Original research| Volume 100, ISSUE 10, P1939-1944, October 2019

Validation of Upper Extremity Motor Function as a Key Predictor of Bladder Management After Spinal Cord Injury



      To validate if better upper extremity (UE) motor function predicts clean intermittent catheterization (CIC) adoption and adherence after spinal cord injury (SCI) using a validated instrument (as opposed to prior research using scales based on expert opinion).


      We examined data from the Neurogenic Bladder Research Group SCI registry, a multicenter, prospective, observational study assessing persons with neurogenic bladder following SCI. All participants who were unable to volitionally void and were >1 year post injury were included. Participants were dichotomized into those performing CIC vs those using other bladder management methods. In addition to demographic and clinical characteristics, UE motor function was examined using the SCI-Fine Motor Function Index using validated categorization levels: (1) no activities requiring hand function, (2) some activities involving gross hand movement, (3) some activities requiring dexterity or coordinated UE movement, or (4) most activities requiring dexterity and coordinated UE movement. Associations were examined using logistic regression.


      Multicenter study.


      Registry participants unable to volitionally void after SCI (N=1236).


      Not applicable.

      Main Outcome Measure

      Upper extremity motor function association with CIC.


      A total of 1326 individuals met inclusion criteria (66% performing CIC, 60% male, and 82% white). On multivariate analysis, better UE motor function was associated with a statistically increased odds of performing CIC (odds ratio, 3.10 [Level 3] and odds ratio, 8.12 [Level 4] vs Levels 1 and 2 [P<.001]).


      In persons with SCI who are unable to volitionally void, UE motor function is highly associated with CIC. These results validate prior findings and continue to suggest that following SCI, the degree of preserved UE motor function is associated with CIC more than any other factor.


      List of abbreviations:

      BMI (body mass index), CIC (clean intermittent catheterization), OR (odds ratio), SCI (spinal cord injury), SF-12 (12-Item Short Form Health Survey), UE (upper extremity)
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        • Anderson K.D.
        Targeting recovery: priorities of the spinal cord-injured population.
        J Neurotrauma. 2004; 21: 1371-1383
        • Ditunno P.L.
        • Patrick M.
        • Stineman M.
        • Ditunno J.F.
        Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study.
        Spinal Cord. 2008; 46: 500-506
        • Hagen E.M.
        • Rekand T.
        Management of bladder dysfunction and satisfaction of life after spinal cord injury in Norway.
        J Spinal Cord Med. 2014; 37: 310-316
        • Hicken B.L.
        • Putzke J.D.
        • Richards J.S.
        Bladder management and quality of life after spinal cord injury.
        Am J Phys Med Rehabil. 2001; 80: 916-922
        • Nevedal A.
        • Kratz A.L.
        • Tate D.G.
        Women's experiences of living with neurogenic bladder and bowel after spinal cord injury: life controlled by bladder and bowel.
        Disabil Rehabil. 2016; 38: 573-581
        • Oh S.J.
        • Ku J.H.
        • Jeon H.G.
        • Shin H.I.
        • Paik N.J.
        • Yoo T.
        Health-related quality of life of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury.
        Urology. 2005; 65: 306-310
        • Simpson L.A.
        • Eng J.J.
        • Hsieh J.T.
        • Wolfe D.L.
        The health and life priorities of individuals with spinal cord injury: a systematic review.
        J Neurotrauma. 2012; 29: 1548-1555
        • Ord J.
        • Lunn D.
        • Reynard J.
        Bladder management and risk of bladder stone formation in spinal cord injured patients.
        J Urol. 2003; 170: 1734-1737
        • Weld K.J.
        • Dmochowski R.R.
        Effect of bladder management on urological complications in spinal cord injured patients.
        J Urol. 2000; 163: 768-772
        • Cameron A.P.
        • Wallner L.P.
        • Tate D.G.
        • Sarma A.V.
        • Rodriguez G.M.
        • Clemens J.Q.
        Bladder management after spinal cord injury in the United States 1972 to 2005.
        J Urol. 2010; 184: 213-217
        • Seth J.H.
        • Haslam C.
        • Panicker J.N.
        Ensuring patient adherence to clean intermittent self-catheterization.
        Patient Prefer Adherence. 2014; 8: 191-198
        • Walsh K.
        • Troxel S.A.
        • Stone A.R.
        An assessment of the use of a continent catheterizable stoma in female tetraplegics.
        BJU Int. 2004; 94: 595-597
        • Zlatev D.V.
        • Shem K.
        • Elliott C.S.
        How many spinal cord injury pCatients can catheterize their own bladder? The epidemiology of upper extremity function as it affects bladder management.
        Spinal Cord. 2016; 54 (287-91)
        • Zlatev D.V.
        • Shem K.
        • Elliott C.S.
        Predictors of long-term bladder management in spinal cord injury patients-Upper extremity function may matter most.
        Neurourology and urodynamics. 2018; 37: 1106-1112
        • Jette A.M.
        • Slavin M.D.
        • Ni P.
        • et al.
        Development and initial evaluation of the SCI-FI/AT.
        J Spinal Cord Med. 2015; 38: 409-418
        • Patel D.P.
        • Lenherr S.M.
        • Stoffel J.T.
        • et al.
        Study protocol: patient reported outcomes for bladder management strategies in spinal cord injury.
        BMC Urol. 2017; 17: 95
        • Ware Jr., J.
        • Kosinski M.
        • Keller S.D.
        A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
        • Krogh K.
        • Christensen P.
        • Sabroe S.
        • Laurberg S.
        Neurogenic bowel dysfunction score.
        Spinal Cord. 2006; 44: 625-631
        • Jamison J.
        • Maguire S.
        • McCann J.
        Catheter policies for management of long term voiding problems in adults with neurogenic bladder disorders.
        Cochrane Database Syst Rev. 2013; 11: CD004375
        • Patel D.P.
        • Stoffel J.T.
        • Elliott S.P.
        • et al.
        Reasons for clean intermittent catheterization cessation after spinal cord injury: results from the Neurogenic Bladder Research Group (NBRG).
        in: Western Section of the American Urologic Association - Abstracts 2018. 2018
        • Marino R.J.
        • Shea J.A.
        • Stineman M.G.
        The capabilities of upper extremity instrument: reliability and validity of a measure of functional limitation in tetraplegia.
        Arch Phys Med Rehabil. 1998; 79: 1512-1521
        • Kalsi-Ryan S.
        • Beaton D.
        • Curt A.
        • et al.
        The Graded Redefined Assessment of Strength Sensibility and Prehension: reliability and validity.
        J Neurotrauma. 2012; 29: 905-914
        • Elliott C.S.
        • Zlatev D.
        • Crew J.
        • Shem K.
        Do appreciable changes in the upper extremity motor capability to perform clean intermittent catheterization come about with time after traumatic spinal cord injury?.
        Neurourol Urodyn. 2019; 38 (975-80)