Effects of abdominal vibration combined with walking exercise as an adjunct to standard bowel preparation in older patients with constipation / Zhang Yuanyuan

Zhang , Yuanyuan (2024) Effects of abdominal vibration combined with walking exercise as an adjunct to standard bowel preparation in older patients with constipation / Zhang Yuanyuan. PhD thesis, Universiti Malaya.

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Abstract

High-quality bowel preparation is an important prerequisite for a successful colonoscopy. However, older patients with constipation are at high risk for inadequate bowel preparation. This study aimed to evaluate the effectiveness of an abdominal vibration combined with walking exercise (AVCWE) programme compared with walking exercise (WE) and standard bowel preparation regimens for bowel preparation in older patients with constipation. A prospective, single-blinded, three-arm randomised controlled trial was conducted between February and August 2023. Older patients with constipation who underwent colonoscopy at a tertiary hospital in China were prospectively enrolled and randomly assigned to one of the three groups: the AVCWE group, the WE group, or the control group. During the period of laxative ingestion, patients assigned to the AVCWE group were asked to walk independently for at least 5,500 steps at no more than moderate intensity and received two cycles of moderate-intensity abdominal vibrations. Patients in the WE group were required to walk independently for at least 5,500 steps at no more than moderate intensity, whereas patients in the control group received only the standard bowel preparation regimen. The primary outcome was the quality of bowel preparation assessed by the Boston Bowel Preparation Scale (BBPS). The secondary outcomes included adenoma detection rate, caecal intubation rate, caecal intubation time, adverse events, satisfaction, and willingness to repeat the same preparation. Additionally, logistic regression analysis was performed to identify risk factors for inadequate bowel preparation. A total of 271 patients were randomly divided into AVCWE group (n = 90), WE group (n = 90), and control group (n = 91). The total BBPS score in the AVCWE group (M = 6.99, SD = 0.93) was significantly higher compared with both the WE group (M = 6.58, SD = 1.08) and the control group (M = 5.96, SD = 1.14) (p < 0.001). Similarly, compared with other groups, the AVCWE group also had significant advantages in improving adenoma detection rate (AVCWE group vs WE group vs control group: 42.2% vs 24.4% vs 20.9%, p = 0.003), satisfaction score (91.98 [SD = 5.93] vs 89.39 [SD = 7.48] vs 87.37 [SD = 8.25], p < 0.001) and reducing the incidence of bloating (22.2% vs 38.9% vs 40.7%, p = 0.016). However, there were no significant differences in caecal intubation rate, caecal intubation time, and willingness. Besides, the first colonoscopy (OR, 2.329; 95% CI, 1.210–4.485; p = 0.011), laxative use ≥ 3 times per week (OR, 2.675; 95% CI, 1.452–4.931; p = 0.002), and poor dietary compliance (OR, 2.249; 95% CI, 1.142–4.430; p = 0.019) were found to be significant predictors of inadequate bowel preparation in older patients with constipation. The AVCWE programme significantly improved the quality of bowel preparation, adenoma detection rate, satisfaction, and significantly reduced the incidence of bloating in older patients with constipation. Healthcare providers are recommended to adopt this strategy to optimise the detection of colorectal diseases and elevate the standard of healthcare services for this ‘difficult-to-prepare’ population.

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