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

Abstract

Retrospective analysis. In patients with spinal cord injury, limitations in upper extremity (UE) motor function are cited as a reason for the lack of adherence to clean intermittent catheterization (CIC). By examining the UE function in spinal cord injury (SCI) patients, we aim to provide insight into why CIC 'dropout' occurs and determine a more appropriate target percentage for CIC in this patient population. United States centers participating in National Spinal Cord Injury Database (NSCID). We assessed discharge data from the 2006 to 2012 NSCID. Neurologic motor scores for C5 to C8 (involved in UE movement) were transformed into a binary variable consisting of the ability ('strong') or the inability ('weak') to achieve active motion against resistance. We generated an algorithm based on expert opinion and published literature to categorize a person's ability to perform CIC by the UE function alone. Of the 4481 patients evaluated, 77.3% were unable to volitionally void. Of this subset, 58.8% were categorized as able to catheterize, 12.9% as possibly able, 4.3% as only able with surgical assistance and 23.3% as unable. Among patients discharged with an indwelling catheter, 33.4% had adequate UE function for CIC. Among patients performing CIC at discharge, 14.1% had inadequate UE function for self-catheterization. CIC dropout may occur at least, in part, because of inadequate UE motor function. In a 'best-case' scenario, ~76% of patients with SCI who cannot volitionally void could potentially perform CIC given appropriate assistance.