Primary Outcome Measures:
- Primary encopretic symptoms (as defined by):
1. Number of episodes of fecal soiling
2. Number of bowel movements in the toilet
3. Increased trips to the bathroom (both parent and self-prompted) [ Time Frame: Baseline, 6 weeks, 6 months, 1 year ] [ Designated as safety issue: No ]
Secondary Outcome Measures:
- Behavior change around encopresis (as measured by):
1. Appropriate clean-out
2. Appropriate laxative use
3. Appropriate rectus abdominis straining
4. Toileting routine [ Time Frame: Baseline, 6 weeks, 6 months, 1 year ] [ Designated as safety issue: No ]
- Secondary encopretic symptoms (as defined by):
1. Appropriate bowel movement consistency
2. Reduced bowel-specific difficulties [ Time Frame: Baseline, 6 weeks, 6 months, 1 year ] [ Designated as safety issue: No ]
- Frequency and Severity of perianal pain [ Time Frame: Baseline, 6 weeks, 6 months, 1 year ] [ Designated as safety issue: No ]
- Costs (as measured by):
1. Time spent managing symptoms
2. Doctor visits
3. Medication usage
4. Missed school/work days
5. Diapers used
6. Therapist time in stepped-care component
7. Expenses associated with building and maintaining web program [ Time Frame: Baseline, 6 weeks, 6 months, 1 year ] [ Designated as safety issue: No ]
- Website Utilization (as measured by):
1. Time spent on website
2. Number of log-ins
3. Number of completed website Modules and Follow-Ups [ Time Frame: Throughout Intervention (from Baseline to 1 year) ] [ Designated as safety issue: No ]
It is estimated that between 1.5% and 7.5% of children experience encopresis. In most children, encopresis is a complication of long-standing constipation. Encopresis is defined as the repeated passage of feces in inappropriate places at least once a month, for three months, and not induced through substances or due to a general medical condition. Typically, treatment consists of medical management alone, which focuses on diet and/or laxative therapy and has a relatively low success rate. A combination of specialized medical and behavioral interventions for encopresis (Enhanced Toilet Training) has been found to have high success rates. Unfortunately, it is not readily available because of a lack of trained professionals to deliver the treatment and the amount of time and costs spent in delivering this treatment. Internet interventions, however, may lower some of the barriers associated with traditional face-to-face treatments by removing the inconvenience of scheduling appointments, missing work/school, and traveling to and from a clinician's office. This study will evaluate whether an Internet intervention is more effective than patient education in treating pediatric encopresis. This study will also evaluate whether stepped care support is additive to the effectiveness of the Internet intervention. Stepped care will involve adding personal e-mail and phone support to help families overcome obstacles to using and implementing the intervention.
Participants are randomized to receive a patient education website, the Internet intervention alone, or the Internet intervention plus stepped care. The intervention period lasts for 6 weeks. During the intervention period, subjects assigned to the patient education website will be given content addressing treatment of encopresis. Those assigned to use the Internet intervention will review interactive tutorials tailored to the user's difficulties. The stepped care group will receive the Internet intervention as well as additional support if they fail to reach specific intervention milestones. All families will complete assessment questionnaires and daily diaries of the children's symptoms and bowel behaviors for one week at baseline, following the intervention period, and at 6 and 12 months follow-up.
Purpose
