Decreasing recurrent bowel obstructions, improving quality of life with physiotherapy: Controlled study

Table 1 Demographics

Characteristics	Control	CPA treatment	P value
Age, yr
Median	33.5	57	< 0.001
Range	19-71	19-89
Sex
Male	58	33	0.0853
Female	78	70
Race
White	80	90
Black/African American	39	1
American Indian/Alaska Native	1	2
Asian	3	2
Native Hawaiian/Pacific Islander	0	0
Other	11	0
Unknown	2	8
Ethnicity
Hispanic or Latino	12	1
Not Hispanic or Latino	108	91
Unknown	16	11
Marital Status
Married/long term relationship	47	69
Single	63	16
Divorced/widowed	25	11
Unknown	1	7

CPA: Clear Passage Approach.

Table 2 Medical history

	Control	CPA treatment	P value
Number of previous surgeries
0	4	4	< 0.001
1-2	89	16
3-5	39	34
> 6	3	49
unknown	1	0
Number of prior partial bowel obstructions in the last 3 yr			< 0.001
0	3	24
1-10	132	70
11-20	1	8
> 20	0	1
Number of prior total bowel obstructions			0.4894
0	4	53
1	47	29
2	46	11
3	27	3
4 or more	12	7
Number of years impact on life due to bowel issues
Average (SD)	5.5 (7.2)	10.7 (11.2)	< 0.0001

CPA: Clear Passage Approach.

Table 3 Average difference (before/after) in Small Bowel Obstruction Questionnaire scores and P-values for each domain and question for the control group

Domain question	Difference mean, St. Dev		Raw P-value	Multiplicity adjusted P-value	Lower confidence bound	Upper confidence bound
Diet	-0.06	0.93	0.425	1.000	-0.28	0.15
Liquid	-0.09	1.08	0.342	1.000	-0.39	0.21
Soft	-0.20	1.20	0.055	1.000	-0.54	0.14
Solid	-0.11	1.48	0.388	1.000	-0.53	0.31
Anything	0.13	1.35	0.256	1.000	-0.25	0.51
Pain1	0.17	0.61	0.002	0.013	0.02	0.31
General2	0.50	1.23	0.000	0.000	0.15	0.85
Upper GI	0.00	1.11	1.000	1.000	-0.31	0.31
Lower GI2	0.35	1.14	0.000	0.016	0.03	0.67
BM2	0.50	0.96	0.000	0.000	0.23	0.77
Head_neck	0.01	1.05	0.935	1.000	-0.29	0.30
Migrane	0.05	1.18	0.612	1.000	-0.28	0.38
Coccyx	-0.13	1.07	0.150	1.000	-0.43	0.17
Eating2	0.35	1.24	0.001	0.045	0.00	0.70
Drinking	0.02	1.10	0.815	1.000	-0.29	0.33
Back	0.01	1.11	0.877	1.000	-0.30	0.33
GI symptoms1	0.18	0.58	0.000	0.003	0.05	0.32
Nausea	0.29	1.22	0.006	0.215	-0.05	0.64
Vomit	-0.04	0.88	0.627	1.000	-0.28	0.21
GI_spasm	-0.01	0.97	0.860	1.000	-0.29	0.26
Constipation	0.06	0.90	0.448	1.000	-0.19	0.31
Diarrhea	0.26	1.14	0.010	0.354	-0.06	0.58
BS_JLM	0.04	0.96	0.592	1.000	-0.22	0.31
Gas_bloat_dist2	0.39	1.32	0.001	0.028	0.02	0.76
Inc_sounds2	0.41	1.14	0.000	0.002	0.09	0.73
No_BM	0.07	1.10	0.437	1.000	-0.24	0.38
Ab_BM	0.01	1.22	0.889	1.000	-0.33	0.36
Eat_bloat2	0.45	1.51	0.001	0.025	0.03	0.88
Medication	-0.03	1.39	0.804	1.000	-0.35	0.29
Meds	-0.03	1.39	0.804	1.000	-0.42	0.36
Quality of life	0.10	0.77	0.126	0.759	-0.08	0.28
Off_work	0.13	1.19	0.218	1.000	-0.21	0.46
Off_social	0.10	1.42	0.396	1.000	-0.30	0.50
Off_sex	0.12	1.37	0.313	1.000	-0.27	0.51
Off_daily_function	0.25	1.38	0.036	1.000	-0.14	0.64
Off_eat_out	0.34	1.23	0.002	0.059	-0.01	0.69
Massage_worry	-0.31	1.19	0.003	0.104	-0.65	0.02
Worry	0.06	1.07	0.521	1.000	-0.24	0.36
Pain severity	0.23	1.46	0.064	0.382	-0.10	0.57
Duration_pain	0.33	1.24	0.003	0.105	-0.02	0.68
Recent_max_pain	0.24	2.62	0.295	1.000	-0.50	0.97
Recent_min_pain	0.35	2.17	0.064	1.000	-0.26	0.96
Recent_avg_pain	0.02	1.89	0.892	1.000	-0.51	0.55

¹Denotes domains for which average scores (over all questions within a domain) are significantly different between the initial and the follow-up survey, controlling the familywise error rate (over the 6 domains) at 5%.

²Denotes questions for which scores are significantly different between the initial and the follow-up survey, controlling the familywise error rate (over the 37 questions included in the SBO-Q) at 5%. SBO-Q: Small Bowel Obstruction Questionnaire.

