Systematic Review and Meta-Analysis of Behavioral Interventions for Fecal Incontinence With Constipation

Freeman, Kurt A.; Riley, Andrew R.; Duke, Danny C.; Fu, Rongwei

doi:10.1093/jpepsy/jsu039

Cited by 52 publications

(47 citation statements)

References 58 publications

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“…About 1.5-7.5 per cent of preschool and elementary school children have encopresis (Mellon and Houts, 2017). Systematic reviews and meta-analyses show that multimodal programmes involving medical assessment and intervention followed by behavioural family therapy are effective for 43-75 per cent of cases (Brazzelli et al, 2011;Freeman et al, 2014;McGrath et al, 2000). Initially, a paediatric medical assessment is conducted, and if a faecal mass has developed in the colon, this is cleared with an enema.…”

Section: Encopresismentioning

confidence: 99%

Family therapy and systemic interventions for child‐focused problems: the current evidence base

Carr

2018

Journal of Family Therapy

209

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This review updates previous similar papers published in JFT in 2000, 2009 and 2014. It presents evidence from meta‐analyses, systematic literature reviews, narrative literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with common mental health problems and other difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training, or parent implemented behavioural programmes. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; recovery from child abuse and neglect; conduct problems, emotional problems, eating disorders, somatic problems, and first episode psychosis.

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Section: Encopresismentioning

confidence: 99%

Family therapy and systemic interventions for child‐focused problems: the current evidence base

Carr

2018

Journal of Family Therapy

209

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“… 12 But, a recent meta-analysis and a Cochrane study suggest that behavior therapy added to laxative therapy may improve symptoms of children with constipation-associated fecal incontinence. 58 , 59 Optimal treatment of FC, especially with fecal incontinence, requires a perfect relation with great empathy between the child and the practitioner. Using an external person for behavior therapy can trouble this relation.…”

Section: Treatmentmentioning

confidence: 99%

Functional constipation in children: challenges and solutions

Levy

Lemmens

Vandenplas

et al. 2017

PHMT

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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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“…Madan and colleagues [ 31 ] highlight that this was a problem in considering the 36 different possible combinations of components in their multiple interventions meta-analysis of smoking cessation. By way of further example, in Freeman and colleagues’ [ 35 ] systematic review of behavioural interventions for childhood fecal incontinence and constipation, the ten included studies did not produce reliable results, and authors instead meta-analysed four studies comparing an intervention against treatment as usual.…”

Section: Discussionmentioning

confidence: 99%

Emergent approaches to the meta-analysis of multiple heterogeneous complex interventions

Melendez‐Torres

Bonell

Thomas

2015

BMC Med Res Methodol

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BackgroundMultiple 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.SummaryDespite 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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Systematic Review and Meta-Analysis of Behavioral Interventions for Fecal Incontinence With Constipation

Abstract: Although evidence supports behavioral treatments for fecal incontinence with constipation in children, available evidence is limited. More and higher-quality trials are needed to better understand the relative effects of different treatments, including behavioral strategies.

Cited by 52 publications

References 58 publications

Family therapy and systemic interventions for child‐focused problems: the current evidence base

Family therapy and systemic interventions for child‐focused problems: the current evidence base

Functional constipation in children: challenges and solutions

Emergent approaches to the meta-analysis of multiple heterogeneous complex interventions

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