The Effect of Constipation Insoles on the Management of Constipation

Constipation Insoles

Constipation is a common symptom among patients receiving palliative care and significantly affects their quality of life. Effective management of constipation requires both pharmacological and non-pharmacological approaches. Reflexology has been increasingly used as a complementary method for constipation management; however, factors such as the need for a trained reflexology specialist, time limitations, and financial constraints may limit patients' access to this intervention. To overcome these barriers, a constipation insole based on reflexology principles has been developed, which can be easily used by patients either at home or in clinical settings.

This study was designed as a randomized controlled experimental trial to evaluate the effectiveness of a constipation insole in the management of constipation in patients receiving palliative care. During the first week of the study, no intervention was applied in order to assess participants' baseline bowel habits. Starting from the second week, patients in the experimental group were instructed to walk with the constipation insole for 20 minutes per day for a total of four weeks. Patients in the control group were instructed to walk for 20 minutes per day for the same duration, without using the insole.

At baseline, data were collected using the Patient Identification Form and the General Comfort Scale. Throughout the study period, bowel function and constipation-related outcomes were monitored using standardized measurement tools. The Constipation Assessment Scale was planned to be administered every three days, the Constipation Severity Scale daily, and the Bristol Stool Consistency Scale at each defecation. The General Comfort Scale was planned to be re-administered on the 28th day of the intervention period.

The findings obtained from this study are expected to provide evidence regarding the potential role of constipation insoles as a complementary intervention in constipation management for patients in palliative care.

Study Overview

• Status: Completed
• Conditions: Constipation; Palliative Care
• Intervention / Treatment: Behavioral: constipation insole; Behavioral: Walk

• Study Type: Interventional
• Enrollment (Actual): 139
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye), 34295
    • Istanbul Aydin University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Patients who volunteer to participate in the study and are over 18 years of age,
• Patients without any cognitive, mental, or verbal communication impairments,
• Patients receiving palliative care,
• Patients with constipation,
• Patients with fewer than 3 bowel movements per week and/or at least one of the following constipation problems (straining during bowel movements, hard stools, feeling of incomplete emptying, gas/bloating, pressure/feeling of needing to defecate in the rectum).

Exclusion Criteria:

