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Abdominal massage plus advice, compared with advice only, for neurogenic bowel dysfunction in MS: a RCT.

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Abdominal massage combined with advice improved bowel regularity and completeness in people with multiple sclerosis (PwMS) experiencing neurogenic bowel dysfunction (NBD). While not statistically significant for the primary outcome, the intervention showed patient-reported benefits and warrants consideration of low-cost versions.

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Area of Science:

  • Clinical Medicine
  • Neurology
  • Gastroenterology

Background:

  • Neurogenic bowel dysfunction (NBD) affects 50-80% of people with multiple sclerosis (PwMS), significantly impacting quality of life and potentially leading to hospitalization.
  • NBD encompasses both constipation and fecal incontinence, presenting a substantial challenge in managing MS symptoms.

Purpose of the Study:

  • To evaluate the clinical and cost-effectiveness of abdominal massage combined with bowel symptom advice for PwMS with NBD.
  • To conduct a process evaluation to understand factors influencing treatment effectiveness and implementation.

Main Methods:

  • A randomized controlled trial involving 189 PwMS with bothersome NBD across 12 UK hospitals.
  • Intervention group received daily abdominal massage for 6 weeks plus standard bowel advice; control group received advice only.
  • Primary outcome: change in NBD score at 24 weeks. Secondary outcomes included bowel diary, adherence, constipation scores, and quality of life (EQ-5D-5L).

Main Results:

  • No statistically significant difference in the primary NBD score between groups (p=0.0558).
  • Significant improvements favoring the intervention group in stool evacuation frequency (p=0.039) and sensation of complete bowel emptying (p=0.002).
  • 75% of interviewed participants reported benefits (e.g., easier stool passage, reduced bloating), and 85% continued the massage; cost-utility analysis showed intervention was dominated by control.

Conclusions:

  • Abdominal massage shows potential for improving specific aspects of bowel function in PwMS with NBD, despite not meeting primary outcome significance.
  • The intervention was not cost-effective in terms of Quality-Adjusted Life Years (QALYs).
  • A low-cost adaptation of the abdominal massage intervention may be considered valuable by some patients.