Search

Bowel dysfunction is a frequent and serious side effect of opioid analgetics. In spite of its common occurrence, in the course of clinical routine, it is frequently ignored or underestimated. Authors of the analysed literature widely agree that a prophylactic and routine pharmacotherapy is necessary. For this purpose, laxatives, enemas and suppositories, prokinetic agents and opioid antagonists can be considered. Bulk-forming laxatives did not prove to be effective, since the quantity of fluid intake required for the action usually cannot be provided. Furthermore, the benefit of emollient agents is doubted. As a monotherapy they are not sufficient. By contrast, stimulant and osmotic laxatives proved to be active. Prokinetic drugs are not recommended because of their serious side effects. Effective abatement of opioid-induced obstipation by opioid antagonists has been proven in numerous studies. However, the loss of analgesia and opioid withdrawal symptoms were described as adverse effects. Development of quaternary opioid antagonists such as methylnaltrexone was allowed for mitigating these adverse effects.

This study was conducted to examine the inter-rater reliability of the "Functional Independence Measure" (FIM). The FIM is an assessment to determine the functional independence of patients with disabilities. It consists of eighteen items to assess activities of daily living. The degree of independence is measured by a seven point ordinal scale. The inter-rater reliability was examined by a convenience sample of 128 assessments with the FIM. Fifteen nurses assessed thirty patients with brain injuries in a centre for rehabilitation. The design was correlational. The degree of agreement between the assessments was calculated by Cohen's Kappa coefficients. The Kappa coefficients of the assessments were between kappa = 0.56 and kappa = 0.78; the median of the Kappa coefficients is kappa = 0.65. This indicates a moderate to high inter-rater reliability of the FIM when used by nurses for the assessment of patients with head injuries.