• Individuals with peripheral neuropathy,
• impaired foot skin integrity,
• flat feet or any foot deformity,
• and those using complementary treatments such as abdominal massage, acupressure, or acupuncture to relieve constipation were excluded from the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental Group; Patients in the experimental group were instructed to walk with the constipation insole for 20 minutes a day for four weeks, starting from the second week	Behavioral: constipation insole; Patients in the experimental group were instructed to walk with the constipation insole for 20 minutes a day for four weeks, starting from the second week; Behavioral: Walk; Patients in the control group were only instructed to walk for 20 minutes a day for four weeks
Other: Control Group; Patients in the control group were only instructed to walk for 20 minutes a day for four weeks.	Behavioral: Walk; Patients in the control group were only instructed to walk for 20 minutes a day for four weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Constipation Severity Scale	The Large Bowel Syndrome (LBS) consists of 16 questions in total and was developed to determine the frequency, intensity, and difficulty during defecation. The LBS comprises three sub-dimensions: "large bowel sluggishness," "fecal obstruction," and "pain." The highest possible score on the scale is 73. Scores for fecal obstruction range from 0-28, for large bowel sluggishness from 0-29, and for pain from 0-16.	First week
Constipation Severity Scale	The Large Bowel Syndrome (LBS) consists of 16 questions in total and was developed to determine the frequency, intensity, and difficulty during defecation. The LBS comprises three sub-dimensions: "large bowel sluggishness," "fecal obstruction," and "pain." The highest possible score on the scale is 73. Scores for fecal obstruction range from 0-28, for large bowel sluggishness from 0-29, and for pain from 0-16.	second week
Constipation Severity Scale	The Large Bowel Syndrome (LBS) consists of 16 questions in total and was developed to determine the frequency, intensity, and difficulty during defecation. The LBS comprises three sub-dimensions: "large bowel sluggishness," "fecal obstruction," and "pain." The highest possible score on the scale is 73. Scores for fecal obstruction range from 0-28, for large bowel sluggishness from 0-29, and for pain from 0-16.	third week
Constipation Severity Scale	The Large Bowel Syndrome (LBS) consists of 16 questions in total and was developed to determine the frequency, intensity, and difficulty during defecation. The LBS comprises three sub-dimensions: "large bowel sluggishness," "fecal obstruction," and "pain." The highest possible score on the scale is 73. Scores for fecal obstruction range from 0-28, for large bowel sluggishness from 0-29, and for pain from 0-16.	fifth week
Constipation Assessment Scale	This is a scale consisting of 8 items in total, which inquires about abdominal bloating, gas, bowel sounds, fecal incontinence, feeling of fullness/pressure in the rectum, pain during defecation, small or lumpy stools, and the presence of an urgent need to defecate but inability to do so.	Baseline
Constipation Assessment Scale	This is a scale consisting of 8 items in total, which inquires about abdominal bloating, gas, bowel sounds, fecal incontinence, feeling of fullness/pressure in the rectum, pain during defecation, small or lumpy stools, and the presence of an urgent need to defecate but inability to do so.	third day
Constipation Assessment Scale	This is a scale consisting of 8 items in total, which inquires about abdominal bloating, gas, bowel sounds, fecal incontinence, feeling of fullness/pressure in the rectum, pain during defecation, small or lumpy stools, and the presence of an urgent need to defecate but inability to do so.	sixth day
Constipation Assessment Scale	This is a scale consisting of 8 items in total, which inquires about abdominal bloating, gas, bowel sounds, fecal incontinence, feeling of fullness/pressure in the rectum, pain during defecation, small or lumpy stools, and the presence of an urgent need to defecate but inability to do so.	ninth day
Constipation Assessment Scale	This is a scale consisting of 8 items in total, which inquires about abdominal bloating, gas, bowel sounds, fecal incontinence, feeling of fullness/pressure in the rectum, pain during defecation, small or lumpy stools, and the presence of an urgent need to defecate but inability to do so.	twelfth day
Constipation Assessment Scale	This is a scale consisting of 8 items in total, which inquires about abdominal bloating, gas, bowel sounds, fecal incontinence, feeling of fullness/pressure in the rectum, pain during defecation, small or lumpy stools, and the presence of an urgent need to defecate but inability to do so.	fifteenth day
Constipation Assessment Scale	This is a scale consisting of 8 items in total, which inquires about abdominal bloating, gas, bowel sounds, fecal incontinence, feeling of fullness/pressure in the rectum, pain during defecation, small or lumpy stools, and the presence of an urgent need to defecate but inability to do so.	eighteenth day
Constipation Assessment Scale	This is a scale consisting of 8 items in total, which inquires about abdominal bloating, gas, bowel sounds, fecal incontinence, feeling of fullness/pressure in the rectum, pain during defecation, small or lumpy stools, and the presence of an urgent need to defecate but inability to do so.	twenty-first day
Constipation Assessment Scale	This is a scale consisting of 8 items in total, which inquires about abdominal bloating, gas, bowel sounds, fecal incontinence, feeling of fullness/pressure in the rectum, pain during defecation, small or lumpy stools, and the presence of an urgent need to defecate but inability to do so.	twenty-fourth day
Constipation Assessment Scale	This is a scale consisting of 8 items in total, which inquires about abdominal bloating, gas, bowel sounds, fecal incontinence, feeling of fullness/pressure in the rectum, pain during defecation, small or lumpy stools, and the presence of an urgent need to defecate but inability to do so.	twenty-seventh day
Constipation Assessment Scale	This is a scale consisting of 8 items in total, which inquires about abdominal bloating, gas, bowel sounds, fecal incontinence, feeling of fullness/pressure in the rectum, pain during defecation, small or lumpy stools, and the presence of an urgent need to defecate but inability to do so.	thirtieth day
Overall Comfort Scale	It is a scale developed to assess an individual's need for comfort. In the evaluation of the scale, negatively worded items are reverse-coded and summed together with the positively worded items. The highest possible total score on the scale is 192, while the lowest possible total score is 48. The total score obtained is divided by the number of items on the scale to calculate the mean score, which is expressed on a scale ranging from 1 to 4. A score of 1 indicates low comfort, whereas a score of 4 indicates high comfort.	Baseline
Overall Comfort Scale	It is a scale developed to assess an individual's need for comfort. In the evaluation of the scale, negatively worded items are reverse-coded and summed together with the positively worded items. The highest possible total score on the scale is 192, while the lowest possible total score is 48. The total score obtained is divided by the number of items on the scale to calculate the mean score, which is expressed on a scale ranging from 1 to 4. A score of 1 indicates low comfort, whereas a score of 4 indicates high comfort.	thirty-fifth day

