Clinical trial NCT04914975: The Effect of NMES on Bowel Management in People with Chronic SCI
Official title: The Effect of Neuromuscular Electrical Stimulation on Bowel Management in People with Chronic Spinal Cord Injury - a Pilot Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Electric Stimulation Therapy
Bowel Dysfunction
Spinal Cord Injuries
Defecation Disorder
Keywords: Spinal Cord Injuries
Electrical Stimulation
Bowel Management
Transit Time
Incontinence
Quality of Life
Lead sponsor: Swiss Paraplegic Research, Nottwil
Sponsor class: NETWORK
First posted: 2021-06-07
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: repeated measures interventional single subject design
Primary purpose: TREATMENT

Brief summary: It has been reported that 62% of all people with Spinal Cord Injury (SCI) have experienced faecal incontinence and that neurogenic bowel dysfunction (NBD) is a major sequela. As an alternative to abdominal massage or the use of suppositories, the electrical stimulation (ES) of the abdominal wall has been shown to be effective in decreasing the bowel transit time as well as decreasing constipation in children with slow-transit constipation. Due to the intrinsic nature of the guts' innervation, we expect to reproduce these positive effects in people with SCI through administration of neuromuscular electrical stimulation (NMES).

Detailed description: A SCI entails devastating changes to a person's life. The extent of these changes depends on the level and degree of the lesion. NBD is one of the most important sequelae occurring in the majority of people with a SCI. It has been reported that 62% of people with SCI had experienced faecal incontinence . In fact, NBD is caused by a disruption of the autonomic nervous system leading to a disturbed colonic peristalsis. The enteric nervous system of the intestines is an intrinsic system that can function independently, but it is widely influenced by the autonomic nervous system. As such, its regulation is perturbed because the parasympathetic and the sympathetic nervous systems do modulate it but do not directly control the smooth muscle cells of the bowel . Depending on the level of the lesion, the bowel function can be affected in various ways ranging from constipation to overflow incontinence.

Hence, NBD has a major impact on the quality of life of paraplegics and tetraplegics. Not only is there a physical component to it consisting of constipation, haemorrhoids or abdominal distension but these gastrointestinal impairments also have a social aspect. People with SCI often end up avoiding social events and tend to isolate because of the fear of incontinence.

The immense expenditure of time for bowel evacuation is a consequence of the dyscoordination of faecal elimination. According to a survey study, 22% of all participants with SCI spend 31 to 60 minutes and 14% more than 60 minutes on bowel care per defecation. For example, people with an upper motor neuron lesion to their bowel are mainly confronted with faecal retention and constipation. Among the methods for bowel evacuation, the application of digital stimulation of the rectum and/or the insertion of a suppository are mostly used. Some people also use abdominal massage just before bowel evacuation . Only a few studies have investigated the effect of ES to the abdominal wall on the defaecation time in people with SCI and an upper motor neuron lesion but none investigated the defecation time in people with SCI with a lesion below the level of Th12. Nevertheless, the results of this therapeutic modality are very promising for different populations such as multiple sclerosis and children with slow-transit constipation by decreasing constipation and increasing transit times respectively.

By means of providing a more efficient and reliable method to support people with SCI in their bowel management strategy.A pilot study with a convenience sample of 20 out- and inpatients of the Swiss Paraplegic Centre will be conducted. Patients who have found a good bowel management method for themselves but claim to invest too much time in this routine are eligible for the study. During their participation, they should follow their usual routine after applying ES for 30 minutes before defaecation.

Based on the recent findings and clinical experience, it is hypothesized that NMES has the potential to reduce defaecation times as well as the bowel transit time in people with SCI experiencing NBD.

Eligibility criteria: Inclusion Criteria:

* Traumatic and non-traumatic SCI; \> 1 year
* Level of lesion: C2 - L5
* AIS score A/B/C/D
* Age: ≥ 18 years
* Urge to reduce defaecation time

Exclusion Criteria:

* Patients during primary rehabilitation
* Bladder stimulator
* Autonomic dysreflexia by application of ES of the abdominal wall
* Pregnancy: test in women of childbearing age (15 - 49 years)
* Opioid use
* Inflammatory bowel disease
* Cancerous tissue in abdominal region
* Patients' inability to follow the study, e.g. mental-health problems, language problems, dementia etc.

Primary outcomes:
measure: Neurogenic Bowel Dysfunction Score (NBDS) and the defaecation time from the stimulation protocol
timeFrame: 24 weeks
Secondary outcomes:
measure: Corn Test
timeFrame: 24 weeks; 5 time points
measure: Bristol Stool Form Scale (BSFS)
timeFrame: 24 weeks; at each defaecation
Other outcomes:
measure: Qualiveen Short Form (SF)
timeFrame: 24 weeks; 5 times
measure: International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI)
timeFrame: 24 weeks; 5 times
measure: Questionnaire of treatment effectiveness
timeFrame: 24 weeks; 2 times
Locations:
city: Nottwil
country: Switzerland
facility: Swiss Paraplegic Centre
state: LU
Study officials:
affiliation: International FES Centre - Swiss Paraplegic Centre Nottwil
name: Ines Bersch, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Korsten MA, Fajardo NR, Rosman AS, Creasey GH, Spungen AM, Bauman WA. Difficulty with evacuation after spinal cord injury: colonic motility during sleep and effects of abdominal wall stimulation. J Rehabil Res Dev. 2004 Jan-Feb;41(1):95-100. doi: 10.1682/jrrd.2004.01.0095.
citation: Krassioukov A, Eng JJ, Claxton G, Sakakibara BM, Shum S. Neurogenic bowel management after spinal cord injury: a systematic review of the evidence. Spinal Cord. 2010 Oct;48(10):718-33. doi: 10.1038/sc.2010.14. Epub 2010 Mar 9.
citation: Clarke MC, Catto-Smith AG, King SK, Dinning PG, Cook IJ, Chase JW, Gibb SM, Robertson VJ, Di Simpson, Hutson JM, Southwell BR. Transabdominal electrical stimulation increases colonic propagating pressure waves in paediatric slow transit constipation. J Pediatr Surg. 2012 Dec;47(12):2279-84. doi: 10.1016/j.jpedsurg.2012.09.021.
citation: Benevento BT, Sipski ML. Neurogenic bladder, neurogenic bowel, and sexual dysfunction in people with spinal cord injury. Phys Ther. 2002 Jun;82(6):601-12.