Nicholas Dietz1, Kwadwo Sarpong2, Beatrice Ugiliweneza1,3,4, Dengzhi Wang1,3, Sevda S Aslan1,3, Camilo Castillo1,5, Maxwell Boakye1,3, April N Herrity1,3,6. 1. Department of Neurological Surgery, University of Louisville, Louisville, Kentucky. 2. School of Medicine, Georgetown University, Washington, DC. 3. Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky. 4. Department of Health Management and Systems Science, University of Louisville, Louisville, Kentucky. 5. Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, Kentucky. 6. Department of Physiology, University of Louisville, Louisville, Kentucky.
Abstract
Background: Neurogenic bowel dysfunction (NBD) following spinal cord injury (SCI) represents a major source of morbidity, negatively impacting quality of life and overall independence. The long-term changes in bowel care needs are not well-reported, preventing consensus on the natural course and optimal management of NBD following injury. Objectives: To understand the changes in bowel management needs over time following SCI. Methods: A retrospective observational study using the National Spinal Cord Injury Model Systems database evaluated the degree of independence with bowel management at discharge from inpatient rehabilitation across time (1988-2016). The prevalence and consecutive trajectory of bowel management was also evaluated at discharge and at each 5-year follow-up period, for 25 years. Results: The majority of individuals discharged from inpatient rehabilitation (n = 17,492) required total assistance with bowel management, a trend that significantly increased over time. However, by 5-years post injury, there was a significant shift in bowel management needs from total assistance to modified independence. In those with consecutive 25-year follow-up data (n = 11,131), a similar shift in bowel management to a less dependent strategy occurred even at chronic time points post injury, primarily in individuals with paraplegia and classified as motor and sensory complete. Conclusion: The findings of this study highlight the need for providing continued multipronged interventions (e.g., rehabilitative, educational, psycho-social) at the different stages of SCI to support individuals not only in the immediate years after discharge but also well into the chronic stages after injury.
Background: Neurogenic bowel dysfunction (NBD) following spinal cord injury (SCI) represents a major source of morbidity, negatively impacting quality of life and overall independence. The long-term changes in bowel care needs are not well-reported, preventing consensus on the natural course and optimal management of NBD following injury. Objectives: To understand the changes in bowel management needs over time following SCI. Methods: A retrospective observational study using the National Spinal Cord Injury Model Systems database evaluated the degree of independence with bowel management at discharge from inpatient rehabilitation across time (1988-2016). The prevalence and consecutive trajectory of bowel management was also evaluated at discharge and at each 5-year follow-up period, for 25 years. Results: The majority of individuals discharged from inpatient rehabilitation (n = 17,492) required total assistance with bowel management, a trend that significantly increased over time. However, by 5-years post injury, there was a significant shift in bowel management needs from total assistance to modified independence. In those with consecutive 25-year follow-up data (n = 11,131), a similar shift in bowel management to a less dependent strategy occurred even at chronic time points post injury, primarily in individuals with paraplegia and classified as motor and sensory complete. Conclusion: The findings of this study highlight the need for providing continued multipronged interventions (e.g., rehabilitative, educational, psycho-social) at the different stages of SCI to support individuals not only in the immediate years after discharge but also well into the chronic stages after injury.
Authors: Stephen Burns; Fin Biering-Sørensen; William Donovan; Daniel E Graves; Amitabh Jha; Mark Johansen; Linda Jones; Andrei Krassioukov; Steven Kirshblum; M J Mulcahey; Mary Schmidt Read; William Waring Journal: Top Spinal Cord Inj Rehabil Date: 2012
Authors: Chiara Pavese; Lucas M Bachmann; Martin Schubert; Armin Curt; Ulrich Mehnert; Marc P Schneider; Giorgio Scivoletto; Enrico Finazzi Agrò; Doris Maier; Rainer Abel; Norbert Weidner; Rüdiger Rupp; Alfons G Kessels; Thomas M Kessler Journal: Neurorehabil Neural Repair Date: 2019-08-27 Impact factor: 3.919