A randomised controlled trial to evaluate the feasibility and effectiveness of a nurse-led clinic compared with a medical clinic for the management of intractable functional constipation in children
Ed Juszczak, Jon Deeks and Mike Bradburn with Peter Sullivan (Oxford)
Childhood constipation is a common, complex and often intractable problem that is relatively under-researched. It has a high treatment failure rate due to inappropriate management and insufficient follow-up. The aim of this research was to improve outcome of treatment for children with intractable functional constipation, by formally comparing the feasibility and effectiveness of a nurse-led clinic (NLC) with a paediatric gastroenterology clinic (PGC) in a randomised trial.
Children between the ages of two and fifteen years who have received a diagnosis of functional constipation according to a standard definition (decreased frequency of bowel movements and/or harder stool consistency and/or subjective difficulty in defaecation) were eligible for the trial. At the end of the initial consultation in the paediatric gastroenterology clinic, informed consent was obtained from the parent or carer and the child randomised to the NLC or PGC. An identical treatment escalation algorithm was used as the basis for management in both the medical and the nursing clinics. A radiographic score obtained at the time of initial assessment was used both as a diagnostic tool and as a semi-quantitative marker of severity of constipation. Bowel charts were used as a record of progress as were dedicated case report forms, designed to document all outpatient visits, inter-visit contact, a record of laxative use, and details surrounding discharge and completion of the study. Parent satisfaction was evaluated with the Modified Leeds Satisfaction Questionnaire.
Final results following 2 years complete follow-up for all children will clarify whether there is an important role for clinical nurse specialists in the management of intractable constipation in childhood.
Publication: 86
