Abstract
BACKGROUNDBowel and bladder problems in children with cerebral palsy (CP) negatively affect both the children and their families. Routine physical therapy (PT) may contribute to relieving constipation in children with CP by reducing spasticity. OBJECTIVETo determine the effectiveness of PT in relieving constipation in children with spastic CP. DESIGNThis was a single-blinded randomized crossover trial (Clinical Trail # NCT03379038) that included 35 children with spastic CP. The children who fulfilled the inclusion criteria were randomly assigned to one of two groups: the progressive physical therapy (PPT) or the maintenance physical therapy (MPT) group. METHODSData was collected via general demographic questionnaire, defecation frequency (DF) questionnaire, Constipation Assessment Scale (CAS) and the Modified Ashworth Scale (MAS) at baseline and at the 2nd, 4th, and 6th week before and after crossover. The Mann Whitney U-test was used for between-group comparisons and the Friedman and Wilcoxon signed-rank test for post hoc analysis tests were used for within-group changes. To determine the relationship between spasticity and constipation, simple linear regression was used. SETTINGNational Institute of Rehabilitation Medicine, Islamabad, Pakistan. RESULTSNeither group showed a significant difference in spasticity level or DF at baseline or at the end of the 2nd week. However, at the end of the 4th week (PPT = 4[1] vs MPT = 2[1]; U = 192; P < .001) and 6th week (PPT = 4[1] vs 3(1); U = 158; P < .001) DF was significantly better in the PPT group than in the MPT group. Regarding constipation severity, the PPT group showed significantly better results on all items of the Constipation Assessment Scale (CAS) compared with the MPT group after intervention (P < .001). The results showed that spasticity was significantly correlated with DF (r = -0.81; P < .001) and constipation severity (r = 0.45; P < .001). CONCLUSIONPhysical therapy significantly improves DF and reduces constipation severity in children with spastic CP.