A Randomized Controlled Trial To Investigate Percutaneous Tibial Nerve Stimulation For The Treatment Of Constipation After Spinal Cord Injury

Objective:To observe the clinical therapeutic effects of percutaneous tibial nerve stimulation on the patients with constipation after spinal cord injury, to explore the effects of percutaneous tibial nerve stimulation on intestinal function, quality of life, and psychological status, to explore the safety of percutaneous tibial nerve stimulation, to evaluate the change of patient’s satisfaction degree of bowel management program after receiving the percutaneous tibial nerve stimulation, to provide some theoretical guidance to help the researchers find the best rehabilitation program for the patients with constipation after spinal cord injury.Methods: The 60 patients with constipation after spinal cord injury, whose course of disease were more than 6 months, were chosen from inpatient department of rehabilitation department in Hebei General Hospital and the Third Hospital of Hebei Medical University between March 2014 to June 2014. This was an randomized controlled trial. The patients were randomly divided into two groups, the intervention group and control group. Each group had 30 patients. Patients in the intervention group were treated with conventional therapy combined with percutaneous tibial nerve stimulation, and patients in the control group were treated with conventional therapy combined with placebo therapy. All patients were assessed before training, after training, and three months after training. The assessed items included:(1) Cleveland clinical constipation score and Bristol stool form scale were used to evaluate the intestinal function of the patients; (2)SF-36 scale which was used to evaluate the quality of life of the patient; (3)Zung self-rating depression scale and Zung self-rating anxiety scale which were used to evaluate the psychological status of the patient; (4)Visual analogue scale which was used to evaluate the patient’s satisfaction degree of the bowel management program and patient’s need for assistance during bowel management;(5)Adverse events which were used to evaluate the safety of percutaneous tibial nerve stimulation. All treatments were received by two groups for one time everyday and six times a week. The patients received the intervention for four weeks and in the other time the patients received the daily rehabilitation training. The clinical effects of percutaneous tibial nerve stimulation after the treatment and three months after the treatment were observed.Results:(1) Comparison within groups: There are significant improvements (P<0.05) of Cleveland clinical constipation score, Bristol stool form scale score, SF-36 score, Zung self-rating depression scale score, Zung self-rating anxiety scale score, patient’s satisfaction degree of bowel management program, patient’s need for assistance during bowel management before the treatment compared with data after the treatment and three months after the treatment. And there are not significant differences (P>0.05) of data after the treatment compared with the data three months after the treatment. (2) Comparison between groups:There are not significant differences (P>0.05) of Cleveland clinical constipation score, Bristol stool form scale, SF-36 score, Zung self-rating depression scale score, Zung self-rating anxiety scale core, patient’s satisfaction degree of bowel management program, patient’s need for assistance during bowel management between the intervention group and the control group before the treatment. But there are significant differences (P< 0.05) of data between the intervention group and the control group after the treatment and three months after the treatment.Conclusion: The percutaneous tibial nerve stimulation can effectively improve the bowel function of the patients with constipation after spinal cord injury, improve the patient’s quality of life and psychological status, reduce the needs for assistance during bowel management, and improve the patient’s satisfaction degree of bowel management program. And the percutaneous tibial stimulation has less adverse events. The safety of this therapy is good. It is worth promoting this therapy in the clinic.