Randell et al. 2001;
New Zealand
 Downs & Black = 17
Case-control
N=52

Population: 26 subjects with colostomy: age: 22-87 yr, 10 subjects with cervical injuries, 16 with lumbar/lower thoracic injuries matched with 26 subjects without colostomy.
Treatment: Colostomy
Outcome Measures: Burwood Quality of Life Questionnaire: 5 areas: systemic symptoms, and emotional, social, work and bowel function 

1. No significant difference (p>0.05) in the group with a colostomy compared to the group without a colostomy in regard to their general well being, emotional, social or work functioning.

Kelly et al. 1999; United Kingdom
Downs & Black = 15
Post-test
N=14

Population: 12 males and 2 females; Age at time of operation: mean 54.8, range 20-65; time from injury to stoma formation: 15 years, 2-37; Level of injury: C4-T11; 3 subjects with cervical injuries, 10 with thoracic, and 1 with lumbar injuries.
Treatment: 12 patients underwent left iliac fossa end colostomy and 2 patients right iliac fossa end ileostomy
Outcome Measures: Time spent on bowel care per week; independence in bowel care; quality of life

1. Colostomy patients (n=12): mean time spent on bowel care per week before stoma formation was 8.8 h (0.6-12.2) compared with 1.4 h (0.3-3.5) after; 50% of these patients were independent in bowel care before, 92% independent after; 10 patients claimed that the colostomy had a beneficial effect on their quality of life
2. Illeostomy patients (n=2): mean time spent on bowel care per week before ileostomy was 17.5 h and this was unchanged after ileostomy formation. 1 subject decreased the time he spent on bowel care from 28 h to 14 h; the other developed complications and his time increased from 7 h to 21 h.

Munck et al. 2008;
Belgium
Downs & Black  = 13
Case-series
N = 23

Population: 23 SCI subjects who had a colostomy in the digestive surgery department of Brugmann Hospital between Jan 1996 and Dec 2005 (age range 22-72).
Treatment: Intestinal stoma formation
Outcome Measures: Demographic information and medical information on the stoma formation and complications, collected from patients’ medical records; quality of life questionnaire

1. 10 subjects had a stoma for perineal wounds
2. Average time spent on bowel care per week decreased from 5.95 hr prior to stoma formation to 1.5 hr after
3. Of the 10 patients, 3 reported cutaneous irritations and 1 reported detachment of the pocket
4. Of the 10 patients, 9 reported having much easier bowel care since the stoma formation, and 6 felt that the stoma had given them greater independence.

Luther et al. 2005; USA
Downs & Black = 12
Post-test
N=370

Population: Patients in 6 centers that were selected to be representative of the 23 Veteran Affairs SCI centers. Survey respondents with colostomies were matched to controls based on age, year of injury, classification of paralysis and marital status by calculating propensity scores. Comparison of 74 patients with a sample of 296 matched controls without colostomies.
Treatment: Colostomy
Outcome Measures: Bowel care-related items; quality of life

1. No statistically significance differences were found in the demographic distributions for cases and controls.
2. No statistically significant differences were reported between the cases and the matched controls for any of the bowel care outcomes or bowel-related quality of life both groups reported low incidence of accidental/unplanned bowel movements and falls related to bowel care.
3. Mean responses to the quality of life items were generally very high; however, a large number of respondents continue to express dissatisfaction with bowel care.

Safadi et al. 2003; USA
Downs & Black  = 13
Post test
N = 45

Population: 21 subjects with tetraplegia, 24 subjects with paraplegia (44 male, mean age 55.9), 20 right side colostomy, 21 left side, 7 underwent an ileostomy
Treatment: Colostomy
Outcome Measures: quality of life, colonic transit time, bowel care time

1. Colonic transit time was significantly longer in the right side colostomy compared to the left side colostomy and the ileostomy.
2. In all groups, quality of life increased and bowel care time decreased

Frisbie et al. 1986; USA
Downs & Black = 9
Post-test
N=20

Population: 19 males and 1 female; Age: median 55, range 27-75; Level of injury: 9 cervical, 11 thoracic; Duration of the enterostomies at time of interview was 3 months to 14 years, median 11 months
Treatment: A total of 24 enterostomies were carried out in 20 subjects: 17 sigmoid colostomies, 5 transverse colostomies, and 2 ileostomies.
Outcome Measures: Bowel care time, bowel care frequency, bowel care related complaints, quality of life

1. Bowel care frequency increased from a median 3 times/week (range 2-7) before enterostomy to a median 7 times/week (range 4-14) after enterostomy
2. Bowel care duration diminished from a median 6 hours/week (range 0.7-14 hours) before enterostomy to a median 1 hour/week (range 1.3-7 hours) after enterostomy
3. The number of patients affected by bowel care related complaints pre- vs. post-operatively, respectively, were as follows: abdominal pain in 10 vs. 2, fecal leakage in 8 vs. 0, anorexia in 7 vs. 2, flatus in 9 vs. 4, sweating  in 4 vs. 2 and foul odor in 4 vs. 5
4. Bowel care programs were simplified

Branagan et al. 2003; UK
 Downs & Black = 11
Case Series
N=32

Population: Age at injury: average 28.9 yrs; 10 subjects with cervical injuries, 18 with thoracic, and 3 with lumbar injuries; length of injury: mean 17.1 years
Treatment: Medical records were reviewed for patients who had a colostomy.
Outcome Measures: Results of surgery

1. The average time spent on bowel care per week decreased from 10.3 hours to 1.9 hours (p<.0001).
2. 18/31 patients felt the colostomy gave them greater independence.
3. 25 patients wished they had been offered a stoma earlier.
4. No patients wanted a stoma reversal.

Stone et al. 1990; USA
 Downs & Black = 11
Case Series
N=7

Population: Mean age 51.6 years, level of injury C4-T10; length of injury mean 15.7 years
Treatment: Medical records were reviewed for patients who had undergone a colostomy
Outcome Measures: Efficacy of colostomy.

1. All seven patients who had colostomy performed as an adjunct to the treatment of perianal pressure ulcers successfully healed their ulcers.
2. The amount of time spent on bowel care decreased dramatically in the patients with prolonged bowel care.

Rosito et al. 2002; USA
 Downs & Black = 8
Case Series
N=27

Population: mean age=62.9 years; 26 males, 1 female, level of injury range=C4-L3; 17 subjects with complete and 10 with incomplete injuries; mean length of injury=25.8 years
Intervention: Colostomy
Outcome Measures: Quality of Life questionnaire with 5 domains: physical health, psychosocial adjustment, body image, self-efficacy, and recreation/leisure

1. Quality of life improved significantly (p<0.0001) after colostomy.
2. All 27 patients were satisfied, 16 very satisfied
3. Colostomy reduced the number of hospitalizations caused by chronic bowel dysfunction by 70.4%.
4. After colostomy, the average amount of time spent on bowel care was reduced from 117.0 min/day to 12.8 min/day (p<0.0001).
5. Significant improvements were recorded in the areas of physical health, psychosocial adjustment, and self-efficacy.