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Follow-up in Childhood Functional Constipation: A Randomized, Controlled Clinical Trial
Line Modin1, Anne-Mette Walsted, Charlotte S Rittig
1*Department of Pediatrics, Hospital Lillebaelt, Kolding †Department of Pediatrics, Aaarhus University Hospital, Aarhus, Denmark.
Insights
Web-based information improved short-term recovery for childhood functional constipation. Patient empowerment through digital tools may enhance treatment effectiveness more than traditional follow-up methods.
Area of Science:
- Pediatric Gastroenterology
- Digital Health Interventions
- Evidence-Based Medicine
Background:
- Childhood functional constipation guidelines emphasize close follow-up.
- Limited evidence exists on optimal follow-up strategies for pediatric constipation.
Purpose of the Study:
- To compare the effectiveness of web-based self-management versus phone follow-up for childhood functional constipation.
- To evaluate treatment outcomes based on different follow-up regimens.
Main Methods:
- Randomized controlled trial involving 235 children (ages 2-16) with functional constipation.
- Three groups: control (no contact), phone follow-up, and web-based information access.
- Primary outcome: successfully treated children at 3, 6, and 12 months.
Main Results:
- The web group showed significantly higher treatment success at 3 and 6 months compared to control and phone groups (p=0.007/p=0.03).
- No significant difference in treatment success was observed at 12 months across all groups.
- Relapses, fecal incontinence, and laxative use did not differ between the interventions.
Conclusions:
- Web-based self-management promotes faster short-term recovery in childhood functional constipation.
- Patient empowerment through accessible digital information may be more effective than healthcare-led follow-up for improving treatment outcomes.
Objectives:
Guidelines recommend close follow-up during the treatment of childhood functional constipation. Only sparse evidence exists on how follow-up is best implemented. Our aim was to evaluate whether follow-up by phone or self-management through Web-based information improved treatment outcomes.
Methods:
In this randomized controlled trial, conducted in secondary care, 235 children, ages 2 to 16 years, who fulfilled the Rome III criteria of childhood constipation, were assigned to 1 of the 3 follow-up regimens: control group (no scheduled contact), phone group (2 scheduled phone contacts), and Web group (access to Web-based information).
Primary Outcome:
number of successfully treated children after 3, 6, and 12 months.
Secondary Outcomes:
phone contacts, relapse, fecal incontinence, and laxative use.
Results:
After 3 and 6 months, significantly more children in the Web group (79.7%/75.9%) were successfully treated compared with the control and phone groups (59.7%/63.6% and 63.3%/64.6%) (P = 0.007/P = 0.03). No difference was found after 12 months (control, 72.7%; phone, 68.4%; Web group, 78.5%; P = 0.40). Extra phone consultations were significantly more frequent in the Web group (44.3%) compared with the control group (28.6%) (P = 0.04). Before 3 months, 45.5% of phone consultations were completed in the Web group versus 28.8% and 25.8% in the control and phone groups (P = 0.05/P = 0.02). Relapses, fecal incontinence, and laxative use were not different between interventions.
Conclusions:
Improved self-management behavior caused by access to self-motivated Web-based information induced faster short-term recovery during the treatment of functional constipation. Patient empowerment rather than health care-promoted follow-up may be a step toward more effective treatment for childhood constipation.
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