Creation and validation of a new tool for the monitoring efficacy of neurogenic bowel dysfunction treatment on response: the MENTOR tool

Abstract

Study design Prospective observational study. Objectives A tool to help decision-making tool for Neurogenic Bowel Dysfunction (NBD) in individuals with SCI is needed. We present a project to create and validate a new tool, the Monitoring Efficacy of NBD Treatment On Response (MENTOR), and to determine its level of concordance with decisions made by experienced clinicians in the field. Setting UK, Denmark, USA, Italy, The Netherlands, Germany. Methods The first phase was creation of the tool through a modified Delphi process. The second phase was the validation, wherein individuals with spinal cord injury with NBD were asked to complete the MENTOR tool immediately prior to clinic consultation. From the responses to the questionnaire of the tool, each participant was allocated into one of three categories reflecting the possible therapeutic recommendations ("recommend change", "further discussion" and "monitoring"). An expert clinician then assessed the participant, blinded to MENTOR results, and made an independent treatment decision. Results A total of 248 MENTOR forms were completed. Strong agreement was found when the MENTOR tool recommended monitoring (92%) or treatment change (83%); the lowest concordance when the decision was for the "further discussion" option (59%). Patient acceptability was reported by 97% of individuals. Conclusions MENTOR is an easy to use tool to monitor the treatment of NBD and determinate progression through the clinical pathway. This validation study shows good correspondence between expert clinician opinion and MENTOR result. The tool has potential to be used in other patient groups, following further studies.

The Monitoring Efficacy of Neurogenic Bowel Dysfunction Treatment on Response (MENTOR) in a Non-Hospital Setting

“…Based on the MENTOR, the potential need for change in bowel care is classified as either “monitor”, indicating that bowel care is sufficient; “discuss”, indicating that there may be a need for change; and “act”, indicating that bowel care is unsatisfactory and that there is a need for change. The grouping of responses into the three categories corresponds well with the opinion of experts in NBD [ 13 ]. The main finding of the present study was that 56% of non-hospitalised persons with SCI had a need for discussion or change of bowel management.…”

“…The MENTOR was developed as an easy-to-use instrument for assessment of the need for change in bowel care in individuals with SCI [ 13 ]. It incorporates the commonly used 10-item NBD score; patient satisfaction with current treatment; and so called “special attention symptoms”, which indicate unsatisfactory bowel management.…”

“…Special attention symptoms are symptoms that indicate insufficient management of NBD. Those symptoms were included in the questionnaire and have been described in detail previously [ 13 ].…”

“…It combines three domains: the NBD score, special attention symptoms indicating insufficient treatment, and patient satisfaction with their bowel function. Thus, it offers a holistic outcome that has been shown to be both easy and reliable to use in clinical practice [ 5 , 13 ]. The MENTOR was developed in a hospital setting, and it has been validated among persons with SCI in four European countries and the USA [ 13 ].…”

“…Thus, it offers a holistic outcome that has been shown to be both easy and reliable to use in clinical practice [ 5 , 13 ]. The MENTOR was developed in a hospital setting, and it has been validated among persons with SCI in four European countries and the USA [ 13 ]. At present, MENTOR has not been applied in a broader community-based group of people with NBD.…”