Do improvements in upper extremity motor function affect changes in bladder management after cervical spinal cord injury?

The Journal of Spinal Cord Medicine, 2024 · DOI: 10.1080/10790268.2021.1999715 · Published: January 1, 2024

Spinal Cord Injury Urology Rehabilitation

Simple Explanation

This study investigates if improvements in arm and hand function after a cervical spinal cord injury (SCI) lead to changes in how people manage their bladder, specifically regarding the use of clean intermittent catheterization (CIC). The researchers analyzed data from a large spinal cord injury database, looking at patients who had their arm and hand function assessed at discharge from rehabilitation and again one year later. The study found that while some people did improve their ability to use their arms and hands, this didn't necessarily translate into more people starting to use CIC. In fact, more people stopped using CIC than started.

Study Duration

2000-2016

Participants

1,191 subjects with cervical spinal cord injury

Evidence Level

Not specified

Key Findings

1
More patients with SCI transitioned away from CIC than converted to it within the first year after rehabilitation.
2
Significant improvements in UE motor function during the first year after rehabilitation discharge do not significantly affect bladder management decisions.
3
CIC adoption was significantly increased only in persons initially classified as “able to independently catheterize” who had been discharged with a non-CIC bladder management.

Research Summary

The study evaluated the impact of upper extremity (UE) motor function improvements on bladder management decisions, specifically CIC adoption, in patients with cervical SCI. The findings indicated that improvements in UE motor function in the first year after rehabilitation discharge did not significantly increase CIC adoption rates, and more patients discontinued CIC than started it. The authors suggest that factors beyond UE motor function, such as access to support and patient preferences, play a crucial role in long-term bladder management choices after SCI.

Practical Implications

Re-evaluate UE motor function

Healthcare providers should re-evaluate an individual’s capacity to perform CIC and then provide ongoing support for those with improved UE motor function.

Address bladder management problems

A more structured care environment, especially during the first year after discharge from acute rehabilitation might be warranted to address common bladder management problems.

Decrease time spent on bladder management

Recognizing problems and intervening prior to a subject becoming frustrated and opting for another bladder management, might decrease the time spent on bladder management, improve patient quality of life and bolster CIC adoption and adherence.

Study Limitations

1
The algorithm to predict the ability to independently perform CIC based on UE motor function examination is based on expert opinion and not formally validated.
2
The NSCID only accounts for primary bladder management method and does not account for combinations.
3
Further assessment of the reasons for never adopting CIC, especially in populations with adequate UE motor function to perform the task is needed.

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