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NCT Number: NCT07576491

Correlation Between Toilet Sitting Position, Ankle Range of Motion, and Lower Limb Strength in Children

This study investigates the relationship between different toilet sitting styles (squat vs. western) and their effects on ankle range of motion (ROM), constipation symptoms, and lower limb strength in school-going children aged 6-12 years. With increasing urbanization, the shift from traditional squat toilets to sitting toilets may influence children's musculoskeletal development and bowel health. Squatting involves greater ankle dorsiflexion and muscle activation, which may contribute to better lower limb strength and improved bowel function compared to sitting postures.

A comparative cross-sectional design will be used, including participants from public and private schools. Data on toilet usage habits will be collected along with demographic information. Ankle ROM will be measured using a goniometer, lower limb strength will be assessed through the 1-minute sit-to-stand test and standing long jump, and constipation symptoms will be evaluated using the PAC-SYM questionnaire. Data analysis will be conducted using SPSS version 26. Ethical approval will be obtained from the Research Ethics Committee of Riphah International University, Lahore.

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Key information

Conditions

Children, Only Constipation Pathological Conditions, Signs and Symptoms Signs and Symptoms Signs and Symptoms, Digestive

Age range

6 year–12 year

Sex eligibility

All sexes

Study type

Observational

Primary location

About this study

This study aims to explore the correlation between different toilet sitting styles and their effects on ankle range of motion (ROM), constipation symptoms, and lower limb strength in school going children. With modernization and urbanization, there has been a significant shift from traditional squat toilets to western-style sitting toilets, especially in schools and households.This change in toileting posture may have a direct impact on musculoskeletal development and gastrointestinal health in growing children. Prolonged use of sitting toilets might limit the natural ankle dorsiflexion used during squatting and reduce muscle activation in the lower limbs, potentially contributing to strength limitations and altered bowel habits. The study intends to investigate whether habitual use of squat toilets promotes better ankle flexibility, stronger lower limbs, and fewer constipation-related symptoms in comparison to sitting toilet users.

A comparative cross-sectional study design will be employed, targeting children aged 6 to 12 years from selected public and private schools. After obtaining informed consent from guardians and assent from children, demographic data will be collected along with their toilet usage history. Ankle ROM will be measured using a goniometer, while lower limb strengthwill be assessed using the 1 minute sit-to-stand test and estimated long standing jump testing.Constipation symptoms will be evaluated using the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire. Data will be analyzed through SPSS version26.0.Descriptive statistics will be used to determine the association between toilet type and the selected outcome variables. The synopsis will be presented to the Research Ethical committee of Riphah International University, Lahore, for ethical approval to conduct this study.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Students age group: 6-12 year.
  • Both male and female groups
  • Normal developing children
  • Children who have been using either sitting or squatting toilet type .
  • Children's who are willing to participate and perform functional tasks.

Exclusion criteria

Children with abdominal surgery

  • Children with lower limb surgery
  • Children with acute or chronic disease like irritable bowel syndrome
  • Children using both toilet postures
  • Children with neurological or developmental delays affecting toilet independence like Cerebral Palsy and autism.
  • Children on medications that affect bowel movement (e.g., laxatives, opioid)

Treatment and study plan

Primary outcomes

  1. Goniometer

    Time frame: Baeline

    A goniometer is a reliable tool used to measure ankle range of motion (ROM), including dorsiflexion and plantarflexion. The axis is placed at the lateral malleolus, with arms aligned along the fibula and fifth metatarsal. Assessment is done in a seated or supine position** with the knee flexed or extended.

  2. 1 Minute Sit-to-Stand Test

    Time frame: Baeline

    1-minute Sit-to-Stand Test (1-MSTST) is a simple and reliable test to assess lower limb strength and endurance in children. The participant sits on a standard chair with arms crossed and performs maximum sit-to-stand repetitions in 60 seconds. Each full stand and return to sitting is counted as one repetition. The total number of repetitions is recorded, showing **high reliability in pediatric populations.

  3. Standing Long Jump

    Time frame: Baeline

    The Standing Long Jump (SLJ), also known as the standing broad jump, is a field test used to evaluate explosive lower-limb power in children and adolescents. Participants start with both feet together just behind a marked line, execute a countermovement by flexing the knees and hips, swing their arms, and leap forward as far as possible, landing on both feet without falling backward. The distance from the take-off line to the back of the heel nearest the line is measured in centimeters. No shoes or minimal footwear are allowed to ensure consistency .Each participant performs two trials, and the longest valid jump is recorded as their score .Research including large pediatric samples confirms that the SLJ test exhibits excellent test-retest reliability.

  4. Patient Assessment of Constipation Symptoms (PAC-SYM) Questionnaire

    Time frame: Baeline

    The PAC-SYM (Patient Assessment of Constipation Symptoms) is a validated questionnaire used to assess constipation severity over the past two weeks. It includes 12 items covering abdominal, stool, and rectal symptoms, rated on a 5-point Likert scale (0-4). Scores indicate severity ranging from minimal to very severe symptoms.

Study contacts

Contact information is provided by the study sponsor or research team.

Imran Amjad, PhD

CONTACT

[email protected]

9233224390125

Muhammad Asif Javed, MS-PT

CONTACT

[email protected]

923224209422

Sponsors and collaborators

Lead sponsor

Riphah International University

Other

Registry information

Official study title

Correlation Of Different Toilet Sitting On Ankle Range Of Motion, Constipation And Lower Limb Strength In School Going Children

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
May 8, 2026
Registry last updated
May 8, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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