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Neurogenic Bowel Dysfunction Score (NBDS)
Availability
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Classification
Supplemental - Highly Recommended: Spinal cord Injury (SCI)*
 
*Recommendation of Use: To assess bowel characteristics, methods of management, and symptoms of complications such as incontinence, constipation and impact on QOL.  (Tate et al., 2020)
Short Description of Instrument
The Neurogenic Bowel Dysfunction Score (NBDS) is a self-report questionnaire that evaluates the individual's degree of neurogenic bowel dysfunction (NBD) symptomatology. (Krogh et al., 2006) It was developed to evaluate the severity of colorectal dysfunction clinically in patients with SCI.
Scoring and Psychometric Properties
Scoring
 
The NBD score is a 10-item questionnaire that is associated with impaired QoL caused by bowel symptoms, including frequency of defecation (0-6 points), time used for each defecation (0-7 points), uneasiness or headache or perspiration during defecation (0-2 points), regular use of tablets against constipation (0-2 points), regular use of drops against constipation (0-2 points), digital stimulation or evacuation of the anorectum (0-6 points), frequency of fecal incontinence (0-13 points), medication against fecal incontinence (0-4 points), flatus incontinence (0-2 points) and perianal skin problems (0-3 points).
 
The 10-items are scored on an ordinal scale. One additional question regarding general satisfaction, is not included in the total score.
 
The NBD weighted score ranges between 0 and 47 points. A higher overall NBD score indicates more severe bowel symptoms.
The NBD severity level is divided into four subgroups based on the scores (Krogh et al., 2006; Bournet-Blanquart et al., 1990; Menardo et al., 1987; Krogh et al., 2000; MacDonagh et al., 1992; Liu et al., 2000; Agachan et al, 1996):
Score 0-6: Very minor
Score 7-9: Minor
Score 10-13: Moderate
Score 14+: Severe
 
Psychometric Properties
 
Reliability: Test-retest and interrater reliability of the selected items good (Krogh et al., 2006; Erdem et al., 2017)
 
Validity: High internal consistency (Krogh et al., 2006; Erdem et al., 2017; Mallek et al., 2016) Correlation was 0.91 between NBD and physician's global assessment (Krogh et al., 2006) Correlation was 0.92 between NBDS and impact of NBD on QoL (Erdem et al., 2017)
 
Responsiveness: Correlation 0.82 between change NBDS and global rating of change. Erdem et al., 2017) Four SCI trials showed significant change of NBDS scores. (Christensen et al., 2006)
Rationale/Justification
Strengths/Weaknesses: The NBDS is widely used in SCI and provides an assessment of the impact of symptoms on quality of life. (Tate et al., 2020). Future studies will establish minimal detectable change, minimal clinically important difference as well translations in other languages.
References
Key Reference:
 
Krogh K, Christensen P, Sabroe S, Laurberg S. Neurogenic bowel dysfunction score. Spinal Cord 2006;44:625-631.
 
Additional References:
 
Agachan F, Chen T, Pfeiffer J, Reisman P, Wexner SD . A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 1996;39:681-685.
 
Bournet-Blanquart F, Weber J, Gouverneur JP, Dermangeon S . Large bowel transit time and anorectal manometric abnormalities in 19 patients with complete transection of the spinal cord. J Aut Nerv Syst 1990;25:109-112.
 
Christensen P, Bazzocchi G, Coggrave M, Abel R, Hultling C, Krogh K, et al. A randomized, controlled trial of transanal irrigation versus conservative bowel management in spinal cord- injured patients. Gastroenterol 2006;131:738-747.
 
Christensen P, Bazzocchi G, Coggrave M, Abel R, Hulting C, Krogh K, et al. Outcome of transanal irrigation For bowel dysfunction 1N patients with spinal cord injury. J Spinal Cord Med 2008;31:560-567.
 
Erdem D, Hava D, Keskinoglu P, Bircan C, Peker O, Krogh K, et al. Reliability, validity and sensitivity to change of neurogenic bowel dysfunction score in patients with spinal cord injury. Spinal Cord 2017;55:1084-1087.
 
Krogh K, Mosdal C, Gregersen H, Laurberg S . Rectal wall properties in patients with acute and chronic spinal cord lesions. Dis Colon Rectum 2002;45:641-649.
 
Krogh K, Mosdal C, Laurberg S. Gastrointestinal and segmental colonic transit times in patients with acute and chronic spinal cord lesions. Spinal Cord. 2000 Oct;38(10):615-621.
 
Krogh K, Halvorsen A, Pettersen AL, Biering-SØrensen F. Version 2.1 of the international spinal cord injury bowel function basic data set. Spinal Cord Series and Cases [Internet] 2019;5(1).
 
Liu CW, Huang CC, Yang YH, Chen SC, Weng MH, Huang Mh . Relationship between neurogenic bowel dysfunction and health-related quality of life in persons with spinal cord injury. J Rehabil Med 2009;41:35-40.
 
MacDonagh RP, Sun WM, Thomas DG, Smallwood R, Read NW . Anorectal function in patients with complete supraconal spinal cord lesions. Gut 1992;33:1532-1538.
 
Mallek A, Elleuch MH, Ghroubi S. Neurogenic bowel dysfunction (NBD) translation and linguistic validation to classical Arabic. Prog Urol 2016;26:553-557.
 
Menardo G, Bausano G, Corazziari E, Fazio A, Marangi A, Genta V et al. Large bowel transit in paraplegic patients. Dis Colon Rectum 1987; 30: 924-928.
 
 
Ozisler Z, Koklu K, Ozel S, Unsal-Delialioglu S. Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction. Neural Regeneration Res 2015;10: 1153-1158.
 
Rasmussen MM, Kutzenberger J, Krogh K, Zepke F, Bodin C, Domurath B, et al. Sacral anterior root stimulation improves bowel function in subjects with spinal cord injury. Spinal Cord 2015;53:297-301.
 
Tate DG, Wheeler T, Lane GI, Forchheimer M, Anderson KD, Biering-Sorensen F, Cameron AP, Santacruz BG, Jakeman LB, Kennelly MJ, Kirshblum S, Krassioukov A, Krogh K, Mulcahey MJ, Noonan VK, Rodriguez GM, Spungen AM, Tulsky D, Post MW. Recommendations for
evaluation of neurogenic bladder and bowel dysfunction after spinal cord injury and/or disease. J Spinal Cord Med. 2020;43(2):141-164.
 
Document last updated November 2021