Barriers to independent bowel care in individuals with paraplegia: An analysis from the second International Spinal Cord Injury Community Survey in Thailand

Objective: To demonstrate the prevalence and barriers to independent bowel care in individuals with paraplegia Study design: A cross-sectional study Setting: Fourteen spinal cord injury (SCI) rehabilitation facilities Subjects: Individuals with paraplegia, i.e. those living with lower extremity weakness but normal upper extremity function, living in the community Methods: Data from the Thai arm of the International Spinal Cord Injury community survey questionnaires were extracted. Twenty factors potentially associated with bowel care dependence statuses were identified by an expert panel, including three demographic parameters, three SCI characteristics, six secondary health conditions, five activity limitations, one personal factor, and two environmental factors. A skeletal directed acyclic graph was used to guide a multivariable logistic regression analysis with an exploratory modelling strategy. Results: Of 453 paraplegic respondents, 45% reported dependent bowel care. Multivariable logistic regression analysis demonstrated that three factors, including dependent transfer from bed to wheelchair, inability to walk for a moderate distance, and lack of medications, medical aids, and supplies, were significantly associated with dependent bowel care, with odds ratios of 2.483, 2.021, and 1.675, respectively. Conclusion: The percentage of dependent bowel care in individuals with paraplegia is unexpectedly high. Dependent transfer from bed to wheelchair, inability to walk for a moderate distance, and an environmental barrier of lack of medications, medical aids and supplies are barriers to independent bowel care. Rehabilitation professionals should focus on restoring performance in transfers and walking, as well as on providing support with relevant medical consumables, to enhance bowel care independence in individuals with paraplegia.