SCI: Fiber and Neurogenic Bowel (2007)
- Critically review and synthesize the scientific literature on neurogenic bowel assessment and management, short- and long-term outcomes, and effects on gastrointestinal function.
- Improve the management of neurogenic bowel.
- Pathophysiology, management, prophylaxis, treatment of complications, epidemiology, and economic issues
- Experimental and observational studies and review articles
- English language.
- Progressive and congenital spinal cord disorders and animal studies
- Studies of children.
The Consortium’s systematic method of search, selection, extraction, review, and synthesis, modeled after the Agency for Health Care Policy and Research. Studies from 1966 - 1997 were included.
Evidence-Based Clinical Practice Guideline—Systematic Review.
Blinding Used (if applicable): not applicable.
Intervention (if applicable): Includes strength of panel opinion as well as strength of evidence.
Statistical analysis not completed.
Timing of Measurements: not applicable
- Neurogenic bowel
- Spinal cord injury
Initial N: 5 studies related to fiber. No research articles were available on fluid needs.
Attrition (final N): 5
Age: Not mentioned
Ethnicity: not mentioned
Other relevant demographics:
Location: Worldwide studies
- High fiber diets (20-30 gm/d) are frequently recommended for persons w/ SCI on the premise that they will respond similar to those without SCI (decrease in transit time and increase in stool weight and volume). However, evidence indicates the neurogenic bowel responds differently.
- Menardo, (1987) reported left colonic transit delay with 16.4 gm/d. Cameron (1996) found increase of 6 gm of wheat bran (aver baseline of 25 gm/d) resulted in increases in mean colonic transit time (CTT) in inpatients with recent SCI. Levine (1992) found SCI subjects consumed an average of 12-14 gm/d and Kirk (1997) reported fiber intake of 7 gm/day. Daily fiber intake of person with SCI is well below the frequently cited goal of 20-30 gm/day to reduce risk of cardiac disease and cancer. Muller-Lissner (1988) in meta analysis on effect of wheat bran in adults with constipation. He found inconsistent effect on CTT.
- Fiber: Individuals with SCI should not be placed uniformly on high fiber diets. A diet history should be taken to determine the individual’s usual fiber intake. The effects of current fiber intake on consistency of stool and frequency of evacuation should be evaluated. A diet containing no less than 15 gm fiber/day is needed initially. Increases should be done gradually, from a variety of sources. Symptoms of intolerance should be monitored and fiber reduced it they occur.
- Fluid: The amount of fluid needed to promote optimal stood consistency must be balanced with the amount needed for bladder management In general, fluid intake should be approximately 500ml/day greater than the standard guidelines for the general public (NRC, 1989), which can be estimated by:
- 1 ml fluid/Kcal energy needs +500 ml/d or
- 40 ml/kg body weight + 500 ml/d.
Exemplary methodology for evidence based guidelines. Unfortunately, little scientific evidence exists.
Quality Criteria Checklist: Review Articles
|1.||Will the answer if true, have a direct bearing on the health of patients?||Yes|
|2.||Is the outcome or topic something that patients/clients/population groups would care about?||Yes|
|3.||Is the problem addressed in the review one that is relevant to dietetics practice?||Yes|
|4.||Will the information, if true, require a change in practice?||Yes|
|1.||Was the question for the review clearly focused and appropriate?||Yes|
|2.||Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described?||Yes|
|3.||Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased?||Yes|
|4.||Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible?||Yes|
|5.||Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined?||Yes|
|6.||Was the outcome of interest clearly indicated? Were other potential harms and benefits considered?||Yes|
|7.||Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described?||Yes|
|8.||Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included?||Yes|
|9.||Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed?||Yes|
|10.||Was bias due to the review's funding or sponsorship unlikely?||Yes|