection consumes a large proportion of clinical trial resources. Each data item requires time and effort for collection, processing and quality control procedures. In general, more data equals a heavier burden for trial staff and participants. It is also likely to increase costs. Knowing the types of data being collected, and in what proportion, will be helpful to ensure that limited trial resources and participant goodwill are used wisely. AIM The aim of this study is to categorise the types of data collected across a broad range of trials and assess what proportion of collected data each category represents. METHODS We developed a standard operating procedure to categorise data into primary outcome, secondary outcome and 15 other categories. We categorised all variables collected on trial data collection forms from 18, mainly publicly funded, randomised superiority trials, including trials of an investigational medicinal product and complex interventions. Categorisation was done independently in pairs: one person having in-depth knowledge of the trial, the other independent of the trial. Disagreement was resolved through reference to the trial protocol and discussion, with the project team being consulted if necessary. KEY RESULTS Primary outcome data accounted for 5.0% (median)/11.2% (mean) of all data items collected. Secondary outcomes accounted for 39.9% (median)/42.5% (mean) of all data items. Non-outcome data such as participant identifiers and demographic data represented 32.4% (median)/36.5% (mean) of all data items collected. CONCLUSION A small proportion of the data collected in our sample of 18 trials was related to the primary outcome. Secondary outcomes accounted for eight times the volume of data as the primary outcome. A substantial amount of data collection is not related to trial outcomes. Trialists should work to make sure that the data they collect are only those essential to support the health and treatment decisions of those whom the trial is designed to inform.
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Affiliation(s)
- Evelyn Crowley
- Health Research Board Clinical Research Facility, University of Cork, Cork, Ireland
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
| | - Katie Banister
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Suzanne Breeman
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Lynda Constable
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Seonaidh Cotton
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Anne Duncan
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Adel El Feky
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Kirsteen Goodman
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Doris Lanz
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Emma Ogburn
- Primary Care Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Kath Starr
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Natasha Stevens
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Marie Valente
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Gordon Fernie
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Birimoglu Okuyan C, Bilgili N. Effect of abdominal massage on constipation and quality of life in older adults: A randomized controlled trial. Complement Ther Med 2019; 47:102219. [DOI: 10.1016/j.ctim.2019.102219] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/15/2019] [Accepted: 10/15/2019] [Indexed: 12/18/2022] Open
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Affiliation(s)
- Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
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Street T, Peace C, Padfield E, Singleton C. Abdominal functional electrical stimulation for bowel management in multiple sclerosis. Neurodegener Dis Manag 2019; 9:83-89. [PMID: 30998082 DOI: 10.2217/nmt-2018-0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: Functional constipation is common in multiple sclerosis (MS) and first line treatments are frequently ineffective. The current study explored the use of abdominal functional electrical stimulation (ABFES) for treating constipation in MS. Patients/methods: 20 people with MS and constipation (ROME IV criteria). The patient assessment of constipation-related quality of life questionnaire was administered at baseline and after 6 weeks of ABFES treatment alongside semi-structured interviews. Results: All patient assessment of constipation-related quality of life subscales were significant: satisfaction (p = 0.003), psychosocial discomfort (p = 0.008), physical discomfort (p = 0.001) and worries and concerns (p = 0.003). A long-term therapeutic effect, reduction in laxative use and improved sexual functioning were also reported. Conclusion: ABFES provides a potential alternative treatment intervention for people with MS and constipation.
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Affiliation(s)
| | - Carla Peace
- Birmingham Community Healthcare NHS Foundation Trust, UK
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McClurg D, Harris F, Goodman K, Doran S, Hagen S, Treweek S, Norton C, Coggrave M, Norrie J, Rauchhaus P, Donnan P, Emmanuel A, Manoukian S, Mason H. Abdominal massage plus advice, compared with advice only, for neurogenic bowel dysfunction in MS: a RCT. Health Technol Assess 2019; 22:1-134. [PMID: 30375324 DOI: 10.3310/hta22580] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Between 50% and 80% of people with multiple sclerosis (PwMS) experience neurogenic bowel dysfunction (NBD) (i.e. constipation and faecal incontinence) that affects quality of life and can lead to hospitalisation. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of abdominal massage plus advice on bowel symptoms on PwMS compared with advice only. A process evaluation investigated the factors that affected the clinical effectiveness and possible implementation of the different treatments. DESIGN A randomised controlled trial with process evaluation and health economic components. Outcome analysis was undertaken blind. SETTING The trial took place in 12 UK hospitals. PARTICIPANTS PwMS who had 'bothersome' NBD. INTERVENTION Following individualised training, abdominal massage was undertaken daily for 6 weeks (intervention group). Advice on good bowel management as per the Multiple Sclerosis Society advice booklet was provided to both groups. All participants received weekly telephone calls from the research nurse. MAIN OUTCOME MEASURES The primary outcome was the difference between the intervention and control groups in change in the NBD score from baseline to week 24. Secondary outcomes were measured via a bowel diary, adherence diary, the Constipation Scoring System, patient resource questionnaire and the EuroQol-5 Dimensions, five-level version (EQ-5D-5L). RESULTS A total of 191 participants were finalised, 189 of whom were randomised (two participants were finalised in error) (control group, n = 99; intervention group, n = 90) and an intention-to-treat analysis was performed. The mean age was 52 years (standard deviation 10.83 years), 81% (n = 154) were female and 11% (n = 21) were wheelchair dependent. Fifteen participants from the intervention group and five from the control group were lost to follow-up. The change in NBD score by week 24 demonstrated no significant difference between groups [mean difference total score -1.64, 95% confidence interval (CI) -3.32 to 0.04; p = 0.0558]; there was a significant difference between groups in the change in the frequency of stool evacuation per week (mean difference 0.62, 95% CI 0.03 to 1.21; p = 0.039) and in the number of times per week that participants felt that they emptied their bowels completely (mean difference 1.08, 95% CI 0.41 to 1.76; p = 0.002), in favour of the intervention group. Of participant interviewees, 75% reported benefits, for example less difficulty passing stool, more complete evacuations, less bloated, improved appetite, and 85% continued with the massage. A cost-utility analysis conducted from a NHS and patient cost perspective found in the imputed sample with bootstrapping a mean incremental outcome effect of the intervention relative to usual care of -0.002 quality-adjusted life-years (QALYs) (95% CI -0.029 to 0.027 QALYs). In the same imputed sample with bootstrapping, the mean incremental cost effect of the intervention relative to usual care was £56.50 (95% CI -£372.62 to £415.68). No adverse events were reported. Limitations include unequal randomisation, dropout and the possibility of ineffective massage technique. CONCLUSION The increment in the primary outcome favoured the intervention group, but it was small and not statistically significant. The economic analysis identified that the intervention was dominated by the control group. Given the small improvement in the primary outcome, but not in terms of QALYs, a low-cost version of the intervention might be considered worthwhile by some patients. FUTURE WORK Research is required to establish possible mechanisms of action and modes of massage delivery. TRIAL REGISTRATION Current Controlled Trials ISRCTN85007023 and NCT03166007. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 58. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Doreen McClurg
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Harris
- Nursing, Midwifery and Allied Health Professionals Research Unit, University of Stirling, Stirling, UK
| | - Kirsteen Goodman
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Selina Doran
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Shaun Treweek
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - John Norrie
- Edinburgh Clinical Trials Unit, The University of Edinburgh, Edinburgh, UK
| | - Petra Rauchhaus
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Peter Donnan
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Anton Emmanuel
- National Hospital for Neurology and Neurosurgery, University College London, London, UK
| | - Sarkis Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
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