Effects of an Accessible Hybrid Telehealth Respiratory Strengthening Program to Alleviate Chronic Constipation: A Pilot Study

Purpose: This pilot study aimed to evaluate the effectiveness of a hybrid telehealth physical therapy (HTPT) model, targeting respiratory muscle strength and coordination, in improving chronic constipation (CC) symptoms and its relationship with respiratory performance measures. Methods: The quasi-experimental study included an intervention group (HTPT) and historical control group that received in-person physical therapy. The HTPT group underwent initial testing of maximal inspiratory and expiratory pressure (MIP and MEP) and received breathing education for defecation and a respiratory muscle strengthening program using a respiratory muscle training device, with weekly telehealth sessions. CC symptoms were assessed using the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire. Results: Out of 28 subjects, 21 completed the 8-week protocol. This resulted in a significant average increase in MIP (24.68%) and MEP (9.18%), along with a significant decrease in PAC-SYM scores. The intervention group’s mean PAC-SYM score decreased from 1.75 at baseline to 1.20 at 4 weeks and 0.97 at 8 weeks ( p < .001), with a large effect size ( ηp 2 = 0.687). Post-hoc comparisons showed significant improvements starting at 4 weeks ( p < .001). No significant differences in PAC-SYM scores were found between the HTPT and historical control group ( N = 35) when comparing post-treatment scores versus pre-treatment scores. A significant moderate negative correlation occurred between changes in MEP and the PAC-SYM ( r = −.402, p < .05). Discussion: The HTPT model significantly improved patient-reported CC symptoms. Exclusive in-person physical therapy that often included internal interventions showed no significant differences compared to the HTPT group. Future research on MEP-targeted interventions for CC appears warranted.