Long-Term Outcomes and Longitudinal Changes of Neurogenic Bowel Management in Adults With Pediatric-Onset Spinal Cord Injury

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• 作者：Miriam Hwang ; MD ; PhD^a ; ^{mhwang@shrinenet.org} ; Kathy Zebracki ; PhD^a ; ^b ; Lawrence C. Vogel ; MD^a ; ^c
• 关键词：Bowel program ; Longitudinal studies ; Neurogenic bowel ; Outcome assessment (health care) ; Rehabilitation ; Spinal cord injuries ; Transition to adult care
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：98
• 期：2
• 页码：241-248
• 全文大小：287 K
• 卷排序：98

文摘

To describe long-term outcomes of neurogenic bowel dysfunction (NBD), determine changes over time in the type of bowel program, and determine changes in psychosocial outcomes associated with NBD-related factors in adults with pediatric-onset spinal cord injury (SCI).DesignLongitudinal cohort survey. Follow-up occurred annually for a total of 466 interviews, with most participants (75%) contributing to at least 3 consecutive interviews.SettingCommunity.ParticipantsAdults (N=131) who had sustained an SCI before the age of 19 years (men, 64.1%; tetraplegia, 58.8%; mean age ± SD, 33.4±6.1y; mean time since injury ± SD, 19.5±7.0y).InterventionsNot applicable.Main Outcome MeasuresType and evacuation time of bowel management programs; standardized measures assessing life satisfaction, health perception, depressive symptoms, and participation. Generalized estimating equations were formulated to determine odds of change in outcomes over time.ResultsAt first interview, rectal suppository/enema use was most common (51%). Over time, the likelihood of using manual evacuation (odds ratio [OR]=1.077; 95% confidence interval [CI], 1.023–1.134; P=.005), oral laxatives (OR=1.052; 95% CI, 1.001–1.107; P=.047), and colostomy (OR=1.071; 95% CI, 1.001–1.147; P=.047) increased, whereas the odds of rectal suppository use decreased (OR=.933; 95% CI, .896–.973; P=.001). Bowel evacuation times were likely to decrease over time in participants using manual evacuation (OR=.499; 95% CI, .256–.974; P=.042) and digital rectal stimulation (OR=.490; 95% CI, .274–.881; P=.017), but increase for rectal suppository/enema use (OR=1.871; 95% CI, 1.264–2.771; P=.002). When the level of injury was controlled for, participants using manual evacuation and digital rectal stimulation were more likely to have increases in community participation scores (P<.05).ConclusionsChanges in type of bowel program over time may be associated with the time required to complete bowel evacuation in this relatively young adult SCI population.