Comparison of therapeutic motor control interventions and conventional treatment in children with functional constipation

The aim of this study was to compare the effects of therapeutic motor control (TMC) interventions and conventional treatment on symptoms, trunk endurance, physical activity, spinal posture and mobility in children with functional constipation (FC). The study included 36 children with functional constipation aged 4-18 years. With two-stratified randomization, children with FC were randomized into TMC (n=18) and conventional group (n=18). Bowel symptoms and symptom severity were assessed by 7-day bowel diary and Bladder and Bowel Dysfunction Questionnaire. Trunk muscle endurance of the children was assessed by flexor, extensor and lateral trunk tests. Spinal posture and mobility were evaluated with Spinal Mouse device and physical activity level was evaluated with physical activity questionnaire. Children in both groups were given informative education and nutritional recommendations. TMC intervention included respiratory exercises, core stabilization exercises, superficial EMG-Biofeedback and pelvic floor muscle exercises; conventional treatment included laxative therapy. The duration of treatment was 8 weeks. After treatment, symptom severity (p=0.0001), stool type and defecation duration improved only in children in the TMC group (p<0.01). Spinal posture parameters of both groups were similar both before and after treatment (p>0.05). When spinal mobility was analyzed, sacral, lumbar and inclination mobility angles increased in the TMC group compared to the conventional group (p=0.01), (p=0.009), (p=0.0001). After treatment, children in the TMC group had higher physical activity compared to the conventional group (p=0.016). When trunk muscle endurance was compared, trunk flexor (p=0.047), extensor (p=0.006), right and left lateral (p=0.001) trunk endurance was better in the TMC group compared to the conventional group. In this randomized study, therapeutic motor control interventions were more effective than conventional treatment in improving symptoms, spinal mobility and trunk endurance in children with FC. It was shown that physiotherapy and rehabilitation interventions alone, without the use of laxatives, may be superior to conventional treatment in improving symptoms in children with FC. This result provides an innovative perspective for future clinical approaches and treatment protocols. KEYWORDS: Biofeedback, core stabilization, pelvic floor, physical therapy,pediatric