Key result
TENS (SMD 1.60; 95% CI 0.28-2.92) and acupuncture (SMD 1.00; 95% CI 0.39-1.60) significantly improved stool frequency compared to placebo for chronic functional constipation.
Why the study?
Do nonpharmacological conservative treatments improve symptoms such as stool frequency and Bristol score in patients with chronic functional constipation?
Meta-Analysis (n=4,324)
Do nonpharmacological conservative treatments improve symptoms such as stool frequency and Bristol score in patients with chronic functional constipation?
Effect estimate: SMD 1.60 (95% CI 0.28-2.92)
TENS and acupuncture appear to be among the most effective nonpharmacological treatments for managing chronic functional constipation, though findings are limited by small study effects.
Supports TENS and acupuncture for chronic functional constipation; extends meta-analytic evidence for nonpharmacological therapies.
BACKGROUND: Patients with functional chronic constipation (CFC) often select nonpharmacological treatments. We aimed to examine the comparative effectiveness of nonpharmacological conservative treatments in treating CFC. METHODS: We searched MEDLINE, EMBASE, Cochrane library, CINAHL, AMED, ISI web of knowledge, and conference proceedings from January 2000 to June 2016. Randomized controlled trials comparing nonpharmacological conservative treatments with placebo, sham interventions, or conventional treatments were included. Nonpharmacological conservative treatments were defined as interventions without involvement of medication or surgery. We extracted trial data in duplicate and assessed the risk of bias. We pooled continuous data using standard mean differences (SMDs) and binary data using risk ratios (RRs), and we provided their 95% confidence intervals. KEY RESULTS: We included 33 trials (4324 participants and 8 nonpharmacological treatments). Compared with placebo interventions, TENS (SMD 1.60, 95% CI 0.28-2.92), probiotic (SMD 1.40, 95% CI 0.94-1.86), and acupuncture (SMD 1.00, 95% CI 0.39-1.60) had significantly larger effect on stool frequency; acupuncture (RR 1.56, 95% CI 1.14-2.14) had significantly higher responder rate; and moxibustion (SMD 2.50, 95% CI 0.05-4.95) had significant larger effect on Bristol score. Compared with laxative, acupuncture had significantly larger effect on stool frequency (RR 2.01, 95% CI 1.16-3.49) and had lower rate of adverse events (RR 0.38, 95% CI 0.18-0.80). CONCLUSIONS: TENS and acupuncture relatively ranked the best in managing CFC, but the results should be interpreted with caution due to small study effects. Registration number: PROSPERO CRD42014006686.
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Zheng et al. (2018) conducted a meta-analysis in Functional chronic constipation (n=4,324). Nonpharmacological conservative treatments (including TENS, probiotics, acupuncture, moxibustion) vs. Placebo, sham interventions, or conventional treatments (e.g., laxatives) was evaluated on Stool frequency (TENS vs placebo) (SMD 1.60, 95% CI 0.28-2.92). TENS (SMD 1.60; 95% CI 0.28-2.92) and acupuncture (SMD 1.00; 95% CI 0.39-1.60) significantly improved stool frequency compared to placebo for chronic functional constipation.
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