Presentation Authors: Christopher Elliott, San Jose, CA, Sara Lenherr*, Jeremy Myers, Salt Lake City, UT, John Stoffel, Ann Arbor, MI, Blayne Welk, Ontario, Canada, Sean Elliott, Minneapolis, MN, Kazuko Shem, San Jose, CA
Introduction: In those unable to volitionally void after spinal cord injury (SCI), clean intermittent catheterization (CIC) is considered the gold standard in bladder management. Despite physician recommendation however, many persons with SCI choose alternative bladder management methods. Our prior research has identified that increased upper extremity (UE) motor function is highly predictive of increased CIC adoption and adherence after SCI. Our findings however have been questioned as the UE motor function scale used was based on expert opinion only. Our aim was to reexamine the role of UE motor function using a distinct validated instrument.
Methods: We examined the NBRG registry, a multicenter, prospective, observational study assessing patient reported outcomes among persons with SCI. We included all participants who were unable to volitionally void one year or more post-injury. Participants were dichotomized by bladder management (CIC vs other). In addition to demographic and clinical characteristics, UE motor function was examined using the SCI-Fine Motor Function Index employing a validated categorization scheme ( 1. no activities requiring hand function, 2. some activities involving gross hand movement, 3. some activities requiring dexterity or coordinated upper extremity movement or 4. most activities requiring dexterity and coordinated upper extremity movement).
Results: A total of 1326 individuals met inclusion criteria (66% performing CIC, 60% male and 82% Caucasian). On multivariate analysis, increasing UE motor function was statistically associated with an increased odds of performing CIC; the absolute proportion performing CIC as the SCI-Fine Motor Function Index increased was 37.9%, 34.2%, 57.1% and 78.6% respectively. Increasing age, increasing years since injury, obese females, non-white race, increasing Charlson comorbidity score and worse SF-12 physical scores were all associated with a significantly decreased odds of performing CIC (Table 1).
Conclusions: In persons with SCI who are unable to volitionally void, UE motor function is highly associated with CIC adoption/adherence after SCI. These results validate our prior study findings and continue to suggest that UE motor function may predict the use of CIC more than any other factor following SCI.
Source of Funding: Source of Funding: Patient Centered Outcomes Research Institute (PCORI) CER14092138.