Collaborators and Investigators

• Sponsor: Istanbul Aydın University
• Collaborators: The Scientific and Technological Research Council of Turkey

Publications and helpful links

General Publications

• References Akyüz Özdemir, F., Can, G. 2024. "The Effect of Reflexology Socks in the Management of Opioid-Induced Constipation: A Randomized Controlled Trial", Cancer Nursing, 10-1097. Anjoman, A. Z., Mirghafourvand, M., Hughes, C., Havizari, S. 2021. "Effect of Foot Reflexology on Constipation: A Systematic Review and Meta-Analysis", [Dergi adı belirtilmemiş]. Arıkan Dirimen, G. 2016. "Palyatif Bakım Tanımı ve Felsefesi", Klinik Tıp Aile Hekimliği, 8(3), 1-5. Ayık Bıçak, D., Can, G. 2020. "Palyatif Bakım Hastalarında Konstipasyonun Yönetimi ve Akupresürün Etkinliği", Sağlık Akademisyenleri Dergisi, 7(2), 141-148. Barichella, M. et al. 2016. "Probiotics and Prebiotic Fiber for Constipation Associated with Parkinson Disease", Neurology, 87(12), 1274-1280. Bassotti, G., Battaglia, E. 2023. "Considerations for laxatives in terms of their interactions with other drugs", Expert Opinion on Drug Metabolism & Toxicology, 19(3), 121-123. Bayan, K. 2017. "Konstipasyona Güncel Yaklaşım", Klinik Tıp Bilimleri Dergisi, 5(2). Bharucha, A. E., Lacy, B. E. 2020. "Mechanisms, Evaluation, and Management of Chronic Constipation", Gastroenterology, 158(5), 1232-1249.e3. Camilleri, M. et al. 2017. "Chronic Constipation", Nature Reviews Disease Primers, 3, 1-19. Canbulat Şahiner, N., Demirgoz Bal, M. 2017. "A Randomized Controlled Trial Examining the Effects of Reflexology on Children With Functional Constipation", Gastroenterology Nursing, 40(5), 393-400. Candy, B. et al. 2015. "Laxatives for the Management of Constipation in People Receiving Palliative Care", Cochrane Database of Systematic Reviews, 5. Cevik, K. 2013. "Complementary and Alternative Therapy in Nursing: Reflexology", Ege Hemşirelik Fakültesi Dergisi, 29(2), 71-82. Cevik, K., Zaybak, A. 2018. "The Effect of Reflexology on Constipation in the Elderly", International Journal of Caring Science, 11(1), 309-318. Clark, K., Currow, D. C. 2013. "Constipation in Palliative Care: What Do We Use as Definitions and Outco

Study record dates

Study Major Dates

• Study Start (Actual): January 10, 2024
• Primary Completion (Actual): November 30, 2024
• Study Completion (Actual): December 30, 2024

Study Registration Dates

• First Submitted: January 4, 2026
• First Submitted That Met QC Criteria: January 13, 2026
• First Posted (Actual): January 14, 2026

Study Record Updates

• Last Update Posted (Actual): January 14, 2026
• Last Update Submitted That Met QC Criteria: January 13, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: palliative care; comfort; nursing; reflexology; constipation
• Additional Relevant MeSH Terms: Signs and Symptoms, Digestive; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Constipation; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Exercise; Locomotion; Walking
• Other Study ID Numbers: Constipation Insoles

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Patients have not given permission to share their data in this area.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No