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Functional independence measure predicts the outcome of clean intermittent catheterization training in patients with multiple sclerosis - 13/04/22

Doi : 10.1016/j.rehab.2021.101539 
Rebecca Haddad a, b, , Nicolas Turmel a, Philippe Lagnau a, Camille Chesnel a, Frédérique Le Breton a, Gérard Amarenco a, Claire Hentzen a
a Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP–HP, Hôpital Tenon, 75020 Paris, France 
b Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium 

Corresponding author at: Hôpital Tenon, Service de Neuro-Urologie, 4, rue de la Chine, 75020 Paris, France.Hôpital Tenon, Service de Neuro-Urologie4, rue de la ChineParis75020France

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Highlights

Clean intermittent catheterization (CIC) is the reference treatment of voiding dysfunction related to neurogenic bladder.
Outcome of CIC training depends on motor and cognitive functions in people with multiple sclerosis (PwMS).
The Functional Independence Measure (FIM) is a validated tool to assess disability in PwMS.
FIM is an independent predictor of successful CIC training in PwMS.

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Abstract

Background

Clean intermittent catheterization (CIC) is the reference treatment of urinary retention in people with multiple sclerosis (pwMS). Predicting which patients could use this treatment, based on their motor and cognitive abilities, is crucial.

Objectives

To determine whether the Functional Independence Measure (FIM), used to assess degree of disability, can predict the outcome of CIC training in pwMS.

Methods

All pwMS attending a tertiary neuro-urology department between 2011 and 2019 and eligible for CIC were included in this retrospective study. Level of disability was assessed with the FIM by an occupational therapist. Success for learning CIC, defined as the ability to perform at least 2 trials of the technique, was recorded at the end of the session by a continence nurse and a physiatrist. The association between the FIM and success for learning CIC was assessed by multivariable analysis.

Results

We included 395 patients (mean [SD] age 49.8 [12.0] years; 70% women). More than half of patients had relapsing-remitting disease, and the Expanded Disability Status Scale score was6. Mean FIM total, motor and cognitive scores were 108.0 (14.2), 75.9 (12.3) and 32.1 (3.7), respectively (maximal scores: 126, 91 and 35). At the end of the session, 87% of patients were successful in learning CIC. After adjustment of potential confounding variables including age, sex, obesity and EDSS score, FIM total, motor and cognitive subscores were significantly associated with success (odds ratio [95% confidence interval] 1.06 [1.03–1.08], 1.05 [1.03–1.08], 1.21 [1.12–1.32], respectively).

Conclusions

FIM was an independent predictor of successful CIC training in pwMS. A 1-point increase in FIM was associated with 6% increased odds of successfully mastering the CIC technique. A widespread use of the FIM could help determine the different cognitive and/or motor objectives that need to be improved before CIC teaching.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Neurogenic lower urinary tract dysfunction, Clean intermittent catheterization, Functional independence measure, Disability, Multiple sclerosis


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© 2021  Pubblicato da Elsevier Masson SAS.
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Vol 65 - N° 2

Articolo 101539- marzo 2022 Ritorno al numero
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