Transanal irrigation is a better choice for bowel dysfunction in adults with Spina bifida: A randomised controlled trial

Association Between Quality of Life and Neurogenic Bowel Symptoms by Bowel Management Program in Spina Bifida

OBJECTIVE

To compare differences in bowel-specific quality of life (QOL), overall qQOL, and neurogenic bowel dysfunction (NBD) severity by bowel management program in patients with spina bifida (SB).

METHODS

We performed a retrospective cross-sectional study of patients ≥12 years old at our multidisciplinary SB center who completed both a modified Peristeen NBD questionnaire (assessing bowel symptom severity and bowel-specific QOL) and the Patient-Reported Outcomes Measurement Information System Pediatric Global Health questionnaire (assessing overall QOL). Nested, multivariable models were fit for associations between outcomes and bowel management program (enemas, conservative management, and none).

RESULTS

A total of 173 patients, 56.1% female and 64.6% with myelomeningocele, were included in our analysis. Median age was 18.2 years old. Patients reported using enemas (n = 42), conservative management (n = 63), and no bowel program (n = 68). When adjusting for covariates, there was no significant association between bowel-specific QOL nor overall QOL across bowel management programs. However, the use of conservative management compared to enemas was associated with worse bowel symptoms severity (adjusted beta=2.58, 95%CI=[0.09,5.06]). Additionally, greater bowel symptom severity was significantly associated with lower overall QOL (adjusted beta=-0.33, 95%CI=[-0.57,-0.10]).

CONCLUSION

NBD symptom severity in SB is more strongly associated with QOL than the individual bowel program being utilized. Our findings suggest that different degrees of NBD require different invasiveness of bowel programs, but it is the outcome of the bowel management program and not the specific program itself that is most associated with QOL.

Occupational therapy combined with repetitive transcranial magnetic stimulation for treatment of spinal cord injury with gastrointestinal dysfunction

BACKGROUND

In the treatment of spinal cord injury (SCI) with gastrointestinal dysfunction, the recovery of neurological function is not ideal. Occupational therapy combined with repetitive transcranial magnetic stimulation (rTMS) is expected to complement each other, exert their respective advantages, and improve the quality of patients' rehabilitation.

AIM

To observe the therapeutic effect of occupational therapy combined with rTMS in patients with SCI accompanied by gastrointestinal dysfunction.

METHODS

A total of 150 patients with SCI and gastrointestinal dysfunction who met the selection criteria from June 2020 to March 2023 were randomly divided into two control groups and one observation group, with 50 patients in each group, using the random number table method. The two control groups were treated with either occupational therapy or rTMS alone, and the observation group was treated with occupational therapy combined with rTMS for three courses. The therapeutic effect was observed, as well as neuroelectrophysiology [tibial somatosensory evoked potential (SEP) and motion-evoked potential (MEP)], peripheral blood cytokines [interleukin-1β (IL-1β), interleukin-6 (IL-6), and transforming growth factor-β1 (TGF-β1)], muscle strength scores of key muscles of lower limbs, intestinal function [neurologic bowel dysfunction (NBD), Cleveland Incontinence Score, Wexner Constipation Score, and Bristol stool grading], limb function recovery indicators [Barthel Index (BI), Functional Independence Measurement (FIM) Scale, and Berg Balance Scale (BBS)] before and after treatment.

RESULTS

The total effective rate in the observation group was 94.00%, which was higher than that of the occupational therapy group (74.00%) and the rTMS group (80.00%) (P < 0.05). After 1 and 3 treatment courses, the latent levels of SEP and MEP of the tibial nerve in ascending order were the observation group, rTMS group, and occupational therapy group, and the peak levels of SEP and MEP of the tibial nerve in descending order were the observation group, rTMS group, and occupational therapy group (P < 0.05); the serum levels of IL-1β, IL-6, and TGF-β1 in ascending order were the observation group, rTMS group, and occupational therapy group (P < 0.05), and the muscle strength scores of key muscle groups of lower limbs in descending order were the observation group, rTMS group, and occupational therapy group (P < 0.05); the NBD, Cleveland incontinence score, and Wexner constipation score in ascending order were the observation group, rTMS group, and occupational therapy group, while BI, FEM, and BBS scores in ascending order were the observation group, rTMS group, and occupational therapy group (P < 0.05).

CONCLUSION

Compared with either rTMS or occupational therapy alone, their combination can reduce immune inflammatory response, improve impaired limb movement and intestinal function in patients with SCI accompanied by gastrointestinal dysfunction, and help them return to their families and society better.