Técnicas de terapia manual no manejo da constipação funcional: uma revisão sistemática com metanálise

Abstract

Introduction: Functional constipation (FC) is a prevalent gastrointestinal disorder affecting patients' quality of life and causing difficulty evacuating. Among the therapeutic resources used by physiotherapy to treat functional constipation, manual therapy (MT) techniques are low-cost approaches and can be performed by the patient himself, if he is properly guided. Despite the good performance of abdominal massage in FC, previous systematic review studies do not gather the possible MT techniques in managing constipation. In addition, there is a lack of systematic studies with meta-analysis that evaluate the effectiveness of different MT techniques in the severity of FC and the quality of life of people affected by this dysfunction. Objective: To evaluate the effectiveness of manual therapy techniques in managing functional constipation. Method: Systematic Review with Meta-Analysis by the PRISMA recommendations. Clinical trials were selected from the following databases: National Library of Medicine (PUBMED/MedLine), EMBASE (Elsevier), Physiotherapy Evidence Database (PEDro), and Biblioteca Virtual de Saúde (BVS), with no restrictions on language or year of publication. The meta-analysis used Reviewer Manager V.5.4. Results: Forty-one studies were included. The results of a subgroup analysis with MT types showed that abdominal massage reduced the severity of constipation and improved quality of life in all comparisons, except with medications, with a mean difference (MD) in severity of 0.16 (95% CI: -6.92 to 7.24, p=0.96); while aromatic abdominal massage only showed a significant effect in the comparison versus control on the outcome quality of life, with an MD of -12.05 (-21.96, -16.14, p<0.00001). Acupressure showed a positive effect on both outcomes evaluated. Osteopathic manipulation demonstrated a positive impact on symptom severity when compared with other therapies or placebo. Conclusion: There is very low to moderate quality evidence that abdominal massage and acupressure, showed more significant results in improving the severity of functional constipation and quality of life. Abdominal meridian massage, osteopathic manipulation, and foot reflexology showed positive effects only on the outcome of constipation severity, whereas aromatic abdominal massage demonstrated benefits solely on the outcome of quality of life.