title: The effectiveness of bowel and bladder interventions in children with spina bifida.
abstract: Using the World Health Organization International Classification of Functioning, Disability and Health (ICF), the aim of this study was to identify effective strategies for managing urinary and bowel complications resulting from spina bifida.
  
  
  
  Charts of 210 children between 4- and 13-years-old with spina bifida were reviewed to quantify medical interventions and continence status. Standardized quality of life (QOL) questionnaires were administered to a subset of participants; child and parent interviews were carried out to examine the experience of living with bowel and bladder incontinence. Practitioners were also interviewed to understand their perspectives of intervention effectiveness.
  
  
  
  Chart review indicated less than half of children were continent for bowel and bladder. More variability existed in bowel continence programs, and practitioners considered bowel continence more difficult to achieve than bladder continence. No significant associations were found between continence status and QOL measures. Interviews, however, reflected how managing continence at home and school more broadly affects QOL. Among practitioners, some focused primarily on optimizing physical health while others focused on activity and participation.
  
  
  
  While continence is a goal, programs used to achieve this are individualized and outcomes may be affected by differential treatment effects, environmental factors, and/or stigma experienced by children.
authors.affiliation: Clinical Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Smith
authors.affiliation: Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Neville-Jan
authors.affiliation: Department of Pediatrics and Psychiatry, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Kurt A
authors.initials: KA
authors.lastname: Freeman
authors.affiliation: Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Adams
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Mizokawa
authors.affiliation: Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Dudgeon
authors.affiliation: Division of Developmental Pediatrics, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Merkens
authors.affiliation: Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: William O
authors.initials: WO
authors.lastname: Walker
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D057928:Intermittent Urethral Catheterization / Q000379:methods*; D008297:Male; D010290:Parents / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D012720:Severity of Illness Index; D016135:Spinal Dysraphism / Q000150:complications* / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014555:Urination Disorders / Q000209:etiology* / Q000523:psychology / Q000628:therapy*