How many spinal cord injury patients can catheterize their own bladder? The epidemiology of upper extremity function as it affects bladder management

Zlatev, Dimitar V.; Shem, Kazuko; Elliott, Christopher S.

doi:10.1038/sc.2015.169

Cited by 34 publications

(38 citation statements)

References 19 publications

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“…Although obesity in female patients has been suggested as a barrier to CIC and has been previously linked to the decreased rate of CIC adherence after initial rehabilitation discharge in a study of 665 women with SCI, we did not identify obesity as a variable that impacted satisfaction rates with CIC in the long‐term. This may be due to the lower number of obese women in our cohort (22.2% or 55/193), which limited the power of this subgroup analysis.…”

Section: Discussionmentioning

confidence: 84%

“…However, population studies have found that only about 50% of patients with SCI use CIC as the primary bladder management method after the initial injury, and 50% of patients with SCI on CIC drop‐out at 5 years of follow up . Female sex, elevated body mass index (BMI), older age, high level of injury/tetraplegia, and impaired upper extremity motor function decreased the odds of bladder management with CIC …”

Section: Introductionmentioning

confidence: 99%

“…1 Female sex, elevated body mass index (BMI), older age, high level of injury/tetraplegia, and impaired upper extremity motor function decreased the odds of bladder management with CIC. 1,4,12 Limited data are available on patient-reported barriers to CIC. Patients who discontinue CIC have reported inconvenience, dislike of CIC, recurrent urinary tract infections (UTIs), incontinence, urethral strictures, and dependence on caregiver as the most common reasons to switch bladder management in small single-center reports.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of low urinary quality of life in spinal cord injury patients on clean intermittent catheterization

Crescenze

Myers

Lenherr

et al. 2019

Neurourology and Urodynamics

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Objective Clean intermittent catheterization (CIC) is a preferred method of bladder management for many patients with spinal cord injury (SCI), but long‐term adherence is low. The aim of this study is to identify factors associated with low urinary quality of life (QoL) in SCI adults performing CIC. Methods Over 1.5 years, 1479 adults with SCI were prospectively enrolled through the Neurogenic Bladder Research Group registry, and 753 on CIC with no prior surgeries were included. Injury characteristics, complications, hand function, and Neurogenic Bladder Symptom Score (NBSS) were analyzed. The NBSS QoL question (overall satisfaction with urinary function) was dichotomized to generate comparative groups (dissatisfied vs neutral/satisfied). Results The cohort was 32.9% female with a median age of 43.2 (18‐86) years, time since the injury of 9.8 (0‐48.2) years, and 69.0% had an injury at T1 or below. Overall 36.1% were dissatisfied with urinary QoL. On multivariable analysis, female gender (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.15‐2.31; P = 0.016), earlier injury (OR, 0.95 per year; 95% CI, 0.93‐0.97; P < 0.001), ≥4 urinary tract infections (UTIs) per year (OR, 2.36; 95% CI, 1.47‐3.81; P = 0.001), and severe bowel dysfunction (OR, 1.42; 95% CI, 1.02‐1.98; P = 0.035) predicted dissatisfaction. Level of injury, fine motor hand function, and caregiver dependence for CIC were not associated with dissatisfaction. Conclusions In a mature SCI cohort, physical disability does not predict dissatisfaction with urinary QoL but severe bowel dysfunction and recurrent UTIs have a significant negative impact. With time the rates of dissatisfaction decline but women continue to be highly dissatisfied on CIC and may benefit from early intervention to minimize the burden of CIC on urinary QoL.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of low urinary quality of life in spinal cord injury patients on clean intermittent catheterization

Crescenze

Myers

Lenherr

et al. 2019

Neurourology and Urodynamics

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“…An algorithm previously published by our group was used to characterize the ability to perform CIC on the basis of UE function alone. Specifically, neurologic motor scores for C5 through C8 (involved in the control of UE movement) were transformed and classified as: (a) able to catheterize; (b) possibly able to catheterize; (c) able to catheterize only with reconstructive surgical intervention (eg, catheterizable stoma construction or tendon transfer surgery); and (d) unable to catheterize even with reconstructive surgical intervention (Figure ) …”

Section: Methodsmentioning

confidence: 99%

Do appreciable changes in the upper extremity motor capability to perform clean intermittent catheterization come about with time after traumatic spinal cord injury?

