Resumo:
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.
