Article

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.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS