Does regular standing improve bowel function in people with spinal cord injury? A randomised crossover trial

Abstract

Study Design: A randomised crossover trial. Objectives: To determine the effects of a 6-week standing programme on bowel function in people with spinal cord injury. Setting: Community, Australia and the United Kingdom. Methods: Twenty community-dwelling people with motor complete spinal cord injury above T8 participated in a 16-week trial. The trial consisted of a 6-week stand phase and a 6-week no-stand phase separated by a 4-week washout period. Participants were randomised to one of two treatment sequences. Participants allocated to the Treatment First group stood on a tilt table for 30 min per session, five times per week for 6 weeks and then did not stand for the next 10 weeks. Participants allocated to the Control First group did the opposite: they did not stand for 10 weeks and then stood for 6 weeks. Participants in both groups received routine bowel care throughout the 16-week trial. Assessments occurred at weeks 0, 7, 10 and 17 corresponding with pre and post stand and no-stand phases. The primary outcome was Time to First Stool. There were seven secondary outcomes reflecting other aspects of bowel function and spasticity. Results: There were three dropouts leaving complete data sets on 17 participants. The mean (95% confidence interval) betweenintervention difference for Time to First Stool was 0 min (−7 to 7) indicating no effect of regular standing on Time to First Stool. Conclusion: Regular standing does not reduce Time to First Stool. Further trials are required to test the veracity of some commonly held assumptions about the benefits of regular standing for bowel function.

Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions

“…ROBO-FES increased leg strength by 1.97 ± 0.88 points, ROBO by 1.50 ± 0.85 more than controls (1.03 ± 0.61, P < 0.05). Cerebral blood flow volume increased in ROBO groups more than controls (P < 0.05) Kwok 2015 [ 59 ] Randomized Crossover Moderate quality (moderate risk) 17 Chronic SCI Tilt-table, as upright as possible 30 mins day 5 × wk × 6 weeks (150 mins/week) No difference in time to first stool or time for bowel care routine. 8/17 reported improved bowel function including decreased abdominal distention.…”

“…Other evidence for impact of standing on bowel and bladder function has only been studied with the SCI population. A randomized trial [ 59 ] found no change in objective measures of bowel function although 8/17 participants reported improvement. Survey and single case study evidence suggests that use of a standing device can improve bowel function [ 20 , 22 , 44 , 54 ] and Dunn [ 38 ] found a correlation between this outcome and use of a standing device daily, for more than 30 min per bout.…”

“…There was a notable disconnect between the qualitative and quantitative data identified in this review. In one study, no change was found on the objective measures, while a significant proportion of subjects reported an improvement in bowel function [ 59 ]. While some studies may not have used a high enough dosage of standing [ 41 ], others may have used outcome measures that were not sensitive or appropriate [ 59 ].…”

Reabilitação de pessoas com lesão medular traumática: estudo do intestino neurogênico e sua relação com a qualidade de vida, satisfação e estilo de vida

“…O tempo necessário para defecação é um dado clinicamente relevante pois está fortemente associado com o impacto que o manejo intestinal traz para QV das pessoas com LM (KROGH et al, 2009;BURNS et al, 2015). Mesmo com vários estudos realizados sobre a avaliação do manejo intestinal ou avaliação de efeitos terapêuticos sobre a função intestinal de pessoas com LM, demonstrando que as mesmas podem necessitar de um tempo acima de 30 minutos para defecação, podendo chegar a duas horas (ENGKASAN;SUDIN, 2013;HANSEN et al, 2015;KWOK et al, 2015), a maioria dos participantes da presente pesquisa, cerca de 90%, relataram necessitar de até 30 minutos para os cuidados intestinais. Nesse sentido, os dados encontrados corroboram com outro estudo que concluiu que as pessoas com LM devem ser capazes de completar seus cuidados intestinais dentro de 45 minutos no máximo, e caso esse tempo ultrapasse mais de uma hora que então seja considerado um caso de disfunção intestinal (ENGKASAN; SUDIN, 2013).…”

Reliability, validity and sensitivity to change of neurogenic bowel dysfunction score in patients with spinal cord injury

“…16 The NBD score has been translated into several languages and recently used in several research on symptoms, pathophysiology and management of NBD in SCI. [17][18][19][20][21][22][23][24] Finally, NBD score has been added to the International SCI Bowel Function Basic Data Set (Version 2.0) that is a simple, standardized tool developed for the collection and reporting of a minimal amount of information on bowel function in daily practice and research. 25 However, the studies investigating the validity and reliability of NBD score are still limited, and there is no study that showed the sensitivity to change of NBD score.…”