{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T19:15:55Z","timestamp":1776366955168,"version":"3.51.2"},"update-to":[{"DOI":"10.12688\/f1000research.159217.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000}},{"DOI":"10.12688\/f1000research.159217.2","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000}}],"reference-count":27,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Center for Higher Education"},{"name":"The Indonesia Endowment Funds for Education"},{"name":"the Directorate of Development and Research of Universitas Indonesia under the HIBAH PUTI 2023","award":["NKB-073\/UN2.RST\/HKP.05.00\/2023"],"award-info":[{"award-number":["NKB-073\/UN2.RST\/HKP.05.00\/2023"]}]}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Background Postoperative immobilization in patients with lower extremity fractures frequently leads to constipation, affecting approximately 50\u201370% of patients. Non-pharmacological nursing interventions such as Swedish abdominal massage and warm water drinking therapy are potential approaches to alleviate this problem. Objective The objective of this study was to compare the effectiveness of Swedish abdominal massage and warm water drinking therapy in reducing constipation scores among patients with postoperative lower extremity fractures. Methods A quasi-experimental pre\u2013posttest design without a control group was conducted with 30 respondents selected using a simple random sampling technique. Constipation was assessed using the Constipation Assessment Scale (CAS) before and after intervention. Data were analyzed using independent <ns3:italic>t<\/ns3:italic>-tests, and results were interpreted with attention to baseline differences between groups. Results Both interventions significantly reduced constipation scores. The mean post-intervention CAS score was 4.60 in the warm water group and 3.56 in the Swedish abdominal massage group (<ns3:italic>p<\/ns3:italic> &lt; 0.001). Although Swedish abdominal massage showed a greater within-group reduction, baseline imbalances in constipation scores may have influenced the observed differences. Conclusion Swedish abdominal massage and warm water therapy are effective nurse-led, non-pharmacological interventions for reducing postoperative constipation. The findings should be interpreted cautiously due to baseline differences and small sample size. Future research with larger samples, controlled designs, and statistical adjustments is recommended to confirm these preliminary findings.<\/ns3:p>","DOI":"10.12688\/f1000research.159217.3","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T15:15:10Z","timestamp":1759504510000},"page":"1531","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Swedish abdominal massage against warm water therapy on postoperative orthopaedic surgery constipation: a comparison quasi-experimental study"],"prefix":"10.12688","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2825-2930","authenticated-orcid":false,"given":"Enny Selawaty","family":"Boangmanalu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masfuri","family":"Masfuri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhamad","family":"Adam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5613-1227","authenticated-orcid":false,"given":"Sri","family":"Nining","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5265-838X","authenticated-orcid":false,"given":"Triani","family":"Banna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Indira Mastura","family":"Pulungan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e44189","DOI":"10.7759\/cureus.44189","article-title":"The Effect of the Flint Water Crisis Secondary to Increased Lead Levels in Drinking Water on Constipation in Children in the City of Flint, Michigan, USA.","volume":"15","author":"K Al-Kharraz","year":"2023","journal-title":"Cureus."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"666-671","DOI":"10.12968\/bjon.2023.32.14.666","article-title":"Abdominal massage and laxative use for constipation: a pilot study.","volume":"32","author":"S Artale","year":"2023","journal-title":"Br. 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We have reviewed and implemented your suggestions. All feedback has been addressed through revisions to the article.  1. \n<b>Respon: <\/b>The respondent characteristics (gender, age, and type of analgesic; p&gt;0.05) indicate that there was no significant difference between the two intervention groups\u2014those receiving warm water therapy and those receiving Swedish abdominal massage. This conclusion is supported by the statistical tests (p-value &gt; 0.05; \u03b1 \u2265 0.05), which demonstrate no significant variance between the groups. The homogeneity of variance was tested using the chi-square test and Levene\u2019s test, confirming that the groups were comparable at baseline.  2. \n<b>Respon:<\/b> The homogeneity of respondent characteristics was tested using the chi-square test and Levine\u2019s test. These tests confirmed that the assumption of homogeneity of variance was met, allowing for valid comparisons between the intervention groups. We acknowledge that alternative statistical methods, such as mixed-effects models, may provide further insight, particularly if baseline differences were present. Additionally, we recognize the importance of discussing the limitations of our sample size and reporting the effect size for a more comprehensive analysis.  3. \n<b>Respon: <\/b>In the warm water therapy group, participants consumed 500 ml of warm water (temperature: approximately 31&deg;C) each morning before breakfast. No other hot beverages (such as tea or coffee) were permitted during the intervention. Participants were allowed to eat breakfast 30-45 minutes after consuming the warm water.  