The Effects of TTNS, TTNS Combined With PHUS, and Conventional Therapy With PHUS in the Treatment of PFC.

NCT ID: NCT07077044

Last Updated: 2025-07-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

64 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-02-21

Study Completion Date

2026-02-25

Brief Summary

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This study is a randomized, controlled trial designed to evaluate the effects of transcutaneous tibial nerve stimulation (TTNS), TTNS combined with pocket-sized handheld ultrasound (PHUS), and conventional therapy with PHUS on children with functional constipation (FC). Participants will be stratified into three intervention arms (n=20 per group).

FC will be defined based on the Rome IV diagnostic criteria, in the absence of organic or anatomical causes. Participants will be between 4 and 14 years old and will have experienced failure of conservative treatment for at least three months prior to enrollment.

The primary outcomes include changes in rectal ultrasound parameters and symptom severity scores. Ultrasound assessments will be conducted by trained clinicians using standardized protocols. Monitoring for adverse events will be performed throughout the intervention phase. Safety considerations include predefined exclusion criteria, such as underlying neurological, metabolic, or cardiac conditions.

Detailed Description

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Eligibility Criteria

Inclusion Criteria:

Children aged 4 to 14 years.

Diagnosis of functional constipation (FC) established prior to study enrollment. FC is defined according to the Rome IV diagnostic criteria, in the absence of identifiable organic or anatomical causes (e.g., no endocrine, metabolic, anatomical, or neuromuscular dysfunction). No additional diagnostic testing is required for inclusion.

Ability to complete daily diaries and TTNS sessions, either independently or with caregiver support.

Documented failure of conservative medical treatment following at least three months of therapy.

Exclusion Criteria:

Malformations of the digestive system or rectal anatomical anomalies (e.g., large intestinal atresia or stenosis, Hirschsprung's disease, congenital anorectal malformations).

Neurological or psychiatric conditions (e.g., cerebral palsy, spina bifida, intellectual disability, anorexia nervosa).

Major cognitive impairments.

Metabolic disorders (e.g., diabetes mellitus, diabetes insipidus, scurvy, phenylketonuria).

Endocrine disorders (e.g., hypothyroidism).

Cardiovascular conditions such as heart disease or arrhythmias, or presence of ventriculoperitoneal shunts or cardiac pacemakers, due to potential electrical interference.

History of thoracic or abdominal surgery.

Presence of dermatological lesions in the area of electrode application.

Presence of active electronic implants.

Conditions

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Constipation Constipation - Functional

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The study will include a convenience sample of 60 children aged 4-14 years who were diagnosed with FC by a physician according to the diagnostic criteria of Rome IV and who had already received treatment for constipation for at least one month, including toilet training and laxative therapy. These will be chosen from the patients visiting the pediatric gastroenterology clinic at Hadassah Medical Center.

An a priori power analysis (G-Power software, Version 3.1) with the following parameters: 1-β = 0.80, effect size = 0.6, and α = 0.05 was calculated to determine the sample size for comparing the effects of TTNS, TTNS combined with PHUS, and conventional therapy with PHUS. This indicated that a total sample of 48 participants would be needed to detect the main effects. To address the problem of inflated effect size estimates and possible dropout of participants, we will recruit a sample of 60 subjects, 20 subjects for each group. A participant is entitled to withdraw from the study at a
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors
Arm 1 - TTNS Treatment Only Participants will receive transcutaneous tibial nerve stimulation (TTNS) according to a predefined home-based protocol.

Arm 2 - TTNS + PHUS Monitoring Participants will receive TTNS as in Arm 1, in combination with periodic monitoring using portable handheld ultrasound (PHUS) to assess rectal parameters.

Arm 3 - Conventional Treatment + PHUS Monitoring Participants will continue standard pharmacological and behavioral therapy (toilet training and laxatives), monitored by PHUS at regular intervals.

