ORIGINAL RESEARCH article
Front. Neurol.
Sec. Experimental Therapeutics
Constructing and Applying a Tiered Family Engagement Strategy for Managing Neurogenic Bowel Dysfunction in TSCI Patients
Provisionally accepted
- Third Hospital of Hebei Medical University, Shijiazhuang, China
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Background:Neurogenic bowel dysfunction (NBD) severely impairs life quality after thoracic spinal cord injury (TSCI). In this 133-patient trial, we evaluated whether a literacy-adaptive, family-centred programme improves outcomes beyond guideline care. Methods: In this single-centre, prospective, stratified, randomised controlled trial, 133 T6–T12 TSCI patients and their primary caregivers were assigned to routine follow-up (n = 67) or a tiered family-engagement intervention matched to caregiver educational level (n = 66). Primary endpoint was change in NBD score; secondary endpoints were caregiver execution score, Zarit Burden Interview (ZBI) and SF-36. Assessments occurred at discharge, 6 and 12 months (intention-to-treat). Results: At 12 months, the intervention group showed a larger mean NBD reduction than controls (-3.2 ± 1.0 vs -0.9 ± 0.8; P < 0.001) and greater improvements in execution (d = 1.55), ZBI (d = -1.33) and SF-36 (d = 0.88). Benefits increased step-wise from tertiary-to primary-education strata, with no significant effect among highly educated caregivers. No programme-related adverse events occurred. Conclusions: Tailoring NBD management to caregiver literacy yields clinically meaningful, durable gains in bowel function, caregiving competence, burden and patient quality of life, especially when baseline self-efficacy is low. Literacy-stratified discharge pathways should be integrated into rehabilitation practice.
Keywords: caregiver burden, family-centeredrehabilitation, Health Education, neurogenic bowel dysfunction, Personalized care, Traumatic spinal cord injury
Received: 29 Jul 2025; Accepted: 27 Nov 2025.
Copyright: © 2025 Li, Wang, Ding, Wang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ruiling Wang
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