The Reliability and Validity of the Turkish Version of the Constipation Risk Assessment Scale

A Common Complication in Orthopedic Patients: Postoperative Constipation and Related Risk Factors

PURPOSE

The purpose of this study was to determine the frequency of postoperative constipation and risk factors in orthopedic patients.

DESIGN

A descriptive model was used.

METHODS

A total of 140 patients who underwent surgical intervention in the Orthopedics and Traumatology Clinic were included in the present study. The Descriptive Characteristics Form, Constipation Risk Assessment Scale, and Visual Analog Scale were used to collect the study data. Frequencies, percentages, Mann Whitney U, Kruskal-Wallis, and Spearman Correlation tests were used to evaluate the data.

FINDINGS

In the present study, 72.1% of the individuals experienced constipation during the hospitalization period, and the constipation risk score was 12.77.á...á4.83. Those who were female, over 65 years old, unemployed, had lower extremity surgery, used opioid analgesics, were dependent on their activities, had prehospital constipation, had a chronic disease, and used drugs regularly had higher constipation risk scores at statistically significant levels. A significant correlation was detected between the constipation risk score and age, pain severity, hospital stay, time to first defecation after surgery, and the amount of fluid consumed daily.

CONCLUSIONS

The majority of the individuals experienced constipation during the hospitalization period, and the constipation risk score was moderate. Those who were female, had advanced age, were unemployed, had high pain severity, opioid use, previous constipation, chronic disease, regular medication, long hospital stay, those whose first defecation period was prolonged after the surgery and whose fluid intake was insufficient had a higher risk of constipation. In this regard, nurses must evaluate orthopedic patients in terms of constipation risk factors and apply nondrug methods that prevent and relieve constipation with laxatives.

Effect of Acupressure and Abdominal Massage on Constipation in Patients with Total Knee Arthroplasty: A Randomized Controlled Study

This study was a randomized controlled trial aimed to compare the effects of acupressure and abdominal massage on constipation development for patients with TKA. The patients were randomly assigned to each group: control group (n = 31), acupressure group (n = 30), and abdominal massage group (n = 30). The finding showed that the severity of constipation and straining stool consistency of the groups in which acupressure and abdominal massage was applied are significantly better than the control group (p < .05). When the first defecation times of the groups are analyzed, it is seen that the patients to whom acupressure and abdominal massage are applied defecate significantly earlier than the control group (p < .05). It has been concluded that safe non-invasive acupressure and abdominal massage that can be easily applied by health professions, healthy individuals, and patients is effective on patients with total knee arthroplasty for the prevention of constipation.

Validation of the Constipation Risk Assessment Scale (CRAS) in Chinese cancer patients

PURPOSE

The Constipation Risk Assessment Scale (CRAS) is a valid tool for predicting the risk of developing constipation. This study aimed to translate the CRAS into Chinese and evaluate its psychometric properties in Chinese cancer patients.

METHOD

The CRAS was translated into Chinese following standard forward- and back-translation procedures. Scale and item indices were calculated for content validity (S-CVI; I-CVI). In total, 175 cancer patients were assessed with the CRAS on the first day of antitumour treatment, of whom 145 were submitted to the predictive validity test, and their defecation pattern, stool consistency, and ease of defecation were assessed for one week. A receiver operating characteristic (ROC) curve was used to describe the prediction accuracy of CRAS-C for constipation. Reliability was evaluated by means of an interrater reliability test using the intraclass correlation coefficient (ICC) in 30 patients.

RESULTS

The S-CVI was 0.99, and for each item, the I-CVI was 0.80-1.00. The area under the curve of CRAS-C was 0.722 (95% CI, 0.631-0.812). A CRAS-C score ≥11 indicated a high constipation risk, and a score <11 indicated a low constipation risk. The sensitivity and specificity were 0.887 (95% CI, 0.763-0.953) and 0.500 (95% CI, 0.376-0.624), respectively, and the positive predictive value and negative predictive value were 0.588 (95% CI, 0.472-0.695) and 0.846 (95% CI, 0.688-0.936), respectively. The ICC between the two raters for the total CRAS-C score was 0.963, and the ICC in the four subscales was 0.843-0.955.

CONCLUSIONS

The CRAS-C demonstrated favourable content validity, predictive validity and interrater reliability. It can be used in the identification of subjects at risk of constipation and the development of constipation prevention programmes in Chinese cancer patients.

Effect of abdominal massage on bowel evacuation in neurosurgical intensive care patients

BACKGROUND

There are many factors, which affect the bowel evacuation of neurosurgical intensive care unit (NICU) patients, resulting in constipation.

AIM AND OBJECTIVES

The aim of this study was to investigate effect of abdominal massage on bowel evacuation and the risk of constipation in NICU patients.

DESIGN

A prospective, randomized-controlled clinical trial.

METHODS

The sample of this study included 80 NICU patients. The patients were randomly assigned to abdominal massage and control groups. The constipation risk of all the patients was assessed with Constipation Risk Assessment Scale (CRAS). The patients in the abdominal massage group received a total of 30 minutes of massage, 15 minutes every morning and evening, until the first defecation. The bowel sounds of all patients in the abdominal massage and control groups were assessed on a daily basis. The days when bowel sounds were heard and the first defecation took place were recorded in a Bowel Evacuation Form.

RESULTS

The risk of constipation was higher in the patients in the abdominal massage (CRAS score 19.02 ± 1.81) and control groups (CRAS score 20.45 ± 2.61). The time of return of bowel sounds and the time of the first defecation were earlier in the abdominal massage group, compared to the control group (P < .05). In the control group, there was a weak correlation (P = .004) between the CRAS score and the time of return of bowel sounds, while there was a moderate correlation between the CRAS score and the time of the first defecation (P < .001).

CONCLUSION

Our study results show that the risk of constipation is high in NICU patients, and abdominal massage is an effective nursing intervention to shorten the time of return of bowel sounds and the time of the first defecation.

RELEVANCE TO CLINICAL PRACTICE

Nurses can safely apply abdominal massage to improve bowel evacuation in NICU patients.

Constipation Risk in Patients Undergoing Abdominal Surgery

Background:

Problems regarding bowel elimination are quite common in patients undergoing abdominal surgery.

Objectives:

To determine constipation risk before the surgery, bowel elimination during postoperative period, and the factors affecting bowel elimination.

Patients and Methods:

This is a cross-sectional study. It was conducted in a general surgery ward of a university hospital in Zonguldak, Turkey between January 2013 and May 2013. A total of 107 patients were included in the study, who were selected by convenience sampling. Constipation Risk Assessment Scale (CRAS), patient information form, medical and nursing records were used in the study.

Results:

The mean age of the patients was found to be 55.97 ± 15.74 (year). Most of the patients have undergone colon (37.4%) and stomach surgeries (21.5%). Open surgical intervention (83.2%) was performed on almost all patients (96.3%) under general anesthesia. Patients were at moderate risk for constipation with average scores of 11.71 before the surgery. A total of 77 patients (72%) did not have bowel elimination problem during postoperative period. The type of the surgery (P < 0.05), starting time for oral feeding after the surgery (P < 0.05), and mobilization (P < 0.05) were effective on postoperative bowel elimination.

Conclusions:

There is a risk for constipation after abdominal surgery. Postoperative practices are effective on the risk of constipation.