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Pelvic floor physiotherapy significantly improves functional constipation in women, with WCSS showing greater responsiveness than PFDI-20 in detecting clinical improvement.
A new study led by Fahimeh Karshenas et al. suggests that structured physiotherapy markedly improves functional constipation symptoms, with the wexner constipation scoring system (WCSS) proving more responsive than the pelvic floor distress inventory-20 (PFDI-20) for measuring treatment outcomes.
In this longitudinal study, 66 women diagnosed with functional constipation received 10 standardized physiotherapy sessions over 4–6 weeks, including electrotherapy, biofeedback, and therapeutic exercises targeting pelvic floor dysfunction. Researchers evaluated the responsiveness of WCSS and PFDI-20 using statistical methods including Cohen’s d, standardized response mean (SRM), Spearman correlation with the global rating of change scale (GRCS), and receiver operating characteristic (ROC) curve analysis.
Minimal clinically important difference (MCID) thresholds were calculated via anchor-based methods. The WCSS illustrated excellent internal and external responsiveness following physiotherapy. It showed Cohen’s d of −2.05 and SRM of −2.71, along with a strong correlation with GRCS (−0.715) and outstanding discriminative ability with an ROC area under the curve (AUC) of 0.94. The MCID was determined to be 4 points, with sensitivity and specificity both reaching 0.88, indicating high accuracy in detecting clinically meaningful improvement.
The PFDI-20 also showed remarkable internal responsiveness, with Cohen’s d of −1.19 and SRM of −1.42, but its external responsiveness was lower (Spearman correlation −0.485) compared with WCSS. The instrument demonstrated excellent discriminative ability (AUC 0.83). Researchers estimated its MCID at 27.09 points, with sensitivity of 0.82 and specificity of 0.70. Among the PFDI-20 subscales, the colorectal anal distress inventory (CRADI) showed comparatively stronger responsiveness for colorectal symptoms, with Cohen’s d of −1.45, SRM of −0.77, Spearman correlation of −0.594, and an ROC AUC of 0.87.
Overall, the study indicates that WCSS is more sensitive and responsive than PFDI-20 for evaluating improvement after physiotherapy in women suffering from functional constipation. Nevertheless, PFDI-20 remains useful for broader pelvic floor assessment, and its CRADI subscale may serve as a complementary tool for monitoring colorectal symptom alterations during treatment.
BMC Women's Health
Pelvic floor distress inventory 20 and Wexner constipation scoring system responsiveness and minimal clinical importance difference in Persian women with functional constipation
Fahimeh Karshenas et al.
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