Table 1.
GRADE evaluation of interventions for constipation in adults
| Important outcomes | Frequency of bowel movement, straining during defecation, hard stool, laxative use, cure of constipation, adverse effects | ||||||||
| Number of studies (participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of non-drug interventions in adults with idiopathic chronic constipation? | |||||||||
| 1 (59) | Frequency of bowel movement | Fibre-rich diet v lower-fibre diet | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for inclusion of co-intervention in statistical analysis |
| 1 (59) | Straining during defecation | Fibre-rich diet v lower-fibre diet | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for inclusion of co-intervention in statistical analysis |
| 1 (59) | Hard stool | Fibre-rich diet v lower-fibre diet | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for inclusion of co-intervention in statistical analysis |
| 1 (43) | Cure of constipation | Exercise v normal lifestyle | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and for not assessing statistical significance |
| 1 (43) | Frequency of bowel movement | Exercise v normal lifestyle | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results (absolute numbers not reported), and for not assessing statistical significance |
| 1 (43) | Straining during defecation | Exercise v normal lifestyle | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results (absolute numbers not reported), and for not assessing statistical significance |
| 1 (43) | Hard stool | Exercise v normal lifestyle | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results (absolute numbers not reported), and for not assessing statistical significance |
| 1 (117) | Frequency of bowel movement | Increased fluid intake plus high-fibre diet v high-fibre diet alone | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (117) | Laxative use | Increased fluid intake plus high-fibre diet v high-fibre diet alone | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (60) | Straining during defecation | Biofeedback plus balloon defecation training v balloon defecation training alone | 4 | –3 | 0 | 0 | 0 | Very low | Quality point deducted for sparse data, incomplete reporting of results (significance not assessed), and other methodological flaws |
| 1 (77) | Cure rate | Biofeedback v sham/standard treatment | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and for incomplete reporting (data presented graphically). |
| 1 (109) | Frequency of bowel movement | Biofeedback v macrogols | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and for incomplete reporting (data presented graphically). Directness point deducted for co-intervention (advice on prevention of constipation) in only one arm |
| 1 (77) | Frequency of bowel movement | Biofeedback v sham/standard treatment | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and for incomplete reporting (data presented graphically) |
| 1 (109) | Straining during defecation | Biofeedback v macrogols | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for co-intervention (advice on prevention of constipation) in only one arm |
| 1 (77) | Straining during defecation | Biofeedback v sham/standard treatment | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and for incomplete reporting (data presented graphically) |
| 1 (109) | Laxative use | Biofeedback v macrogols | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for co-intervention (advice on prevention of constipation) in only one arm |
| 1 (77) | Laxative use | Biofeedback v sham/standard treatment | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and for incomplete reporting (data presented graphically) |
| What are the effects of bulk-forming laxatives in adults with idiopathic chronic constipation? | |||||||||
| 1 (201) | Frequency of bowel movement | Ispaghula husk v placebo | 4 | 0 | 0 | 0 | 0 | High | |
| 1 (196) | Straining during defecation | Ispaghula husk v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (124) | Frequency of bowel movement | Ispaghula husk v lactulose | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results (data presented graphically and statistical data not reported) |
| 1 (124) | Straining during defecation | Ispaghula husk v lactulose | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results (statistical data not reported) |
| 1 (170) | Frequency of bowel movement | Ispaghula husk v docusate | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for uncertainty of clinical benefit |
| 1 (170) | Straining during defecation | Ispaghula husk v docusate | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| What are the effects of faecal softeners in adults with idiopathic chronic constipation? | |||||||||
| We found no studies on the effects of faecal softeners | |||||||||
| What are the effects of osmotic laxatives in adults with idiopathic chronic constipation? | |||||||||
| 1 (304) | Cure rate | Macrogols v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 4 (544) | Frequency of bowel movement | Macrogols v placebo | 4 | –2 | 0 | 0 | 0 | Low | Quality point deducted for non-assessment of significance in one RCT, and incomplete reporting of results in one RCT |
| 1 (55) | Straining during defecation | Macrogols v placebo | 4 | –2 | 0 | 0 | 0 | Low | Quality point deducted for sparse data and for incomplete reporting (absolute numbers not reported) |
| 1 (304) | Laxative use | Macrogols v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 2 (183) | Frequency of bowel movement | Macrogols v ispaghula husk | 4 | –2 | 0 | –2 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness points deducted for unclear outcomes and inclusion of a co-intervention (electrolytes) |
| 1 (120) | Hard stool | Macrogols v ispaghula husk | 4 | –1 | 0 | –2 | 0 | Very low | Quality point deducted for sparse data. Directness points deducted for unclear outcomes and inclusion of a co-intervention (electrolytes) |
| 1 (115) | Frequency of bowel movement | Macrogols v lactulose | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (115) | Straining during defecation | Macrogols v lactulose | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for unclear definition of outcome |
| 1 (24) | Frequency of bowel movement | Lactulose v placebo | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data. Directness point deducted for using high-dose of intervention |
| 1 (30) | Hard stool | Lactulose v placebo | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and for not reporting pre-crossover results. Directness point deducted for unclear definition of outcome |
| 1 (43) | Frequency of bowel movement | Lactitol v placebo | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results. Directness point deducted for including only people in nursing homes |
| 3 (181) | Frequency of bowel movement | Lactitol v lactulose | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| What are the effects of stimulant laxatives in adults with idiopathic chronic constipation? | |||||||||
| 1 (55) | Frequency of bowel movement | Bisacodyl v placebo | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and short follow-up |
| 1 (55) | Hard stool | Bisacodyl v placebo | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and short follow-up |
| What are the effects of prostaglandin derivatives in people with idiopathic chronic constipation? | |||||||||
| 2 (371) | Cure rate | Lubiprostone v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 2 (371) | Frequency of bowel movement | Lubiprostone v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 2 (371) | Straining during defecation | Lubiprostone v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 2 (371) | Hard stools | Lubiprostone v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| 2 (371) | Laxative use | Lubiprostone v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting of results |
| What are the effects of 5-HTA agonists in people with idiopathic chronic constipation? | |||||||||
| 1 (53) | Cure rate | Prucalopride v placebo | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 4 (2056) | Frequency of bowel movement | Prucalopride v placebo | 4 | 0 | 0 | 0 | 0 | High | |
| 1 (641) | Hard stool | Prucalopride v placebo | 4 | 0 | 0 | 0 | 0 | High | |
| 3 (1885) | Straining during defecation | Prucalopride v placebo | 4 | 0 | 0 | 0 | 0 | High | |
Type of evidence: 4 = RCT; 2 = Observational.Consistency: similarity of results across studies Directness: generalisability of population or outcomes Effect size: based on relative risk or odds ratio