Development and validation of a bowel-routine-based self-report questionnaire for sacral sparing after spinal cord injury

TY - JOUR

T1 - Development and validation of a bowel-routine-based self-report questionnaire for sacral sparing after spinal cord injury

AU - Liu, N

AU - Xing, H

AU - Zhou, M-W

AU - Biering-Sørensen, F

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Study design:An observational study.Objective:To develop a self-administered tool for assessment of sacral sparing after spinal cord injury (SCI) and to test its validity in individuals with SCI.Setting:Peking University Third Hospital, Beijing, China.Methods:A 5-item SCI sacral sparing self-report questionnaire was developed based on several events that most patients might experience during bowel routine. 102 participants who sustained SCI within 12 months were asked to complete the questionnaire followed by an anorectal examination. Agreements of answers to the questionnaire and the physical examination were analyzed. Sensitivity, specificity and Youden's index of each item was calculated.Results:The first four questions regarding the S4-5 sensation including deep anal pressure showed high agreement with the results of the physical examination (ΰ: 0.79-0.93). Sensitivity, specificity and Youden's index were also high (all above 80%). For the fifth question related to the voluntary anal contraction, the agreement was almost perfect with good sensitivity and specificity among patients without increased anal sphincter tone (AST). In patients with increased AST, the agreement was fair.Conclusion:The validity of this questionnaire for the assessment of sacral sparing in up to 12 months post injury is good except for the motor function when there was increased AST. In some situations it could be considered as an alternative tool for digital rectal examination, especially when repeated examinations are not feasible. It is suggested that change of sacral sparing may be detected by the questionnaire.

AB - Study design:An observational study.Objective:To develop a self-administered tool for assessment of sacral sparing after spinal cord injury (SCI) and to test its validity in individuals with SCI.Setting:Peking University Third Hospital, Beijing, China.Methods:A 5-item SCI sacral sparing self-report questionnaire was developed based on several events that most patients might experience during bowel routine. 102 participants who sustained SCI within 12 months were asked to complete the questionnaire followed by an anorectal examination. Agreements of answers to the questionnaire and the physical examination were analyzed. Sensitivity, specificity and Youden's index of each item was calculated.Results:The first four questions regarding the S4-5 sensation including deep anal pressure showed high agreement with the results of the physical examination (ΰ: 0.79-0.93). Sensitivity, specificity and Youden's index were also high (all above 80%). For the fifth question related to the voluntary anal contraction, the agreement was almost perfect with good sensitivity and specificity among patients without increased anal sphincter tone (AST). In patients with increased AST, the agreement was fair.Conclusion:The validity of this questionnaire for the assessment of sacral sparing in up to 12 months post injury is good except for the motor function when there was increased AST. In some situations it could be considered as an alternative tool for digital rectal examination, especially when repeated examinations are not feasible. It is suggested that change of sacral sparing may be detected by the questionnaire.

KW - Adult

KW - Anal Canal/physiopathology

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Muscle Contraction

KW - Muscle Hypertonia/diagnosis

KW - Physical Examination

KW - Sacrum

KW - Self Report

KW - Sensitivity and Specificity

KW - Spinal Cord Injuries/diagnosis

KW - Touch Perception

KW - Volition

U2 - 10.1038/sc.2017.77

DO - 10.1038/sc.2017.77

M3 - Journal article

C2 - 28695901

SN - 1362-4393

VL - 55

SP - 1010

EP - 1015

JO - Spinal Cord

JF - Spinal Cord

IS - 11

ER -