腹部按摩於改善脊髓損傷者神經性腸道功能障礙之 成效 系統性文獻回顧

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1 90 Abdominal Massage for Neurogenic Bowel Dysfunction 腹部按摩於改善脊髓損傷者神經性腸道功能障礙之 成效 系統性文獻回顧 * 摘要 背景 目的 方法 結果 結論 / 實務應用 Downs Black 關鍵詞 : 前言 spinal cord injury 12, %40.6% National Spinal Cord Injury Statistical Center, % neurogenic bowel dysfunction 12reflex 1 flaccid bowel function doi: /jn * hhwang@kmu.edu.tw 引用格式 [Wu, T. J., Lin, C. C., & Wang, H. H. (2017). The effectiveness of abdominal massage on neurogenic bowel dysfunction in patients with spinal cord injury: A systematic review. The Journal of Nursing, 64(1), ] doi: /jn The Journal of Nursing Vol. 64, No. 1, February 2017

2 Chen, Lai, & Wu, 2011; Pardee, Bricker, Rundquist, MacRae, & Tebben, 2012 neurogenic bowel training Ash, 2005 Coggrave, Wiesel, & Norton, 2006 Coggrave, 2008 Albers et al., 2006; Coggrave, Burrows, & Durand, 2006; Coggrave & Norton, 方法一 研究樣本 Cochrane Library MEDLINE complete EBSCOhostCINAHL Cumulative Index to Nursing and Allied Health Literature Plus with Full Text PubMed ProQuest CEPS Chinese Electronic Periodicals Service medical subject headings, MeSH and/ or/not/limit spinal cord injury, spinal cord injuries bowel training, bowel management abdominal massage neurogenic bowel dysfunction, neurogenic bowel defecation, colonic transit time, fecal incontinence, bowel functionabstract (1) 18 (2) (3) (4) (1)(2) (3) (4) EndNote 二 研究工具 Downs Black 1998 randomized control studies non-randomized control studies (1) reporting (2) external validity 3 (3) bias 7 internal validity (4) confounding factor 6 搜尋資料庫包含 1. Cochrane Library (n = 4) 2. MEDLINE / EBSCO (n = 9) 3. CINAHL Plus with Full Text (n = 2) 4. PubMed (n = 55) 5. ProQuest (n = 232) 6. CEPS (n = 0) (N = 302) n = 297 N = 8) 圖一文獻選取流程圖 n = 5 刪除不符合文獻 N = n = 4 2. n = 4 3. n = 281 護理雜誌 64 卷 1 期 中華民國 106 年 2 月

3 92 Abdominal Massage for Neurogenic Bowel Dysfunction selection bias assignment (5) power 1 effect size 0 5 結果一 研究樣本特性與品質 Coggrave Norton 二 腹部按摩介入措施與成效 8 表一 腹部按摩介入改善脊髓損傷病人腸道功能障礙之文獻評讀摘要表 1. Albers Ayaş % T5 Phase I g Phase II ± ± ± ± Coggrave % in protocol phase, 62.8% in baseline, p < Coggrave ASIA a A D p = p = p = The Journal of Nursing Vol. 64, No. 1, February 2017

4 93 表一 腹部按摩介入改善脊髓損傷病人腸道功能障礙之文獻評讀摘要表 續 5. Correa ± % < % Hu ± ± ± ± 8.9 ml 31.5 ± 11.8ml Janssen ± Ozisler ± ± ASIA A, B ASIA C, D ASIA = American Spinal Injury Association a ASIA (1) A = 4 5 (2) B = (3) C = 3(4) D = 33(5) E = Coggrave Norton 2010 Janssen Prakken Hendriks Lourens van der Vlist Smit 2014 討 一 文獻研究樣本差異 論 護理雜誌 64 卷 1 期 中華民國 106 年 2 月

5 94 Abdominal Massage for Neurogenic Bowel Dysfunction Janssen2014 Ozisler ± ± 146 Ozisler Ayaş Leblebici Sözay Bayramoğlu Niron % Albers % Correa Rotter % 5 5 Coggrave, 2008 Coggrave Norton 2010 二 研究措施及成效 Ayaş et al., 2006; Emmanuel, 2010; McClurg & Lowe-Strong, 2011 Janssen tensegrity massage principle compression kneading tension Kassolik et al., 2015Kassolik ± ± 10.5 Hu et al., ± ± Ayaş et al., % Correa & Rotter, Hu et al., 2013; Janssen et al., 2014 結論與建議 RCT meta-analysis 4 The Journal of Nursing Vol. 64, No. 1, February 2017

