Does standing improve bowel function in people with spinal cord injury? A randomised controlled trial.
Rehabilitative Studies Unit
20 participants
Dec 1, 2011
Interventional
Conditions
Summary
The majority of individuals with spinal cord injury (SCI) have neurogenic bowel dysfunction. Severity of the condition is dependent upon the completeness and the level of lesion. Constipation and faecal incontinence are common problems experienced by individuals with SCI and have significant impact on their physical, social and psychological lives. People with SCI rate bowel care as one of the most disabling aspects of SCI and of more importance to them than the inability to walk. It is therefore appropriate that research attention be directed at improving bowel care. People with SCI claim that regular standing improves bowel regularity and bowel function. However, there is no high quality evidence to substantiate these claims. A recent Cochrane review noted that there is still limited research on the management of neurogenic bowel dysfunction and it is not possible to draw any recommendation from the trials included in the review. It is important to determine whether regular standing is therapeutic because it is a costly and time consuming activity. Hence the primary aim of this study is to determine the benefits of regular standing on bowel function in people with spinal cord injury or lesion. The null hypothesis is that regular standing will have no effect on bowel function in people with spinal cord injury or lesion.
Eligibility
Inclusion Criteria7
- Participants will be included if they:
- are more than 18 years of age
- have sustained a AIS A or B traumatic spinal cord injury or spinal lesion above T8
- are more than one year post onset of spinal cord injury or lesion
- have a stable bowel regime that is unlikely to change in the near future
- are medically stable to participate in standing
- can independently transfer themselves into standing position on the tilt table or have a carer to assist them
Exclusion Criteria10
- Participants will be excluded if they:
- are pregnant
- have a current or past history of bowel disease
- have had surgery of the bowel
- have a stoma
- are unwilling to comply with the standing regime
- do not live in the Sydney metropolitan area
- are unable to speak sufficient English to participate in the study without the assistance of a translator
- are regularly standing and/or walking and not wheelchair-dependent unless they are willing to stop standing for two months prior to the commencement of the trial
- have a current or past history of osteoporosis and/or osteoporotic fracture(s) unless medical clearance is attained
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Interventions
Six weeks of standing on a tilt table for 30 minutes, five times a week, superimposed on regular bowel care routine. A tilt table is a piece of rehabilitative equipment that allows a person to stand. The tilt table used for this trial is electrically operated with tilt angles varying between 0 to 90 degrees. There are safety straps that secure the person's upper and lower body on the tilt table. Participants will trial standing on the tilt table with one of the research team members prior to the start of the treatment-first phase. Training and education will be provided to the participants and their carers prior to commencing the standing program. Regular bowel care routine is the routine a participant uses to assist emptying the bowels. The frequency and duration of the routine differs between individuals. This is a crossover study. Participants allocated to the treatment-first group will receive the treatment first consisting of six weeks of standing superimposed on a regular bowel routine. This will be followed by four weeks of washout period where the participant does not stand but continues with regular bowel routine, then the control intervention, namely six weeks of regular bowel routine. Participants allocated to the control-first group will receive the opposite: six weeks of regular bowel routine but no standing, four weeks of washout period and then six weeks of standing superimposed on a regular bowel routine.
Locations(1)
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ACTRN12612000003875