CON-COUR study: Interferential therapy in the treatment of chronic constipation in adults: study protocol for a randomized controlled trial

Véronique Vitton (1, 2) , Alban Benezech (2) , Stéphane Honoré (3) , Patrick Sudour (4) , Nathalie Lesavre (5) , Pascal Auquier (6) , Karine Baumstarck (6)

1 CRN2M - Centre de recherche en neurobiologie - neurophysiologie de Marseille
2 Service de Gastroentérologie
3 Unité d’expertise pharmaceutique et recherche biomédicale
4 Direction de la Recherche
5 CIC-UPCET - Centre investigation clinique - Unité de pharmacologie clinique et d'évaluations thérapeutiques
6 SPMC - Santé Publique et maladies Chroniques : Qualité de vie Concepts, Usages et Limites, Déterminants

Background: The prevalence of chronic constipation is about 15 % in Western countries with a significant impact on quality of life and health care costs. The first-line therapy, based on medical treatment combined with laxatives and dietary rules, is often disappointing. Interferential therapy is a new treatment that has demonstrated its efficiency in the treatment of chronic constipation in children and encouraging results in adults. The primary objective of this study is to assess the efficacy of interferential therapy during 8 weeks in adult patients. The secondary objectives are to assess this new and noninvasive therapy in terms of persistence of the clinical efficacy, colonic transit time, ano-rectal manometry, patient satisfaction and quality of life (QoL), and tolerance. Methods/ Design: Design: multicenter, prospective, randomized, placebo-controlled, double blind, two-parallel groups study. Setting: nine French adult gastroenterology centers. Inclusion criteria: adult patients with a history of chronic constipation refractory to medical treatment for at least 3 months. Treatment groups: (1) interferential-experimental group (effective stimulation); (2) placebo-control group (sham stimulation). Randomization: 1:1 allocation ratio. Evaluation times: inclusion (T0, randomization), baseline assessment (T1), start of stimulation (T2), intermediary assessment (T3, 4 weeks), end of stimulation (T4, 8 weeks), follow-up (T5 and T6, 1- and 6-month). Endpoints: (1) primary: short-term efficacy at T4 (treatment response defined as three or more spontaneous, complete bowel movements per week); (2) secondary: efficacy at T5 and T6, symptoms (Patient Assessment of Constipation Symptoms questionnaire), colonic transit time, anorectal manometry, patient satisfaction (analogical visual scale), patient QoL (Patient Assessment of Constipation Quality of Life Questionnaire), side/unexpected effects. Sample size: 200 individuals to obtain 80 % power to detect a 20 % difference in treatment response at T4 between the two groups (15 % of lost to follow-up patients expected). Discussion: The randomized, double-blind, placebo-controlled design is the most appropriate to demonstrate the efficacy of a new experimental therapeutic (Evidence-Based Medicine Working Group classification). National and international recommendations could be updated based on the findings of this study.

Mots clés: Interferential therapy; Medical-refractory chronic constipation; Adults; Randomized controlled trial; SLOW-TRANSIT CONSTIPATION; ELECTRICAL-STIMULATION; NERVE-STIMULATION; CHILDREN; QUESTIONNAIRE; VALIDATION; DEFECATION; QUALITY

Domaines: Hépatologie et Gastroentérologie

Véronique Vitton, Alban Benezech, Stéphane Honoré, Patrick Sudour, Nathalie Lesavre, et al.. CON-COUR study: Interferential therapy in the treatment of chronic constipation in adults: study protocol for a randomized controlled trial. Trials, 2015. ⟨hal-01208277⟩