{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T10:29:06Z","timestamp":1787135346385,"version":"build-2736575974"},"reference-count":23,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Princess Nourah bint Abdulrahman University,Researchers Supporting Project","award":["PNURSP2025R168"],"award-info":[{"award-number":["PNURSP2025R168"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Integrative and Complementary Medicine"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Objectives:<\/jats:title>\n                    <jats:p>Functional constipation is a common gastrointestinal disorder, particularly among obese individuals, due to factors such as reduced physical activity, altered gut motility, and increased intra-abdominal pressure. Visceral manipulation (VM), a manual therapy targeting internal organs, has emerged as a potential non-pharmacological intervention. This randomized controlled trial aimed to evaluate the efficacy of osteopathic VM in improving symptoms of functional constipation in obese adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>\n                      A total of 102 obese adults (Body Mass Index \u2265 30 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), diagnosed with functional constipation based on the Rome IV criteria, were randomly assigned to either an intervention group receiving VM alongside standard care (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 51) or a control group receiving standard care alone (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 51). The intervention group underwent 20 VM sessions over four weeks. Primary outcomes included stool consistency (assessed by the Bristol Stool Scale) and defecation pain (measured by the Visual Analogue Scale). Secondary outcomes included defecation frequency and oral laxative usage. Data were analyzed using mixed-design Multivariate Analysis of Variance (MANOVA).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Compared with the control group, the VM group showed significant improvements in stool consistency (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.001), increased defecation frequency (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.001), reduced defecation pain (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.001), and lower oral laxative intake (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01). No adverse events were reported, and the treatment was well-tolerated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Visceral Manipulation appears to be an effective adjunctive therapy for managing functional constipation in obese adults. It offers a safe, noninvasive approach that improves gastrointestinal function and may reduce the need for pharmacological treatment. Further long-term studies are warranted to confirm these findings and assess sustained outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/27683605261427696","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T04:22:36Z","timestamp":1775794956000},"page":"684-691","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Osteopathic Visceral Manipulation on Functional Constipation in Obese Adults: A Randomized Controlled Clinical Trial"],"prefix":"10.1177","volume":"32","author":[{"given":"Mohamed S.","family":"Zidan","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, Faculty of Applied Medical Science, Al-Zaytoonah University of Jordan, Amman, Jordan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M.","family":"Elfahl","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Faculty of Applied Medical Science, Al-Zaytoonah University of Jordan, Amman, Jordan."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basant Hamdy","family":"Elrefaey","sequence":"additional","affiliation":[{"name":"Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia."},{"name":"Department of Physical Therapy for Cardiovascular\/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6309-3484","authenticated-orcid":false,"given":"Zizi M.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba M.","family":"Elfeky","sequence":"additional","affiliation":[{"name":"Department of Basic Science, Faculty of Physical Therapy, Cairo University, Cairo, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10081738"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S140250"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.21608\/mjmr.2022.166298.1195"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.31557\/APJCP.2022.23.10.3473"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu16162657"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcm.2018.11.005"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2016.06.055"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOSGlobal-D-17-00088"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000001462"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/apha.70008"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14030767"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-024-03547-7"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1159\/000543166"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2020.110209"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e18098"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.5056\/jnm.2013.19.2.149"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12155083"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2021-324598"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31824eccb7"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1179\/2042618610Y.0000000001"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-052620-103528"},{"key":"e_1_3_6_23_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2012.168"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmpt.2019.05.013"}],"container-title":["Journal 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