Behavioral intervention for bladder control and its impact on quality of life in persons with traumatic paraplegia: A one-arm interventional study

Abstract

Background: Injury to spinal cord results in many neurological problems, and bladder dysfunction is one of the major factors affecting quality of life (QOL). Improvement in bladder control leads to improvement of psychosocial well-being related to urinary incontinence, thereby enhancing QOL. The effect of behavioral intervention (BI) on bladder control is well documented in patients with urinary incontinence. However, very few evidences are available on its effect in patients with traumatic paraplegia in Indian context. Objectives: The study objective was to determine the effect of BI on bladder control and QOL in patients with traumatic paraplegia and to find the relationship between status of bladder control and QOL. Study Design: This was a one-arm interventional study design. Methods: Initial screening was done by using the American Spinal Injury Association (ASIA) Impairment Scale, and thirty six traumatic paraplegics were recruited for the study. BI along with traditional bladder management was provided to them for 8 weeks, and after this period, home exercise program was prescribed. Pre- and postintervention data were recorded using Urogenital Distress Inventory short form (UDI-6) and Incontinence QOL (IQOL). Follow-up data were recorded 6 months after completion of intervention to measure the retention effect. Results: Friedman test showed a significant difference (P = 0.000 and 95% confidence interval [95% CI]: 0.000–0.080) across preintervention, postintervention, and follow-up data for both outcome measures. Post hoc Wilcoxon signed-rank test showed a significant difference (P = 0.000 and 95% CI: 0.000–0.080) between preintervention and postintervention scores as well as preintervention and follow-up scores for both the outcome measures. No significant difference was noted on analysis of postintervention and follow-up scores (P=0.472 and 95% CI: 0.026-0.052) for UDI-6 and (P=0.743 and 95% CI:0.000-0.0130) for IQOL. When preintervention scores of UDI-6 and IQOL were correlated using Kendall's tau correlation coefficient, it gave a high negative correlation (−0.725), which implied that the poorer status of bladder control is related to poorer QOL. Conclusion: BI was an effective technique in improving bladder control, aid to faster improvement when used along with other traditional bladder management techniques in patients with traumatic paraplegia leading better QOL seen over a period of 6 months.