Comparative Effects of Thoracolumbar Manipulation versus Abdominal Massage on Functional Constipation and Quality of Life

Background: Functional constipation is a chronic constipation without any aetiology. Rome IV criteria defined functional constipation as having hard or lumpy stools, excessive straining during defecation, less than three bowel movements per week and an obstructive feeling during evacuation. Pathophysiology of functional constipation includes eating disorders, physical inactivity, fibre-deficient diet, family history and behavioural factors like stool withholding attitude. Physical therapy interventions can play a vital role in relieving functional constipation and improving quality of life. Objective: To investigate the comparative effects of thoracolumbar manipulation versus abdominal massage on functional constipation and quality of life. Methodology: This double-blinded, randomised controlled trial was conducted in the independent hospital physiotherapy department of Faisalabad with concealed allocation. A consecutive sample of 40 patients with functional constipation based on Rome IV criteria was taken. Patients were referred from gastroenterologists and general physicians and were randomly allocated by a universal lottery method to group A (lower thoracic-lumber manipulation, 3 sessions per week) and group B (abdominal massage for 15 minutes, 3 sessions per week). The Constipation Scoring System and Patient Assessment of Constipation Quality of Life Questionnaire were evaluated at baseline, 2 weeks, and 4 weeks after treatment. A total of 12 sessions in 4 weeks were provided to patients. Data was analysed by using non-parametric tests, Kruskal-Wallis Test and Friedman Test and SPSS version 25. Results: The age of the participants in both groups was the mean and standard deviations (29.23±3.23). Within-group analysis showed a significant relationship in both groups (Group A manipulation and Group B abdominal massage) (p<0.05). Constipation scoring system and patient assessment of constipation showed significant value (p<0.00), indicating that statistically significant relation between both groups. Conclusion: This study concluded that abdominal massage is a superior method to deal with functional constipation patients as compared to Maitland lower thoracolumbar manipulations.