Measuring Bowel Dysfunction After SCI: Strategies and Findings
1Tate D, 2Post M, 3Tulsky D, 1Rodriguez G
1University of Michigan, Ann Arbor, Michigan, USA; 2University of Groningen Department of Rehabilitation Medicine, Groningen, NA, The netherlands; 3University of Delaware College of Health Sciences, Maryland, Delaware, USA
Objective: The vast majority of those with SCI and neurological impairment also have associated bowel dysfunction making this aspect of their care relevant to providers, researchers and especially to those with SCI, their families and caregivers. While some progress has been made in balder management and prevention of medical complications, bowel management and complications after SCI have been significantly understudied. In fact, current US guidelines reveal that because so few randomized controlled trials have been published on the topic, many recommendations in this set of guidelines are based largely on expert opinion rather than research. The field has been slow to conduct rigorous studies and clinical trials in part due to the lack of appropriate and reliable measures for bowel management and dysfunction. The lack of data from studies with larger samples of patients is also another factor contributing to the lack of progress in this area. The proposed course will offer information on this topic from a team of experts on research and outcomes measures related to bowel dysfunction after SCI.
Design/Methods: Four presenters (Tate, Chair, Post, Tulsky and Rodriguez) will discuss methods of assessing bowel management, dysfunction symptoms and complications and will present and illustrate their methods with findings from larger studies conducted in this area. Dr. Tate will chair this panel and will discuss the development of the Bowel and Bladder Treatment Inventory (BBTI) based on the International SCI Datasets for Bowel Function, she will share data from a sample of over 300 individuals with traumatic SCI from Michigan and California. Dr. Post will share his findings from a study conducted in the Netherlands describing bowel management and outcomes in individuals living with SCI for at least 10 years. He will discuss the NBD in greater details and results from his sample of 258 subjects. Dr. Tulsky will report on the SCI-QOL data, a Patient Report Outcome Measure, which includes items on bowel management and complications in relation to quality of life. His study included over 800 subjects from 8 centers from the Model Systems across the United States. Dr. Rodriguez will present her study on the smart pill and how this device can be used as a way to assess transit in the gut after SCI.
Results: Bowel dysfunction and management can be assessed using patient self-report measures , clinical observation measures such as the international datasets for bowel function and the BBTI and wireless motility devices such as the smart pill as well as other biomedical interventions and modalities. These will be discussed during this presentation. Bowel incontinence, constipation and hemorrhoids are some of the most prevalent complications following SCI being associated with age, time since injury, medication use, diet and race.
Conclusions: Each presenter will have 15 minutes to present their data and assessment modalities, this will be followed by a 30 minute of panel discussion with questions and comments from the audience.
Support: Craig H Neilsen Foundation, NIDILRR, NIH/NINDS.
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