Published online May 21, 2018. doi: 10.3748/wjg.v24.i19.2108
Peer-review started: February 27, 2018
First decision: March 15, 2018
Revised: April 22, 2018
Accepted: May 6, 2018
Article in press: May 6, 2018
Published online: May 21, 2018
To compare (1) quality of life and (2) rate of recurrent small bowel obstructions (SBO) for patients treated with novel manual physiotherapy vs no treatment.
One hundred and three subjects (age 19-89) with a history of recurrent adhesive SBO were treated with a manual physiotherapy called the Clear Passage Approach (CPA) which focused on decreasing adhesive crosslinking in abdominopelvic viscera. Pre- and post-therapy data measured recurring obstructions and quality of life, using a validated test sent 90 d after therapy. Results were compared to 136 untreated control subjects who underwent the same measurements for subjects who did not receive any therapy, which is the normal course for patients with recurring SBO. Comparison of the groups allowed us to assess changes when the physiotherapy was added as an adjunct treatment for patients with recurring SBO.
Despite histories of more prior hospitalizations, obstructions, surgeries, and years impacted by bowel issues, the 103 CPA-treated subjects reported a significantly lower rate of repeat SBO than 136 untreated controls (total obstructions P = 0.0003; partial obstructions P = 0.0076). Subjects treated with the therapy demonstrated significant improvements in five of six total domains in the validated Small Bowel Obstruction Questionnaire (SBO-Q). Domains of diet, pain, gastrointestinal symptoms, quality of life (QOL) and pain severity when compared to post CPA treatment were significantly improved (P < 0.0001). The medication domain was not changed in the CPA treated group (P = 0.176).
CPA physical therapy was effective for patients with adhesive SBO with significantly lower recurrence rate, improvement in reported symptoms and overall quality of life of subjects.
Core tip: A manual soft tissue physical therapy protocol is an effective low risk preventative treatment option for patients who suffer recurrent adhesive small bowel obstructions. It increased the quality of life of subjects by decreasing pain, decreasing recurrent obstructions, improving diet and increasing bodily function. Because the therapy was performed in an outpatient setting, it eliminated the need for hospitalization and the risk and increased cost of surgery.