Validation of MENTOR tool to describe bowel dysfunction in inpatient rehabilitation setting and facilitate management across the 1st year post-injury

We propose a two-aim study to 1) validate the MENTOR tool in an acute/subacute population with traumatic SCI in the US inpatient rehabilitation setting and 2) use the MENTOR tool from discharge through the first-year post-injury to describe the progression of bowel dysfunction and determine if the tool prompts changes in bowel management when indicated. It has been known for more than two decades that people living with SCI rate bowel control as one of the most difficult issues to manage and one of the biggest daily challenges (Widerström-Noga et al., 1999; NASCIC, 2019), yet little progress has been made. There are many options for bowel care, but there has not been a clear definition of treatment failure or guidance regarding when to change strategies. These shortcomings contribute to persons with SCI living through prolonged periods of poor bowel management. There is no validated clinical decision-making tool to guide neurogenic bowel management during the acute and subacute period after SCI. Recently, the Monitoring Efficacy of NBD Treatment On Response (MENTOR) tool was developed and validated in the early chronic to chronic period to allow informed, shared decision making by the clinician and the person living with SCI in bowel management (Emmanuel et al., 2020). If the clinical goal is to best improve bowel management, then patient-specific tailoring should begin early after injury with a valid clinical decision-making tool. Therefore, there is a need to validate a clinical decision-making tool in that early setting.