SOD of Neuro-Urology, Careggi University Hospital, Florence, Italy.
Technical and Scientific Committee, Montecatone Rehabilitation Institute S.p.A, Imola, Bologna, Italy.
Eur J Phys Rehabil Med. 2020 Dec;56(6):741-755. doi: 10.23736/S1973-9087.20.06412-6. Epub 2020 Sep 16.
Neurogenic bowel dysfunction (NBD) is an impairment of defecation control due to any nervous system lesion negatively affecting physical health status and quality of life. We aimed at systematically assessing all available evidence on NBD treatment in adults and providing clinical management guidance and recommendations.
PICOs and questions (N.=7) were identified by an expert panel. We searched for and retrieved evidence from the PUBMED and EMBASE databases, limited to the English language and the Western countries context, related to any type of setting and published from 2009 to 2019. Health effects, patient values, preferences and resource use were assessed. Of all, only RCTs, observational studies and systematic reviews on adult population (≥18 years) were analyzed. The study was conducted according to PRISMA guidelines and Cochrane recommendations. The effect size, if possible, was calculated for the interpretation of the outcomes, and evidence was assessed through the GRADE method.
Thirty-one studies were included in our qualitative synthesis. Evidence is generally scarce. Most of the outcomes are narratively described and therefore defined by imprecision. Besides, most of the included studies are affected by risk of bias. Digital stimulation was found to be effective in short term follow-up. The pharmacological treatment choice, combined or alone, needs to be balanced case by case considering clinical history, setting of use and bowel management protocol. According to only one RCT supporting evidence mainly in persons affected by spinal cord injury (SCI), trans-anal irrigation (TAI) improves QoL and patient independency with a significant reduction of time spent for defecation and daily bowel program. History of urinary infections predicts the choice of using TAI. Patient-reported efficacy of colostomy alone or in combination with other surgeries appears evident in terms of patient's satisfaction and QoL over time. Nonetheless, perioperative and late complications can occur and may result in reduced acceptability over time.
Evidence is somehow weak and mainly reported in SCI. The systematic use of assistive interventions does not reduce the need of conservative or invasive approaches. Studies are needed on the role of bowel management in protecting patients from complications secondary to NBD in long term follow-ups.
神经源性肠道功能障碍（NBD）是一种排便控制受损的病症，由于任何神经系统损伤，对身体健康状况和生活质量产生负面影响。我们旨在系统评估成人 NBD 治疗的所有现有证据，并提供临床管理指导和建议。
通过专家小组确定 PICO 和问题（N.=7）。我们从 PUBMED 和 EMBASE 数据库中搜索和检索证据，仅限于英语和西方国家背景，与任何类型的环境相关，并于 2009 年至 2019 年发表。评估健康影响、患者价值观、偏好和资源利用。所有研究均仅分析了成人（≥18 岁）人群的 RCT、观察性研究和系统评价。该研究根据 PRISMA 指南和 Cochrane 建议进行。为了解释结果，如有可能，计算了效应大小，并通过 GRADE 方法评估证据。
31 项研究纳入了我们的定性综合分析。证据普遍匮乏。大多数结果都是描述性的，因此存在不精确性。此外，大多数纳入的研究都存在偏倚风险。短期随访发现，数字刺激有效。药物治疗的选择，联合或单独使用，需要根据临床病史、使用环境和肠道管理方案进行权衡。仅有一项 RCT 支持主要针对脊髓损伤（SCI）患者的证据表明，经肛门灌洗（TAI）可提高生活质量和患者独立性，显著减少排便时间和每日肠道管理计划。尿路感染史预测了 TAI 的使用选择。单独使用结肠造口术或与其他手术联合使用的患者报告疗效在患者满意度和随时间推移的生活质量方面表现明显。然而，围手术期和晚期并发症可能发生，并可能导致随时间推移接受度降低。
证据有些薄弱，主要在 SCI 中报道。辅助干预的系统使用并不能减少对保守或侵入性方法的需求。需要研究肠道管理在长期随访中对保护患者免受 NBD 并发症的作用。