Study Groups

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TTNS treatment with no PHUS assessments

TTNS treatment with no PHUS assessments

Group Type EXPERIMENTAL

The transcutaneous posterior tibial nerve stimulation device

Intervention Type DEVICE

In addition to their conventional treatment, subjects in both TTNS groups will complete eight weeks of home TTNS treatment (3 sessions per week), and each session will last for 20 minutes. Stimulation will be provided by a portable device (Chattanooga®, ContinuumTM, Hixson, TN, USA). The device will be pre-programmed to apply a bi-phasic squared wave with a pulse width of 200μsec, and a pulse frequency of 20 Hz. These are default settings for TTNS that have been used in previous studies for urinary and fecal incontinence59,62,67. Two self-adhesive electrodes (5 x 5 cm) will be placed over the ankle area, one approximately 3 to 4 cm above the medial tibial malleolus and a second electrode just below the medial malleolus of the same leg.

TTNS treatment combined with PHUS assessments

TTNS treatment combined with PHUS assessments

Group Type EXPERIMENTAL

The transcutaneous posterior tibial nerve stimulation device

Intervention Type DEVICE

In addition to their conventional treatment, subjects in both TTNS groups will complete eight weeks of home TTNS treatment (3 sessions per week), and each session will last for 20 minutes. Stimulation will be provided by a portable device (Chattanooga®, ContinuumTM, Hixson, TN, USA). The device will be pre-programmed to apply a bi-phasic squared wave with a pulse width of 200μsec, and a pulse frequency of 20 Hz. These are default settings for TTNS that have been used in previous studies for urinary and fecal incontinence59,62,67. Two self-adhesive electrodes (5 x 5 cm) will be placed over the ankle area, one approximately 3 to 4 cm above the medial tibial malleolus and a second electrode just below the medial malleolus of the same leg.

PSUS

Intervention Type OTHER

Handheld US

Conventional treatment

conventional treatment recommendations (medications, diets, and behaviors) previously prescribed by their treating physician.

Group Type ACTIVE_COMPARATOR

PSUS

Intervention Type OTHER

Handheld US

Interventions

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The transcutaneous posterior tibial nerve stimulation device

In addition to their conventional treatment, subjects in both TTNS groups will complete eight weeks of home TTNS treatment (3 sessions per week), and each session will last for 20 minutes. Stimulation will be provided by a portable device (Chattanooga®, ContinuumTM, Hixson, TN, USA). The device will be pre-programmed to apply a bi-phasic squared wave with a pulse width of 200μsec, and a pulse frequency of 20 Hz. These are default settings for TTNS that have been used in previous studies for urinary and fecal incontinence59,62,67. Two self-adhesive electrodes (5 x 5 cm) will be placed over the ankle area, one approximately 3 to 4 cm above the medial tibial malleolus and a second electrode just below the medial malleolus of the same leg.

Intervention Type DEVICE

PSUS

Handheld US

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

Clinical diagnosis of functional constipation (FC), with no identifiable organic or anatomical cause (e.g., endocrine, metabolic, anatomical, or neuromuscular dysfunction)

FC diagnosis established according to Rome IV criteria

No additional tests required to confirm eligibility

Ability to complete daily diaries and TTNS sessions (by participant or caregiver)

Failure of conservative medical treatment (including toilet training and laxatives) after at least three months

Exclusion Criteria

Neurological or psychiatric disorders (e.g., cerebral palsy, spina bifida, intellectual disability, anorexia nervosa)

Major cognitive impairment

Metabolic conditions (e.g., diabetes mellitus, diabetes insipidus, scurvy, phenylketonuria)

Endocrine disorders (e.g., hypothyroidism)

Cardiac conditions (e.g., heart disease, arrhythmias, presence of pacemaker or ventriculoperitoneal shunt) due to possible interference with electrical stimulation

History of thoracic or abdominal surgery

Presence of skin lesions in the area of electrode application

Presence of active electronic implants
Minimum Eligible Age

4 Years

Maximum Eligible Age

14 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Hadassah Medical Organization

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Hadassah Hebrew University Hospital

Jerusalem, , Israel

Site Status RECRUITING

Countries

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Israel

Central Contacts

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Mordechai Slae, M.D.

Role: CONTACT

+972585356200

Facility Contacts

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Irina Rabkin

Role: primary

0528709824

Related Links

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Other Identifiers

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Hadassah Medical Center trial

Identifier Type: OTHER

Identifier Source: secondary_id

Protocol HMO-0446-23

Identifier Type: -

Identifier Source: org_study_id

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