Elliott

Zlatev

Crew

et al. 2019

Neurourology and Urodynamics

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Introduction Bladder dysfunction after spinal cord injury (SCI) often requires clean intermittent catheterization (CIC) or other management strategies. A common dilemma in those desiring to perform CIC independently but lacking the appropriate upper extremity (UE) motor function is the timing of reconstructive surgery. Methods We assessed the National Spinal Cord Injury Data Set for the years 2000‐2016. Our cohort consisted of persons with cervical SCI, who underwent complete motor examination upon discharge from rehabilitation and at 1‐year follow‐up. Using a previously published algorithm, UE motor scores were transformed to predict a patient's ability to independently perform CIC. Improvements in the predicted ability to self‐catheterize were evaluated. Results Of the 1428 individuals meeting the inclusion criteria, improvements in the predicted UE motor function necessary to independently self‐catheterize were observed in 39%, 42%, and 38% of those deemed possibly able, only able with surgical assistance, or unable to self‐catheterize at rehabilitation discharge, respectively. On multivariate analysis, only increasing Association Impairment Scale (AIS) classification and AIS classification improvement over the first year were associated with an increased odds of improving predicted CIC ability (odds ratio [OR] = 1.44 for AIS C and 1.97 for AIS D compared with AIS A, and OR = 1.90 for AIS classification improvement versus stable AIS classification, P < 0.05 for each). Conclusion Improvements in UE motor function to independently perform CIC occur in approximately 40% of persons with cervical SCI in the first year after rehabilitation discharge. Those with incomplete injuries are more likely to improve. These findings should enhance patient bladder management counseling and guide surgeons in determining an appropriate timeline for offering reconstruction.

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“…Based on the study by Zlatev et al ,36 it was assumed that 60% of patients perform IC. The total number of prevalent patients with SCI performing IC in Italy was estimated to be about 39 000 (65 000×60%), while the total number of incident patients was about 285.…”

Section: Methodsmentioning

confidence: 99%

Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses

Rognoni

Tarricone

2017

BMJ Open

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ObjectivesThis study presents a cost-effectiveness analysis comparing hydrophilic coated to uncoated catheters for patients performing urinary intermittent catheterisation. A national budget impact analysis is also included to evaluate the impact of intermittent catheterisation for management of bladder dysfunctions over a period of 5 years.DesignA Markov model (lifetime horizon, 1 year cycle length) was developed to project health outcomes (life years and quality-adjusted life years) and economic consequences related to patients using hydrophilic coated or uncoated catheters. The model was populated with catheter-related clinical efficacy data retrieved from randomised controlled trials and quality-of-life data (utility weights) from the literature. Cost data (EUR, 2015) were estimated on the basis of healthcare resource consumption derived from an e-survey addressed to key opinion leaders in the field.SettingItalian Healthcare Service perspective.PopulationPatients with spinal cord injury performing intermittent urinary catheterisation in the home setting.Main outcome measuresIncremental cost-effectiveness and cost-utility ratios (ICER and ICUR) of hydrophilic coated versus uncoated catheters and associated healthcare budget impact.ResultsThe base-case ICER and ICUR associated with hydrophilic coated catheters were €20 761 and €24 405, respectively. This implies that hydrophilic coated catheters are likely to be cost-effective in comparison to uncoated ones, as proposed Italian threshold values range between €25 000 and €66 400. Considering a market share at year 5 of 89% hydrophilic catheters and 11% uncoated catheters, the additional cost for Italy is approximately €12 million in the next 5 years (current market share scenario for year 0: 80% hydrophilic catheters and 20% uncoated catheters).ConclusionsConsidered over a lifetime, hydrophilic coated catheters are potentially a cost-effective choice in comparison to uncoated ones. These findings can assist policymakers in evaluating intermittent catheterisation in patients with spinal cord injury.

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How many spinal cord injury patients can catheterize their own bladder? The epidemiology of upper extremity function as it affects bladder management

Cited by 34 publications

References 19 publications

Predictors of low urinary quality of life in spinal cord injury patients on clean intermittent catheterization

Predictors of low urinary quality of life in spinal cord injury patients on clean intermittent catheterization

Do appreciable changes in the upper extremity motor capability to perform clean intermittent catheterization come about with time after traumatic spinal cord injury?

Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses

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