Comparing Manual and Automatic Colonic Massage for Chronic Constipation.

Retrieval Strategy

• Computer retrieval of clinical literature on abdominal massage for constipation published between 1990 and December 2024 will be conducted in:

• NCBI PubMed.
• Research Gate.
• Google Scholar.
• Ovid.
• English retrieval terms included: colon, abdominal, constipation, bowel function, transit time, massage, and device.
• A cross-retrieval will be conducted to screen the literature that met the inclusion criteria.

Literature screening and data extraction

• The literature search will be independently performed by two researchers.
• Identified studies will be imported into EndNote×9 and Mendeley for organization.
• Articles will be evaluated based on predefined inclusion and exclusion criteria.
• Duplicates from various databases will be removed.
• Clearly irrelevant articles will be excluded based on their titles and abstracts.
• Full texts of the remaining studies will be thoroughly reviewed, and those that met the criteria will be included.
• The final dataset will be cross-verified.
• Discrepancies will be resolved through discussion or by involving a third researcher with a PhD for arbitration.
• Extracted data included:

• First author's name
• Publication year
• Study type
• Sample size
• Participant gender and age
• Interventions in both experimental and control groups
• Treatment duration and frequency
• Primary and secondary study outcomes
• Quality assessment of the studies
• Study characteristics, along with the study design, description of interventions (type of colon massage applied), and indices of evaluated results, will be organized using an Excel-based data extraction form.

Quality evaluation

• Quality assessment of the literature will be conducted using the "risk of bias" tool recommended by the Cochrane Handbook for Systematic Reviews (Rob2.0 and Robins-E). These tools evaluate various bias domains, including randomization, deviations from intended interventions, missing data, outcome measurement, and selective reporting. Each domain will be rated as having a high, unclear, or low risk of bias.
• Disagreements between the two researchers regarding the literature's conclusions will be resolved through discussion or by a third researcher.

Literature Inclusion Criteria:

• Study type:

• Clinical studies using abdominal/colon massage to treat constipation.
• Articles published between 1990 and till the day of literature search with original work (experimental and quasi-experimental ) or dealing with the application of colon massage to gastrointestinal function.
• Study subjects:

• Patients with constipation.
• Individuals of any gender, age and ethnicity.
• Interventions:

• Manual or automatic colon massage treatment for constipation.
• Outcomes (including at least one of the following):

• Evacuation frequency.
• Quality of life parameters.
• Symptoms of constipation.
• Use of laxatives or enemas.
• Adverse events.

Literature Exclusion Criteria:

• No abstract available, reviews, conference abstracts, dissertations, registration documents, clinical experience summary analysis, animal experiments, etc.
• Studies where the treatment was non-colon specific.
• Studies involving invasive treatments.
• Other treatments intended to treat constipation such as surgical interventions, acupuncture, acupoint application, and others considered medicinal alternative therapies.
• Documents written in languages other than in English, German, Spanish, as well as other European languages, including Italian, French, and Portuguese.
• Incorrect or incomplete case data.