Is additional abdominal massage on top of lifestyle advice more effective in managing constipation as compared to lifestyle advice alone among patients with Parkinson’s disease?
Date of publication of randomized controlled trial: January 2016
Design
Randomized controlled trial (RCT).
Participants
32 patients with a confirmed diagnosis of Parkinson’s and were over 18 years with self-reported constipation (mean age: 72.3 years, male %: 78.1%).
Intervention
Abdominal massage plus lifestyle advice was used as an intervention. Abdominal massage was practiced by patients or carers after receiving training. The frequency of abdominal massage was 5 to 7 times per week for 6 weeks.
Lifestyle advice referred to advice on bowel management which was provided by trained research assistant once a week for 6 weeks.
Comparator
Comparison: Abdominal massage plus lifestyle advice versus lifestyle advice alone.
Major Outcomes
Outcome 1: Change in symptom score as measured by Gastrointestinal Symptom Rating Scale (GSRS) at week 10;
Outcome 2: Change in symptom score as measured by Constipation Scoring System (CSS) at week 10;
Outcome 3: Change in symptom score as measured by Neurogenic Bowel Dysfunction Score (NBDS) at week 10.
Higher scores in these 3 scales indicated more severe constipation.
Settings
The authors did not state whether the trials were conducted in inpatient or outpatient settings.
Comparison    Abdominal massage plus lifestyle advice versus lifestyle advice alone
Main Results
Both lifestyle advice alone group and abdominal massage plus lifestyle advice group showed improvement in constipation symptoms from baseline to week 10. There was no significant difference in symptoms scores as measured by GSRS (mean difference (MD): -1.81, 95% CI: -7.01 to 3.39), CSS (MD: 0.82, 95% CI: -2.02 to 3.66) and NBDS (MD: -0.22, 95% CI: -2.79 to 2.34) between the two groups.
Comparison: Abdominal massage plus lifestyle advice versus lifestyle advice alone among patients with Parkinson’s disease
Outcomes No. of studies (Total number of participants) Mean (SD)/ No. of participants Heterogeneity test ( I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 1(32) 24.3 (6.6)/16 24.3 (5.2)/16 Not applicable as there is only 1 trial -1.81 (-7.01 to 3.39) 0.477 Low
2 (NA) 1(32) 8.9 (4.7)/16 6.4 (5.0)/16 Not applicable as there is only 1 trial 0.82 (-2.02 to 3.66) 0.555 Low
3 (NA) 1(32) 4.2 (3.5)/16 3.6 (2.7)/20 Not applicable as there is only 1 trial -0.22 (-2.79to 2.34) 0.859 Low
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Abdominal massage plus lifestyle advice versus lifestyle advice alone
Main Results
Both lifestyle advice alone group and abdominal massage plus lifestyle advice group showed improvement in constipation symptoms from baseline to week 10. There was no significant difference in symptoms scores as measured by GSRS (mean difference (MD): -1.81, 95% CI: -7.01 to 3.39), CSS (MD: 0.82, 95% CI: -2.02 to 3.66) and NBDS (MD: -0.22, 95% CI: -2.79 to 2.34) between the two groups.
Comparison: Abdominal massage plus lifestyle advice versus lifestyle advice alone among patients with Parkinson’s disease
Outcomes 1 (NA) 2 (NA) 3 (NA)
No. of studies (Total number of participants) 1(32) 1(32) 1(32)
Mean (SD)/ No. of participants Intervention 24.3 (6.6)/16 8.9 (4.7)/16 4.2 (3.5)/16
Comparator 24.3 (5.2)/16 6.4 (5.0)/16 3.6 (2.7)/20
MD (95% CI) -1.81 (-7.01 to 3.39) 0.82 (-2.02 to 3.66) -0.22 (-2.79to 2.34)
p value 0.477 0.555 0.859
Overall quality of evidence* Low Low Low
Keys: SD= standard deviation; MD: mean difference; CI: confidence interval.
Conclusion
Benefits
Both lifestyle advice alone group and abdominal massage plus lifestyle advice group showed improvement in constipation symptoms from baseline to week 10. However, there was no significant difference in all symptoms scores as measured by GSRS, CSS and NBDS between the two groups. For all outcomes, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
There was no occurrence of adverse events in this trial.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/26826459
The synopsis is based on the following article:
McClurg D, Hagen S, Jamieson K, Dickinson L, Paul L, Cunnington A. Abdominal massage for the alleviation of symptoms of constipation in people with Parkinson's: a randomised controlled pilot study. Age and ageing. 2016 Jan 29;45(2):299-303.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.