Predictors of long-term bladder management in spinal cord injury patients-Upper extremity function may matter most

Clean intermittent catheterization (CIC) is the gold standard for neurogenic bladder management in most patients with spinal cord injury (SCI). There is nonetheless a lack of long-term adherence to CIC, with up to 50% discontinuance at 5-year follow-up. We hypothesize that limitations in upper extremity (UE) motor function represent a strong predictor for long-term CIC adoption.

We assessed Forms I and II data from the 2000-2013 National SCI Database. Bladder management was determined at initial discharge and 1-year follow-up. Upper extremity (UE) motor scores were transformed using a previously published algorithm to predict a patient's ability to independently self-catheterize. Uni- and multivariable logistic regression modeling was performed to assess risk factors affecting: a) a lack of CIC adoption at rehabilitation discharge, b) CIC discontinuance by 1-year follow-up (CIC "dropout"), and c) adherence to management with an indwelling catheter rather than conversion to CIC at 1-year follow-up.

For all three modeled scenarios, UE motor function represented the most significant predictor for lack of CIC adoption (OR range 2.1-6.3, P ≤ 0.003 for all). Other predictors included increasing age (OR 1.01-1.02, P ≤ 0.001 for all models) and female gender (OR 1.6-1.7, P < 0.001 for lack of CIC adoption at discharge).

Among physically limiting factors, impairment in UE motor function appears to be the most significant predictor of a lack of long-term CIC adoption at 1-year follow-up.

Neurourology and urodynamics. 2017 Oct 17 [Epub ahead of print]

Dimitar V Zlatev, Kazuko Shem, Christopher S Elliott

Department of Urology, Stanford University School of Medicine, Stanford, California., Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California.

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