6 (1) (2) (3) 誌謝 CSH-2016-A-002 參考文獻 [Wang, Y. H., & Lin, K. H. (1994). Neurological examination and functional assessment after spinal cord injury. Journal of the Physical Therapy Association of the R.O.C., 19(1), [Li, C. C., Wu, T. Z., & Chen, H. Y. (2012). The experience of nursing a young adulthood incomplete cervical spinal cord injury patient returning to work by using super-link system theory. Chang Gung Nursing, 23(2), ] Ash, D. (2005). Sustaining safe and acceptable bowel care in spinal cord injured patients. Nursing Standard, 20(8), doi: /ns c3994 Albers, B., Cramer, H., Fischer, A., Meissner, A., Schürenberg, A., & Bartholomeyczik, S. (2006). Abdominal massage as intervention for patients with paraplegia caused by spinal cord injury--a pilot study. Pflege Zeitschrift, 59(3), 2 8. Ayaş, Ş., Leblebici, B., Sözay, S., Bayramoğlu, M., & Niron, E. A. (2006). The effect of abdominal massage on bowel function in patients with spinal cord injury. American Journal of Physical Medicine & Rehabilitation, 85(12), doi: /01.phm c0 Chen, H. Y., Lai, C. H., & Wu, T. J. (2011). A study of factors affecting moving-forward behaviour among people with spinal cord injury. Rehabilitation Nursing, 36(3), doi: /j tb00072.x Coggrave, M. (2008). Neurogenic continence. part 3: Bowel management strategies. British Journal of Nursing, 17(15), doi: /bjon Coggrave, M., Burrows, D., & Durand, M. A. (2006). Progressive protocol in the bowel management of spinal cord injuries. British Journal of Nursing, 15(20), doi: /bjon Coggrave, M. J., & Norton, C. (2010). The need for manual evacuation and oral laxatives in the management of neurogenic bowel dysfunction after spinal cord injury: A randomized controlled trial of a stepwise protocol. Spinal Cord, 48(6), doi: /sc Coggrave, M., Wiesel, P. H., & Norton, C. C. (2006). Management of faecal incontinence and constipation in adults with central neurological disease. Cochrane Database of Systematic Review, 2, Art. No.: CD doi: / CD pub3 Correa, G. I., & Rotter, K. P. (2000). Clinical evaluation and management of neurogenic bowel after spinal cord injury. Spinal Cord, 38(5), doi: /sj.sc Downs, S. H., & Black, N. (1998). The feasibility of creating a checklist for the assessment of the methodological quality both of randomized and non-randomized studies of healthcare interventions. Journal of Epidemiology of Community Health, 52(6), doi: /jech Emmanuel, A. (2010). Rehabilitation in practice: Managing neurogenic bowel dysfunction. Clinical Rehabilitation, 24(6), doi: / Hu, C., Ye, M., & Huang, Q. (2013). Effects of manual therapy on bowel function of patients with spinal cord injury. Journal of Physical Therapy Science, 25(6), doi: /jpts Janssen, T. W. J., Prakken, E. S., Hendriks, J. M. S., Lourens, C., Van, D. V., & Smit, C. A. J. (2014). Electromechanical abdominal massage and colonic function in individuals 護理雜誌 64 卷 1 期 中華民國 106 年 2 月

7 96 Abdominal Massage for Neurogenic Bowel Dysfunction with a spinal cord injury and chronic bowel problems. Spinal Cord, 52(9), doi: /sc Kassolik, K., Andrzejewski, W., Wilka, I., Brzozowski, M., Voyce, K., Jaworska-Krawiecka, E., Kurpas, D. (2015). The effectiveness of massage based on the tensegrity principle compared with classical abdominal massage performed on patients with constipation. Archives of Gerontology and Geriatrics, 61(2), doi: / j.archger McClurg, D., & Lowe-Strong, A. (2011). Does abdominal massage relieve constipation? Nursing Times, 107(12), doi: / cd National Spinal Cord Injury Statistical Center. (2013). Spinal cord injury factors and figures at a glance. Retrieved from figures_docs/facts% pdf Ozisler, Z., Koklu, K., Ozel, S., & Unsal-Delialioglu, S. (2015). Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction. Neural Regeneration Research, 10(7), doi: / Pardee, C., Bricker, D., Rundquist, J., MacRae, C., & Tebben, C. (2012). Characteristics of neurogenic bowel in spinal cord injury and perceived quality of life. Rehabilitation Nursing, 37(3), doi: /rnj The Journal of Nursing Vol. 64, No. 1, February 2017

8 97 The Effectiveness of Abdominal Massage on Neurogenic Bowel Dysfunction in Patients With Spinal Cord Injury: A Systematic Review Tzu-Jung Wu 1 Chiu-Chu Lin 2 Hsiu-Hung Wang 3 * 1 MS, RN, Deputy Director, Department of Nursing, Chung Shan Medical University Hospital, and Adjunct Instructor, School of Nursing, Chung Shan Medical University, and Doctoral Student, School of Nursing, Kaohsiung Medical University; 2 PhD, RN, Professor, School of Nursing, Kaohsiung Medical University; 3 PhD, RN, FAAN, Professor, School of Nursing, and Vice President, Kaohsiung Medical University. ABSTRACT Background: Neurogenic bowel dysfunction is a common comorbidity in spinal cord injury patients that may result in fecal incontinence. Abdominal massage is one intestinal training method that is used to improve bowel movement and defecation. Purpose: To review the effectiveness of abdominal massage on neurogenic bowel dysfunction in patients with spinal cord injury. Methods: A systematic review of Chinese and English-language articles was performed in six databases using the following key words: spinal cord injury, abdominal massage, neurogenic bowel dysfunction, and bowel training. Relevant studies published prior to June 2016 that met the inclusion and exclusion criteria were selected. The Downs and Black scale was used to appraise the quality of each of the included studies. Eight studies were included in the final analysis. Results: Four of these studies indicated that abdominal massage significantly improved bowel functions and the regularity and frequency of bowel movements. Although two of the studies indicated that abdominal massage significantly reduced the use of glycerin and laxatives, the remaining six did not. The eight studies earned respective quality scores ranging between 13 and 25. Conclusions / Implications for Practice: The current literature lacks consensus on the efficacy of abdominal massage in terms of improving bowel dysfunction in patients with spinal cord injuries. Future studies should use more stringent experimental designs such as randomized controlled studies to explore the correlations among massage time and frequency and bowel function improvements in order to provide guidelines for clinical care applications. Key Words: spinal cord injury, abdominal massage, neurogenic bowel dysfunction. Accepted for publication: October 6, 2016 *Address correspondence to: Hsiu-Hung Wang, No. 100, Shih-Chuan 1st Rd., Kaohsiung City 80708, Taiwan, ROC. Tel: +886 (7) ext. 2624; hhwang@kmu.edu.tw 護理雜誌 64 卷 1 期 中華民國 106 年 2 月