title: Long-Term Outcomes and Longitudinal Changes of Neurogenic Bowel Management in Adults With Pediatric-Onset Spinal Cord Injury.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Longitudinal cohort survey. Follow-up occurred annually for a total of 466 interviews, with most participants (75%) contributing to at least 3 consecutive interviews.
  
  
  METHODS
  Community.
  
  
  METHODS
  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).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
authors.affiliation: Shriners Hospitals for Children, Chicago, IL. Electronic address: mhwang@shrinenet.org.
authors.forename: Miriam
authors.initials: M
authors.lastname: Hwang
authors.affiliation: Shriners Hospitals for Children, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Kathy
authors.initials: K
authors.lastname: Zebracki
authors.affiliation: Shriners Hospitals for Children, Chicago, IL; Rush Medical College, Chicago, IL.
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Vogel
mesh_terms: D015746:Abdominal Pain / Q000628:therapy; D000328:Adult; D002400:Cathartics / Q000627:therapeutic use*; D003863:Depression / Q000523:psychology; D005242:Fecal Incontinence / Q000628:therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055496:Neurogenic Bowel / Q000209:etiology / Q000523:psychology* / Q000628:therapy*; D010549:Personal Satisfaction; D058992:Social Participation; D013119:Spinal Cord Injuries / Q000150:complications*; D013997:Time Factors
chemical_list: D002400:Cathartics
keywords: Bowel program; Longitudinal studies; Neurogenic bowel; Outcome assessment (health care); Rehabilitation; Spinal cord injuries; Transition to adult care