Are micro enemas administered with a squeeze tube and a 5 cm-long nozzle as good or better than micro enemas administered with a 10 cm-long catheter attached to a syringe in people with a recent spinal cord injury? A non-inferiority, crossover randomised controlled trial

Spinal Cord, 2022 · DOI: 10.1038/s41393-022-00835-5 · Published: July 27, 2022

Spinal Cord Injury Gastroenterology Rehabilitation

Simple Explanation

The study compares two methods of administering micro enemas for bowel management in people with recent spinal cord injuries: a squeeze-tube method and a catheter method. Participants were assigned to use either the squeeze-tube method or the catheter method for 4 weeks, then switched to the other method for another 4 weeks. The study found that the squeeze-tube method is as good as or better than the catheter method, without significantly increasing the time spent on bowel care.

Study Duration

January 2019 to May 2021, excluding a 12-month period

Participants

20 people with recent spinal cord injury

Evidence Level

Level 1, Double-blind, non-inferiority crossover randomised controlled trial

Key Findings

1
The mean between group difference for the time to complete bowel care was −0.5 min (−2.8 to 1.8), where a negative value favours the catheter method.
2
The lower limit of the 95% CI was within the non-inferiority margin of −10 min indicating that the squeeze-tube method is not inferior to the catheter method.
3
All results support the interpretation of the analyses for the primary outcome. That is, the squeeze-tube method is not inferior to the catheter method.

Research Summary

This randomised controlled trial compared the squeeze-tube and catheter methods of micro enema delivery in people with recent SCI. The study found that the squeeze-tube method is as good as or better than the catheter method, with similar results for secondary outcomes like faecal incontinence and quality of life. The results suggest that the less expensive and more convenient squeeze-tube method can be routinely used without significantly affecting bowel care time or effectiveness.

Practical Implications

Clinical Practice

The squeeze-tube method can be considered as a first-line option for micro enema administration in people with recent SCI.

Cost-Effectiveness

Using the squeeze-tube method can reduce costs associated with bowel management due to the lower cost of the supplies.

Patient Preference

The study provides evidence to support the use of a more convenient method, potentially improving patient satisfaction with bowel care routines.

Study Limitations

1
The trial was stopped early, resulting in a smaller sample size than initially planned.
2
Two participants did not fully comply with the trial protocol, which could introduce bias.
3
The mean time to complete bowel care in the participants of this trial was only 18 min.

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