To minimize confounding factors, only non-opioid analgesics were used during the study, and no participants were given laxatives.  The Swedish abdominal massage was performed directly on the skin, involving specific abdominal muscle movements. Each massage session lasted 15-20 minutes and was conducted daily for three consecutive days immediately after waking up. Patients remained in a supine position during the massage and were instructed to delay breakfast for 30-45 minutes post-intervention. The massages were administered by trained nurses, in accordance with their professional scope of practice under national nursing regulations.  \n<b>4. Respon: <\/b>The objective of this study is to compare the effectiveness of drinking warm water versus Swedish abdominal massage on constipation scores on post-operative lower extremity fractures. We accept your advice, we have revised our article","URL":"https:\/\/f1000research.com\/articles\/13-1531\/v3#referee-comment-14074","order":2,"name":"referee-comment-14074","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.183692.r395119, Emil Huriani, Faculty of Nursing, Universitas Andalas, Padang, West Sumatra, 09 Aug 2025, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/13-1531\/v2#referee-response-395119","order":3,"name":"referee-response-395119","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.183692.r395120, Jie Hao, University of Nebraska Medical Center, Omaha, 11 Aug 2025, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/13-1531\/v2#referee-response-395120","order":4,"name":"referee-response-395120","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Sri Nining<\/b>; \n<i>Posted: 24 Sep 2025<\/i>; \n<b>Comment 1<\/b> \n<i>The baseline constipation scores between the two intervention groups differ notably (10.13 vs. 8.40), raising concerns about the comparability of groups. While the authors mention no significant differences in demographics (p&gt;0.05), the baseline CAS differences affect the internal validity of between-group comparisons.<\/i> \n<b>Response:<\/b> Thank you for pointing this out. We have revised the \n<i>Discussion<\/i> section to highlight this limitation. We now explicitly state that the baseline imbalance may have influenced the results, and that the observed superiority of Swedish abdominal massage should be interpreted cautiously. In addition, within-group pre-post analyses were added to the \n<i>Results<\/i> section to provide a clearer picture of intervention effectiveness. We also recommend the use of ANCOVA or stratified randomization in future studies to minimize baseline variability. \n<b>Comment 2<\/b> \n<i>The conclusion that \u201cSwedish abdominal massage was noticeably more successful\u201d may be overstated given this imbalance. A within-group pre-post comparison would be more appropriate, or statistical adjustment could help account for baseline differences.<\/i> \n<b>Response:<\/b> We agree with this comment. The statement in the \n<i>Discussion<\/i> and \n<i>Conclusion<\/i> sections has been revised to a more cautious interpretation. We now emphasize that both interventions were effective, with Swedish abdominal massage showing greater within-group reduction, but superiority cannot be firmly concluded due to baseline differences and the small sample size. \n<b>Comment 3<\/b> \n<i>The study includes only 15 participants per group, which limits the power to detect meaningful differences and generalize the findings. No power analysis is provided to justify the sample size, and effect sizes are not reported.<\/i> \n<b>Response:<\/b> We have acknowledged the small sample size as a key limitation in the \n<i>Discussion<\/i> section and clarified that it reduces statistical power and generalizability. To strengthen the findings, we have now reported effect sizes (Cohen\u2019s \n<i>d<\/i>) and 95% confidence intervals in the \n<i>Results<\/i> section and revised Table 2 accordingly. These additions provide greater clarity regarding the clinical significance of the results. \n<b>Comment 4<\/b> \n<i>The results report p-values but not confidence intervals or effect sizes, which are essential for interpreting clinical significance.<\/i> \n<b>Response:<\/b> This has been addressed in the revised \n<i>Results<\/i> section and Table 2, where we now include 95% confidence intervals and effect sizes for both interventions. The narrative has also been updated to interpret these findings more appropriately.","URL":"https:\/\/f1000research.com\/articles\/13-1531\/v3#referee-comment-14658","order":5,"name":"referee-comment-14658","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>nilton machado<\/b>; \n<i>Posted: 03 Oct 2025<\/i>; Approved version 3.","URL":"https:\/\/f1000research.com\/articles\/13-1531\/v3#article-response-14716","order":6,"name":"article-response-14716","label":"Article Comment","group":{"name":"article-comments","label":"Article Comments"}},{"value":"This study was supported \u202fby the Directorate of Development and Research of  Universitas Indonesia under the HIBAH PUTI 2023 (Grant No. NKB-073\/UN2.RST\/HKP.05.00\/2023). We also want to express our sincere gratitude to The Center for Higher Education (BPPT) and The Indonesia Endowment Funds for Education (LPDP) for their support through scholarship programs that enabled us to conduct this study.  \r\n\r\nThe funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":7,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}