Quality of Life Concepts

Secondary Health Conditions

Neurogenic Bowel Dysfunction (NBD) Score

Description: The NBD is a symptom-based score for neurogenic bowel dysfunction that takes into account both constipation and fecal incontinence, and weighs each symptom of NBD according to its impact on quality of life (QoL; in particular to social aspects). It is used for the clinical assessment of colorectal and anal dysfunction in persons with spinal cord injury (SCI) [1].

Format: 10 items including questions about background parameters, fecal incontinence, constipation, obstructed defecation, and impact on QoL.

Scoring: Scores can range from 0 (very minor bowel dysfunction) to 47 (severe bowel dysfunction). Each item is assigned a score based on odds ratios for associations between items and impact on QoL.

Administration and Burden: Self-administered; Less than 5 minutes.

Psychometrics for SCI: The NBD score was constructed from items with acceptable reproducibility and validity that were significantly associated with impact on QoL [1].

Languages: The NBD has been translated into Danish, German, Italian, and Swedish, but these translations may not have undergone a full linguistic validation process and may require further work to be suitable for use.

QoL Concept: The NBD is a Health-Related QoL measure of Subjective Well-Being, which corresponds to Boxes C (achievements; health-related QoL), D (individual expectations and priorities), and E (subjective evaluations and reactions) of Dijker’s Model.

Permissions/Where to Obtain: Copyrighted; The NBD can be obtained from Dr. Krogh at the Aarhus University Hospital in Aarhus, Denmark.


  1. Krogh K, Christensen P, Sabroe S, Laurberg S. Neurogenic bowel dysfunction score. Spinal Cord 2006;44:625-31.


Bowel Dysfunction SCI Studies: Two cross-sectional surveys; one prospective, randomized controlled multi-center trial.

  1. Krogh K, Christensen P, Sabroe S, Laurberg S. Neurogenic bowel dysfunction score. Spinal Cord 2006;44: 625-31.

  2. Liu CW, Huang CC, Yang YH, Chen SH, Weng MC, 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.

  3. Christensen P, Bazzocchi G, Coggrave M, Abel R, Hultling C, Krogh K, Media S, Laurberg S. Outcome of transanal irrigation for bowel dysfunction in patients with spinal cord injury. J Spinal Cord Med 2008; 31:560-67.

Sensitivity to Impact: In their validation study of the Neurogenic Bowel Dysfunction (NBD) score, Krogh et al. (2006) showed that NBD scores among patients with SCI (N = 424) reporting no, little, some, or major impact on QoL were significantly different to one another. In addition, several items on the NBD showed that the impact on QoL increased with the severity of symptoms.

Liu et al. (2009) showed that persons with SCI (N = 128) with minor NBD had the highest scores on the SF-36, whereas persons with severe NBD had the lowest scores. Significant differences were found on the Physical Functioning and Physical Component Summary sub-scores of the SF-36, supporting the idea that NBD scores were associated with both of these subscales.

Christensen et al. (2008) compared symptoms of neurogenic bowel dysfunction in patients with SCI (N = 62) at baseline and after 10 weeks of treatment with transanal irrigation. Scores on the NBD improved from baseline to termination, but that reduction in impact on QoL depended on completeness of injury, sex, ability to walk, and study center.

Suggestions for Use: The NBD score appears to be sensitive to the impact of SCI-related bowel dysfunction and demonstrates clinical utility.Given that the NBD does not clearly define the specific QoL aspects that are impacted, one recommendation is to use it with another measure of QoL to clarify which QoL construct it is assessing. This measure has been endorsed by the Spinal Cord Outcomes Partnership Endeavor (SCOPE) [1], which is a broad-based international consortium of scientists and clinical researchers representing academic institutions, industry, government agencies, not-for-profit organizations and foundations. However, further work is recommended to improve its clinical and psychometric properties.

Additional References:

  1. Alexander MS, et al. Outcome measures in spinal cord injury: Recent assessments and recommendations for future directions. Spinal Cord 2009:1-10.
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