SNFGE SNFGE
 
Thématique :
- Colo-proctologie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Pauline JOUET
Coup de coeur :
 
 
Gastroenterology
  2017/01  
 
  2017 Jan;152(1):82-91  
  doi: 10.1053/j.gastro.2016.09.015  
 
  Effectiveness of Pelvic Physiotherapy in Children With Functional Constipation Compared With Standard Medical Care.  
 
  van Engelenburg-van Lonkhuyzen ML, Bols EM, Benninga MA, Verwijs WA, de Bie RA  
  https://www.ncbi.nlm.nih.gov/pubmed/27650174  
 
 

Abstract

BACKGROUND & AIMS:

Functional constipation (FC) is a common childhood problem often related to pelvic floor muscle dysfunction. We compared the effectiveness of pelvic physiotherapy (PPT) vs standard medical care (SMC) in children with FC.

METHODS:

We performed a multicenter randomized controlled trial of 53 children (age, 5-16 y) with FC according to the Rome III criteria, at hospitals in The Netherlands from December 2009 to May 2014. Group allocation was concealed using a central computer system. SMC consisted of education, toilet training, and laxatives (n = 26), whereas PPT included SMC plus specific physiotherapeutic interventions (n = 27). Results were obtained from written reports from the subjects' pediatricians and parents. The primary outcome was absence of FC, according to Rome III criteria, after a 6-month follow-up period. Secondary outcomes were global perceived effect (range, 1-9; success was defined as a score ≥ 8), numeric rating scales assessing quality of life (parent and child; scale, 1-10), and the strengths and difficulties questionnaire (SDQ).

RESULTS:

Treatment was effective for 92.3% of the children receiving PPT and for 63.0% of the children receiving SMC (adjusted odds ratio for success of PPT, 11.7; 95% confidence interval, 1.8-78.3) (P = .011). Significantly more children undergoing PPT stopped using laxatives (adjusted odds ratio, 6.5; 95% confidence interval, 1.6-26.4) (P = .009). Treatment success (based on global perceived effect) was achieved for 88.5% of subjects receiving PPT vs 33.3% of subjects receiving SMC) (P < .001). PPT also produced larger adjusted mean differences, before vs after treatment, in numeric rating scales to assess quality of life: an increase of 1.8 points for parents (P = .047) and 2.0 points for children (P = .028). Results from the SDQ did not differ significantly between groups (P = .78).

CONCLUSIONS:

In a randomized controlled trial of children with FC, PPT was more effective than SMC on all outcomes measured, with the exception of findings from the SDQ. PPT should be considered as a treatment option for FC in children 5-16 years old.

 

 
Question posée
 
En cas de constipation fonctionnelle chez l’enfant, y a-t-il un intérêt à faire comme chez l’adulte une rééducation ano-périnéale en plus de la prise en charge médicale standard (conseils hygiéno-diététiques, éducation comportementale et prise de laxatifs) ?
 
Question posée
 
Dans cette étude multicentrique randomisée contrôlée en simple aveugle effectuée chez des enfants âgés de 5 à 16 ans, le traitement était efficace chez 92,3% lorsque la rééducation pelvienne était associée à la prise en charge médicale standard (n=27) vs 63% avec le traitement médical seul (n=26) (p=0,011). De plus, il permettait significativement plus souvent l’arrêt des laxatifs.
 
Commentaires

Une étude qui suggère une efficacité nettement supérieure du traitement de la constipation fonctionnelle chez l’enfant lorsque la rééducation ano-périnéale est associée au traitement médical, mais reste à préciser le sous-groupe d’enfants qui en bénéficie effectivement.

 
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