Is disability measured by FIM a predictor for successful self-intermittent catheterization in neurological patients?

OBJECTIVE: Self-clean intermittent catheterization (CIC) is a part of the arsenal of treatment strategies of neurogenic bladder (1). The acquisition of this technique depends on environment and parameters related to the patients, that can be measured by the FIM score (Functional Independence Measure), validated in various neurological populations (2). The objective of this study is to determine whether disability, as measured by the FIM, is predictive of the acquisition and the retention of CIC.

MATERIALS/PATIENTS AND METHODS: All neurological patients consulting for learning self-CIC between 2011 and 2015 with disability evaluated by FIM were included retrospectively. Demographic and medical characteristics together with the successful acquisition of self-CIC were collected at the end of the learning session, as well as retention at 1 month and between 6 and 12 months. Association between motor (FIMmot), cognitive (FIMcog) scores and success for self-CIC was tested by uni- and multivariate logistic regression models.

RESULTS: Of 460 patients (mean age 52.0±14.3 years; women: 62.4%), 54.8% were diagnosed with multiple sclerosis, 16.5% of "medical" spinal cord condition, 4.6% of spinal cord injury, 14.3% of peripheral neuropathy, 3.7% of neurodegenerative disorders and 3.0% of brain condition. The mean FIMmot and FIMcog scores were 185.1±27.5 and 4.1±31.6. The success rate was 89.6%, with 75.5% holding at 1month and 60.1% at 6-12months. FIMmot and FIMcog scores were associated with success in self-CIC (P<0.001) and retention at 1month (P<0.05). Between 6 and 12 months, only FIMcog remained associated (P=0.003). After adjustment for age, BMI, pathology and social isolation, FIMmot and FIM cog scores as well as male gender were associated with success (OR [CI 95] respectively: 1.02 [1.01-1.03], 1.18 [1.07-1.29], 0.25 [0.09-0.57]). These variables were also associated with retention at 1month and between 6 and 12months (P<0.001).

DISCUSSION/CONCLUSION: FIMmot and FIMcog scores are independent predictors of successful self-CIC acquisition and retention among neurological patients. A significant clinical threshold is to be defined in order to select the best candidates for self-CIC and to propose tailored protocols of CIC acquisition.