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

      Abstract

      Objectives

      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).

      Design

      Longitudinal cohort survey. Follow-up occurred annually for a total of 466 interviews, with most participants (75%) contributing to at least 3 consecutive interviews.

      Setting

      Community.

      Participants

      Adults (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).

      Interventions

      Not applicable.

      Main Outcome Measures

      Type 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.

      Results

      At 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).

      Conclusions

      Changes 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.

      Keywords

      List of abbreviations:

      CHART (Craig Handicap Assessment and Reporting Technique), DS (digital stimulation), GEE (generalized estimating equation), LAX (laxative), NBD (neurogenic bowel dysfunction), QOL (quality of life), SCI (spinal cord injury)
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