Evaluation of bowel management efficacy and subjects' satisfaction in people with spinal cord injury (SCI): An Italian multicenter survey via the MENTOR tool.

Abstract

Study design: Observational prospective multicenter study.

Objectives: The aim of this study is to evaluate the efficacy of bowel management and subjects' satisfaction by the Monitoring the Efficacy of Neurogenic Bowel Treatment On Response (MENTOR) tool and the impact of demographic and clinical factors on bowel management.

Methods: Consecutive patients with SCI were recruited by nine Italian Spinal Units. The MENTOR tool is a three-dimensional questionnaire assessing objective bowel score measures, patient's subjective perceptions, and "special attention symptoms"; the combination of these results defines the allocation of each subject into one of three categories reflecting the possible therapeutic recommendations (red for "recommend change", yellow for "further discussion", and green for "monitoring").

Results: We recruited 352 subjects with subacute or chronic SCI. The NBD average score was 11.7 ± 7.2 with 69.9% that expresses "good" or "adequate" satisfaction. 33.1% had one or more "special attention symptoms (SAS)". About the MENTOR tool color: 34.6% of the current treatment was adequate (green), 29.7% needed a revaluation (yellow), and 35% required a change (red). While in "green" patients the subjective perception coincided with the score, 24% of "yellow" patients and 34.4% of "red" patients answered they were well managed. None of the clinical or demographic characteristics was associated with patients' satisfaction or belonging to the three color zones.

Conclusions: Effective bowel management in subjects with SCI did not correlate with patient characteristics or satisfaction. Many patients have inappropriate bowel management despite their satisfaction and the chronicity of the injury. This disparity calls for a periodic assessment with an objective tool such as MENTOR to identify the individual that requires intervention.