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SCI: Fiber and Neurogenic Bowel (2007)

Citation:

Yim SY, Yoon SH, Lee IY, Rah EW, Moon HW.  A comparison of bowel care patterns in patients with spinal cord injury:  upper motor neuron bowel vs lower motor neuron bowel.  Spinal Cord 2001;39:204-207.

PubMed ID: 11420735
 
Study Design:
Cross-Sectional Study
Class:
D - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:
To evaluate the clinical characteristics of neurogenic bowel in patients with SCI based on the type of neurogenic bowel in order to provide better information for the development of effective bowel care programs for SCI patients.
Inclusion Criteria:
  • SCI patients who had lived at home for at least 6 months after the acute hospitalized-rehabilitation management for SCI
  • Functional Independent Measure score for bowel care had to be 5 or more
  • Upper motor neuron bowel defined as when the spinal cord lesion was above the sacral level
  • Lower motor neuron bowel defined as when the lesion involved the sacral spinal cord, roots, or peripheral nerve innervation of the colon
Exclusion Criteria:
None specifically mentioned.
Description of Study Protocol:

Recruitment

Among 111 SCI patients who visited the Department of Physical Medicine and Rehabilitation of Ajou University Medical Center, Suwon, Korea from January - August 1999, 42 SCI patients who consented to the survey and met inclusion criteria were included.

Design

Cross-Sectional Study - face to face interview.

Blinding used (if applicable)

Not applicable.

Intervention (if applicable)

Not applicable.

Statistical Analysis

Independent t testing was used to analyze differences between groups.

Data Collection Summary:

Timing of Measurements

Face to face interviews were conducted with subjects.

Dependent Variables

  • Frequency of defecation
  • Frequency of fecal incontinence
  • Required time for defecation
  • Number of oral medications used for bowel care
  • Subjective difficulty of bowel care on activities of daily living using visual analog scale
  • Methods of bowel care
  • Use of diet modification for bowel care

Independent Variables

  • Upper motor neuron bowel or lower motor neuron bowel

Control Variables

 

Description of Actual Data Sample:

Initial N: 22 with upper motor neuron bowel (16 males, 6 females) and 20 with lower motor neuron bowel (15 males, 5 females)

Attrition (final N):  as above

Age:  upper motor neuron bowel mean age:  31.41 +/- 8.97 years, lower motor neuron bowel mean age:  35.75 +/- 9.40 years

Ethnicity:  not mentioned

Other relevant demographics:  not mentioned

Anthropometrics:  there were no significant differences in demographics between groups

Location:  Korea

 

Summary of Results:

 

Characteristics

 UMNB group

 LMNB group

 P value

Frequency of defecation per day 0.46 +/- 0.25 1.95 +/- 3.05 0.028

Frequency of fecal incontinence per month

0.21 +/- 0.39

2.61 +/- 3.95

0.017

Required time for defecation per week (min)

184.70 +/- 119.21

395.54 +/- 425.38

0.044

Number of oral medications used for bowel care 0.27 +/- 0.46 0.95 +/- 1.11 0.012
Subjective difficulty of bowel care based on VAS 5.00 +/- 2.83 6.20 +/- 2.26 >0.05

Other Findings

The patients with lower motor neuron bowel demonstrated increased frequency of defecation, increased frequency of fecal incontinence, increased use of oral medications for bowel care, increased required time for defecation and more diet modification than those with upper motor neuron bowel (P < 0.05).

Each patient with upper motor neuron bowel used 1.86 methods for bowel care, whereas each patient with lower motor neuron bowel used 1.65 methods (P = NS).

However, there was no significant difference in the subjective difficulty of bowel care.

Among several available bowel care methods, suppositories were used most frequently by the upper motor neuron bowel group, whereas the Vasalva maneuver was the most frequently used method by the lower motor neuron bowel group. 

Author Conclusion:
In conclusion, management of lower motor neuron bowel tends to be more problematic than that of upper motor neuron bowel among SCI patients.  Therefore, an intensive bowel care program needs to be developed for SCI patients with lower motor neuron bowel.
Funding Source:
University/Hospital: Ajou University School of Medicine
Reviewer Comments:
All collected data based on memory and self-report.  Interview questions not standardized.  Authors note that fiber and fluid intake was not reported which could directly influence bowel habits.
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
 
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
3. Were study groups comparable? Yes
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? Yes
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) Yes
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? Yes
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) Yes
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? ???
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) ???
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? ???
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? ???
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? ???
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? ???
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? ???
  7.5. Was the measurement of effect at an appropriate level of precision? ???
  7.6. Were other factors accounted for (measured) that could affect outcomes? No
  7.7. Were the measurements conducted consistently across groups? ???
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? No
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes