Prospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2018; 24(19): 2108-2119
Published online May 21, 2018. doi: 10.3748/wjg.v24.i19.2108
Decreasing recurrent bowel obstructions, improving quality of life with physiotherapy: Controlled study
Amanda D Rice, Kimberley Patterson, Evette D Reed, Belinda F Wurn, Kristen Robles, Bernhard Klingenberg, Leonard B Weinstock, Janey SA Pratt, C Richard King, Lawrence J Wurn
Amanda D Rice, Department of Internal Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, United States
Kimberley Patterson, Evette D Reed, Belinda F Wurn, Kristen Robles, Lawrence J Wurn, Clear Passage Therapies, Gainesville, FL 32606, United States
Bernhard Klingenberg, Department of Mathematics and Statistics, Williams College, Williamstown, MA 01267, United States
Leonard B Weinstock, Clinical Medicine and Surgery, Washington University School of Medicine, Specialists in Gastroenterology, LLC, St. Louis, MO 63141, United States
Janey SA Pratt, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94035, United States
C Richard King, College of Medicine, University of Florida, Gainesville, FL 32607, United States
Author contributions: Rice AD, Klingenberg B, King CR and Wurn LJ designed the study; Patterson K, Reed ED, Wurn BF and Wurn LJ performed the treatment; Rice AD performed subject follow up and control subject data collection; Klingenberg B performed the statistical analysis; Rice AD wrote the manuscript; Patterson K, Reed ED, Wurn BF, Robles K, Klingenberg B, Weinstock LB, Pratt JS, King CR and Wurn LJ revised the manuscript for final submission.
Institutional review board statement: This study was approved by MaGil Institutional Review Board.
Clinical trial registration: registration #NCT02639195
Informed consent statement: All subjects provided consent for the study. Treated subjects provided written consent; untreated subjects provided consent via the Assessment Center online system.
Conflict-of-interest statement: Belinda F Wurn and Lawrence J Wurn are the owners of Clear Passage. All other authors report no conflicts.
Data sharing statement: Data will be available upon request deidentified with IRB approval.
CONSORT 2010 statement: The guidelines of the CONSORT 2010 Statement have been adopted for this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Lawrence J Wurn, Research Associate, Clear Passage Therapies, 4421 NW 39th Ave, Suite 2-2, Gainesville, FL 32606, United States.
Telephone: +1-352-3361433 Fax: +1-352-3369980
Received: February 26, 2018
Peer-review started: February 27, 2018
First decision: March 15, 2018
Revised: April 22, 2018
Accepted: May 6, 2018
Article in press: May 6, 2018
Published online: May 21, 2018

To compare (1) quality of life and (2) rate of recurrent small bowel obstructions (SBO) for patients treated with novel manual physiotherapy vs no treatment.


One hundred and three subjects (age 19-89) with a history of recurrent adhesive SBO were treated with a manual physiotherapy called the Clear Passage Approach (CPA) which focused on decreasing adhesive crosslinking in abdominopelvic viscera. Pre- and post-therapy data measured recurring obstructions and quality of life, using a validated test sent 90 d after therapy. Results were compared to 136 untreated control subjects who underwent the same measurements for subjects who did not receive any therapy, which is the normal course for patients with recurring SBO. Comparison of the groups allowed us to assess changes when the physiotherapy was added as an adjunct treatment for patients with recurring SBO.


Despite histories of more prior hospitalizations, obstructions, surgeries, and years impacted by bowel issues, the 103 CPA-treated subjects reported a significantly lower rate of repeat SBO than 136 untreated controls (total obstructions P = 0.0003; partial obstructions P = 0.0076). Subjects treated with the therapy demonstrated significant improvements in five of six total domains in the validated Small Bowel Obstruction Questionnaire (SBO-Q). Domains of diet, pain, gastrointestinal symptoms, quality of life (QOL) and pain severity when compared to post CPA treatment were significantly improved (P < 0.0001). The medication domain was not changed in the CPA treated group (P = 0.176).


CPA physical therapy was effective for patients with adhesive SBO with significantly lower recurrence rate, improvement in reported symptoms and overall quality of life of subjects.

Keywords: Clear passage approach, Manual therapy, Physical therapy, Small bowel obstructions, Adhesions, Physiotherapy, Alternative therapy

Core tip: A manual soft tissue physical therapy protocol is an effective low risk preventative treatment option for patients who suffer recurrent adhesive small bowel obstructions. It increased the quality of life of subjects by decreasing pain, decreasing recurrent obstructions, improving diet and increasing bodily function. Because the therapy was performed in an outpatient setting, it eliminated the need for hospitalization and the risk and increased cost of surgery.