Outcomes of combined medical and behavioral treatments for constipation within a specialty outpatient clinic.

Hankinson, Jessica; Borden, Lindsay; Allen, Terrence K.; Domingo, Lisa Santo; Oliva‐Hemker, Maria; Mathews, Tara; Brock, Kristen; Perry-Parrish, Carisa; Reynolds, Elizabeth K.; Specht, Matthew W.; Ostrander, Rick

doi:10.1037/cpp0000202

Cited by 7 publications

(28 citation statements)

References 29 publications

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“…Six studies (6%) included in this synthesis had a clear and explicit equity focus 143,271,282,[300][301][302] ; 13 studies (12%) partially addressed equity in their study. 24,102,103,145,144,255,261,[303][304][305][306][307][308][309][310][311][312][313][314][315][316][317] Age and sex were the most commonly reported factors; few studies reported any other social determinant factors.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Sixty-five studies described evidence uncertainties and a limited evidence base as a significant barrier to implementation. 63,64,69,74,84,92,102,103,119,132,133,136,143,145,149,153,154,161,174,178,185,203,211,214,232,243,255,258,270,282,302,303, Evidence was reported as hampered by variation in diagnostic assessment and inconsistent application of CFC definitions, different outcomes, poor adherence, small sample sizes and general lack of high-quality studies.…”

Section: Intervention Characteristicsmentioning

confidence: 99%

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Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis

Todhunter-Brown,

Booth,

Campbell

et al. 2024

Health Technol Assess

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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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Section: Description Of Studiesmentioning

confidence: 99%

Section: Intervention Characteristicsmentioning

confidence: 99%

Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis

Todhunter-Brown,

Booth,

Campbell

et al. 2024

Health Technol Assess

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“…Most toileting interventions prescribed for FE require constant adult monitoring and prescribed regular defecation attempts, regardless of whether the child feels an urge to defecate, particularly after surgery to correct HD problems. Sometimes this can only happen through enrollment in an outpatient or inpatient behavioral treatment program where treatment can be monitored by nurse practitioners and/or behavioral psychologists (e.g., see Hankinson et al, 2018).…”

Section: Social-emotional and Behavioralmentioning

confidence: 99%

Hirschsprung's disease.

Frisby¹

2023

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H irschsprung's disease (HD) is a congenital disorder characterized by a lack of nerve cells (i.e., ganglion cells) in a portion of the colon of variable length (Kenny et al., 2010). During normal development, nerve cells start growing at the beginning of the bowel and grow toward the end of the bowel. Prior to birth, however, nerve cells may stop growing. In HD, the nerve cells do not reach the end of the baby's bowel. As a result, stool elimination fails to work properly after birth. ETIOLOGYThis condition of the lack of ganglion cells is called aganglionosis (Kenny et al., 2010). Most often, the areas missing the nerve cells are the rectum and the sigmoid (S-shaped) colon. In short-segment HD, nerve cells are missing from the last part of the large intestine. In long-segment HD, nerve cells are missing from most or all of the large intestine and sometimes the last part of the small intestine. In rarer cases, nerve cells are missing in the entire large and small intestine (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDKD], 2015).

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“…Prior research has demonstrated benefits of integrated medical and behavioral treatment in functional constipation in naturalistic studies (e.g. Hankinson et al, 2018; Stark et al, 1997) and randomized control trials (e.g., Cox et al, 1998). The most recent clinical guidelines published by the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommend both medication and psychological intervention strategies including, “demystification, explanation, and guidance for toilet training” (Tabbers et al, 2014).…”

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confidence: 99%

Development and evaluation of an interdisciplinary group intervention for pediatric functional constipation.

Lamparyk¹,

Mathis²,

Piorkowski³

et al. 2023

Clinical Practice in Pediatric Psychology

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Objective: A group behavioral treatment protocol for pediatric encopresis was last described before significant medical advances have changed medical guidelines for constipation treatment, although no updated behavioral treatment protocols have been published. The current study aims to describe an updated interdisciplinary group treatment protocol for pediatric functional constipation and encopresis and evaluate this for feasibility and acceptability. Method: The development and protocol of the Functional Constipation Shared Medical Appointment (FC-SMA) is described in detail. Patients recruited for the initial 24 months of the integrated group treatment program were described and evaluated for protocol feasibility, acceptability, and initial treatment outcomes, utilizing attendance records, a standardized patient satisfaction questionnaire (PSQ), and treatment outcomes recorded in medical records, respectively. Results: Forty-9 patients enrolled in the FC-SMA, with 43 (87.8%) completing the initial 4-sesion protocol and 34 (69.4%) returning for at least 1 follow-up session. Parent satisfaction was high (PSQ M(SD) ranged from 4.41 (.56) to 4.56 (.50)). Initial treatment outcomes demonstrated improvement or resolution of constipation and encopresis in 83.7% and 67.4% of participants, respectively. Conclusions: An interdisciplinary group treatment model for pediatric functional constipation is feasible, acceptable to patients and parents, and demonstrates promising initial outcomes. Updated medical treatment recommendations require modernized complementary behavioral treatment protocols that further address the complex medical-behavioral interactions and ongoing adherence challenges associated with this population.

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Outcomes of combined medical and behavioral treatments for constipation within a specialty outpatient clinic.

Cited by 7 publications

References 29 publications

Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis

Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis

Hirschsprung's disease.

Development and evaluation of an interdisciplinary group intervention for pediatric functional constipation.

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