Constipation, Constipation - Functional, Dyssynergia
Conditions
Keywords
Pelvic floor dysfunction, Dyssynergic defecation
Brief summary
The primary aim of this study will be to determine if a respiratory muscle training program that includes both inspiratory muscle training (IMT) and expiratory muscle training (EMT), targeted at improving respiratory muscle performance-based measures combined with patient education about breathing on the toilet will improve patient satisfaction scores in individuals with chronic constipation (CC).
Interventions
OTHERHybrid Telehealth Program: Respiratory Muscle Training and Patient Education
A testing session will be held where subjects will undergo respiratory muscle testing using the Pro2Fit device to measure PIMax and PEmax. During this session, subjects will be instructed in a respiratory muscle training home program utilizing a provided device call the Breather. They will be instructed to perform this program consisting of breathing exercises for 2 sets of 10 repetitions, twice a day at a difficulty level of 5-7 on the Visual Analogue Scale (VAS) scale for 8 weeks. Subjects will be shown how to follow a training program every day utilizing the free companion application to the device Breather Coach. If subjects have issues with using technology, they will be provided a physical log to record when they complete sessions. Ten to fifteen-minute Zoom sessions with the study coordinator will be held once a week to check in on how the program is progressing, compliance, and if the resistance can be increased.
A group of patients who receive standard physical therapy care for chronic constipation at the University of Miami that consists of biofeedback therapy, manual therapy, therapeutic exercise, and patient education.
Sponsors
American Physical Therapy Association
University of Miami
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Adults \>18 years of age * Complaint of CC and associated symptoms * Willing and able to sign an informed consent * The ability to comply with study guidelines * Report two or more of the following: straining during more than 25% of defecations, lumpy or hard stools more than 25% of defecations, sensations of incomplete bowel evacuation more than 25% of defecations, manual maneuvers to facilitate more than 25% of defecations, sensation of anorectal obstruction/blockage more than 25% of defecations, and fewer than 3 small bowel movements per week.
Exclusion criteria
* Rectal prolapse greater than grade 2 * Pregnancy * Cognitive impairments * Currently receiving physical therapy treatment for conditions associated with pelvic floor muscle dysfunction * Recent surgery within the past 3 months without clearance from a medical doctor * Medication usage that would interfere with their ability to exercise safely * Individuals recovering from a confirmed eating disorder * Recent unexplained weight loss \>10lbs within one month.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change In Patient Assessment of Constipation Symptoms (PAC-SYM) | Baseline, 4 weeks, and 8 weeks | The PAC-SYM questionnaire is a 12 item questionnaire that consists of three subscales: abdominal, rectal, and stool. Each item is scored 0-4 (0: Absent, 1: Mild, 2: Moderate, 3: Severe, 4: Very Severe). The final score is the average of the summed score divided by the number of items, ranging from 0: Absent, 1: Mild, 2: Moderate, 3: Severe, 4: Very Severe. A total raw score can range for 0-48, however the average score is used to indicate the level of constipation from 0-4 with a higher number indicating higher severity of constipation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change In Maximal Inspiratory Pressure (PImax) | Baseline and 8 weeks | PImax will be measured via the test of incremental respiratory endurance (TIRE) using the Pro2fit device and application. Values will be presented in cmH20. Minimal score will be a 0 with a higher value indicating greater inspiratory muscle strength. |
| Change In Maximal Expiratory Pressure (PEmax) | Baseline and 8 weeks | PEmax will be measured via the test of incremental respiratory endurance (TIRE) using the Pro2fit device and application. Minimal score will be a 0 with a higher value indicating greater expiratory muscle strength. |
| Change in Hospital Depression and Anxiety Scale (HADS) | Baseline and 8 weeks | Hospital Anxiety and Depression Scale (HADS) is a 14-item questionnaire with two subscales, each consisting of 7 items. For both subscales, scores between 8-10 indicate mild depression or anxiety, and scores in the range of 11-21 are indicative of depression or anxiety disorder. A cutoff score for both the anxiety and depression subscale of the HADS of ≥ 8 has been suggested as optimal in identifying depression and anxiety in individuals with irritable bowel syndrome (IBS), a disorder of gut-brain interaction. |
Countries
United States
Outcome results
None listed