No evidence that regular standing improves bowel movement in people with spinal cord injury

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Kwok et al note in Spinal Cord that regular standing treatments have been advocated for a long time as an effective way to improve bowel function in spinal cord injury patients, but there is little empirical evidence for this. In their study, they failed to find any evidence to support the advocacy of such methods.

The single-blind randomised crossover trial consisted of a 16-week period including 20 patients with motor complete spinal cord injury, 17 of whom completed the study. The trial consisted of a six-week stand phase and six-week no stand phase separated by a four-week “washout period”. All standing was done on a tilt table for 30 minutes with the patients standing as upright as possible.

The primary outcome that the authors focused on was time to first stool, reflecting the time from commencement of the bowel regime to first stool. Kwok et al report that: “The mean (95% confidence interval (CI)) between-intervention difference for the time to first stool (assessor determined) was 0 min (95% CI, -7 to 7) indicating that regular standing had no effect on time to first stool.” The authors did suggest that a cautious interpretation, based on the 95% CI, is that at best standing may decrease time to first stool by seven minutes, and at worst increase the time by seven minutes. However, even in the best case scenario, “few would consider this sufficient to justify the time and cost associated with regular standing,” they note.

Patients’ perceived benefits were also recorded, eight of whom perceived an improvement in bowel function.  Kwok et al explain that “patients invariably believed that standing was good for them often citing its beneficial effects on blood pressure, bone mineral density and joint mobility. It is not clear whether these perceptions and beliefs reflect real benefits that we were not able to detect with our outcome measures or whether they merely reflect participants’ exposure to the widely articulated beliefs of others about regular standing.”

Though the authors suggest that further research is required to clarify other possible therapeutic effects of standing, “the results of this study should encourage the questioning of long-held assumptions about standing and other similar interventions which have been passed down through the years and have become entrenched in clinical practice without a clear evidence base.”