مرکز منطقه ای اطلاع رساني علوم و فناوري - Associated factors with compliance to clean intermittent catheterisation in patients with spinal cord injury

Abstract :

Our pupose was to examine the compliance with clean intermittent catheterisation and determine clinical and demographical factors that can be related with the compliance in patients with spinal cord injury. Thirty-seven patients with spinal cord injury who were hospitalized for rehabilitation and recommended clean intermittent catheterisation at discharge were enrolled in the study. Information about the compliance with clean intermittent catheterisation was gathered by telephone calls. At the end of follow-up period patients were categorized as “continuing on clean intermittent catheterisation” and “reverted to indwelling catheter” and the relationship between compliance with clean intermittent catheterisation and clinical and demographical factors were investigated. Mean follow up time after discharge was 18.75±8.80 (8-34) months. It was determined that 27% patients reverted clean intermittent catheterisation to indwelling catheters and the clean intermittent catheterisation compliance rate was 73%. Compliance with clean intermittent catheterisation was significantly related to spasticity (r:0.506), maximum cystometric capacity (r:0.377), number of intermittent catheterisation applications (r:0.444), person who applies (r:0.488) and the type of the catheter (r:0.699) (p 0.05). Severe spasticity was present among 60% of the patients reverted to indwelling catheters yet only among 11.1% of clean intermittent catheterisation continuers. Maximum cystometric capacity of the patients who were continuing on clean intermittent catheterisation (438.33±118.10), were higher than the patients who were reverted to indwelling catheters (338.00±94.25). Number of intermittent catheterisation applications were 4 times a day among 77.8% of clean intermittent catheterisation compliants nevertheless 70% of patients who returned to indwelling catheters reported that they had had 6 times a day or more. Rate of self-catheterisation was 81.5% among clean intermittent catheterisation appliers and 30% in indwelling catheter users. 85.2% of patients on clean intermittent catheterisation were using hydrophilic catheters while 90% of patients on clean intermittent catheterisation had been using standard plastic catheters previously. These differences were statistically signifi cant (p 0.05). Age, sex, level of education, level and severity of spinal cord injury, type of neurogenic bladder, incontinance between catheterisation applications and duration of follow-up did not differ between two groups (p 0.05). It was concluded that compliance with clean intermittent catheterisation in spinal cord injury patients is related to spasticity, maximum cystometric capacity, how many times a day catheterisation is performed, who applies the catheter and the type of the catheter. Low degree of spasticity, high maximum cystometric capacity, few number of catheterisation in a day, patient’s own application of the catheter and usage of hydrophilic catheters were shown to increase the compliance.