Table 4 Average difference (before/after) in Small Bowel Obstruction Questionnaire scores and P-values for each domain and question for the Clear Passage Approach treatment group

Domain question	Change mean, St. Dev		Raw P-value	Multiplicity adjusted P-value	Lower confidence bound	Upper confidence bound
Diet1	0.77	1.03	0.000	0.000	0.49	1.04
Liquid2	0.49	1.19	0.000	0.003	0.10	0.87
Soft2	0.71	1.38	0.000	0.000	0.26	1.16
Solid2	0.91	1.70	0.000	0.000	0.35	1.47
Anything2	0.98	1.66	0.000	0.000	0.44	1.53
Pain1	0.52	0.73	0.000	0.000	0.33	0.72
General2	0.88	1.41	0.000	0.000	0.43	1.34
Upper GI2	0.85	1.34	0.000	0.000	0.41	1.29
Lower GI2	0.58	1.49	0.000	0.005	0.10	1.07
BM2	0.49	1.08	0.000	0.001	0.13	0.85
Head_neck	0.39	1.39	0.005	0.201	-0.06	0.85
Migrane	0.11	0.69	0.117	1.000	-0.12	0.34
Coccyx	0.16	0.75	0.035	1.000	-0.09	0.41
Eating2	0.68	1.51	0.000	0.001	0.18	1.17
Drinking2	0.46	1.26	0.000	0.013	0.05	0.87
Back2	0.59	1.29	0.000	0.000	0.17	1.01
GI symptoms1	0.44	0.68	0.000	0.000	0.26	0.62
Nausea2	0.53	1.13	0.000	0.000	0.16	0.90
Vomit	0.17	0.58	0.003	0.113	-0.02	0.36
GI_spasm	0.20	0.89	0.026	0.979	-0.09	0.49
Constipation2	0.54	1.48	0.000	0.013	0.06	1.03
Diarrhea2	0.41	1.19	0.001	0.028	0.02	0.79
BS_JLM	0.06	1.01	0.559	1.000	-0.27	0.39
Gas_bloat_dist2	0.72	1.46	0.000	0.000	0.24	1.19
Inc_sounds	0.37	1.35	0.008	0.286	-0.08	0.81
No_BM2	0.56	1.36	0.000	0.003	0.11	1.01
Ab_BM2	0.63	1.54	0.000	0.003	0.13	1.14
Eat_bloat2	0.71	1.39	0.000	0.000	0.26	1.17
Medication	0.40	1.84	0.029	0.176	-0.09	0.89
Meds	0.40	1.84	0.029	1.000	-0.20	1.00
Quality of life1	0.78	0.85	0.000	0.000	0.55	1.01
Off_work2	0.42	0.91	0.000	0.000	0.12	0.72
Off_social2	0.78	1.29	0.000	0.000	0.36	1.21
Off_sex2	0.61	1.45	0.000	0.003	0.12	1.10
Off_daily_function2	0.99	1.40	0.000	0.000	0.53	1.45
Off_eat_out2	0.64	1.38	0.000	0.000	0.19	1.09
Massage_worry2	0.75	1.82	0.000	0.003	0.15	1.34
Worry2	1.32	1.64	0.000	0.000	0.78	1.85
Pain Severity1	1.51	1.66	0.000	0.000	1.07	1.95
Duration_pain2	1.21	1.86	0.000	0.000	0.61	1.82
Recent_max_pain2	2.70	3.26	0.000	0.000	1.62	3.78
Recent_min_pain2	0.65	1.82	0.001	0.023	0.04	1.25
Recent_avg_pain2	1.20	1.97	0.000	0.000	0.55	1.86

¹Denotes domains for which average scores (over all questions within a domain) are significantly different between the initial and the follow-up survey, controlling the familywise error rate (over the 6 domains) at 5%.

²Denotes questions for which scores are significantly different between the initial and the follow-up survey, controlling the familywise error rate (over the 37 questions) at 5%.

Table 5 Quartile assignment for each domain of the Small Bowel Obstruction Questionnaire for all groups and questionnaire time points

	Baseline					90 d/90 d post treatment
	Diet	Pain	GI	QOL	Medication	Diet	Pain	GI	QOL	Medication
Quartiles for control subjects
Normal	44	16	24	4	100	34	24	26	12	100
Mild	54	76	79	37	27	61	80	86	22	24
Moderate	24	41	29	59	9	30	29	22	78	12
Severe	14	3	4	36	0	11	3	2	24	0
Quartiles for CPA treated subjects
Normal	24	47	50	22	71	52	74	74	60	82
Mild	21	27	34	39	7	26	22	20	26	3
Moderate	35	24	15	27	25	16	6	8	9	18
Severe	23	5	4	15	0	9	1	1	8	0

Table 6 Range of motion averages in Clear Passage Approach treated subjects prior to and post Clear Passage Approach treatment

Range of motion measure (normal)	Pretreatment (n = 103) mean (SD)	Post treatment (n = 103) mean (SD)	Raw P value	Multiplicity adjusted P value	Lower confidence bound	Upper confidence bound
	Number with normal ROM	Number with normal ROM
Flexion (80)	76.9 (19.4)	82.5 (15.1)	< 0.001	0.010	-10.4	-0.7
	48	74
Extension (25)	25.2 (13.7)	29.9 (11.8)	< 0.001	< 0.001	-7.8	-1.5
	45	77
Left side bending (45)	38.0 (10.3)	42.6 (8.7)	< 0.001	< 0.001	-7.2	-2.1
	37	59
Right side bending (45)	38.8 (12.2)	43.4 (8.7)	< 0.001	< 0.001	-7.4	-1.8
	47	62
Left rotation (45)	37.0 (14.8)	44.2 (14.4)	< 0.001	< 0.001	-10.4	-4
	23	47
Right rotation (45)	39.3 (13.6)	45.5 (12.3)	< 0.001	< 0.001	-9.5	-2.9
	44	70

ROM: Range of motion.