Age and factors associated with self-clean intermittent catheterization in patients with spina bifida.
T J Atchley, P P Dangle, B D Hopson and 5 others
PMID 30507589WHAT IT FOUND
In 64 spina bifida patients with transition data, median age at self-catheterization independence was 9 years, and 71.9% were independent by age 10.
After age 10, Medicaid and thoracic spinal lesions were linked with less self-catheterization independence.
Key findings
01Among 64 patients with documented transition ages, the median age at transition from caregiver to self-CIC was 9 years, and 46 of 64 (71.9%) had transitioned by age 10.
02Among 287 patients aged 10 years or older using CIC at last follow-up, 175 (61.0%) were self-CIC and 112 (39.0%) were caregiver-dependent.
03Medicaid insurance status and thoracic-level spinal lesions were independently associated with lower likelihood of self-CIC.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only 64 of 206 patients who self-CIC had a documented age at transition, so the transition-age estimate comes from a small subset. The 64 patients with transition data differed from the 142 patients without documented transition data in community ambulation status: 49 of 64 (76.5%) versus 91 of 142 (64.1%). Transition ages were not collected prospectively and were based on caregiver report, so recollection bias is possible. The study is retrospective and single-center, and it reports associations, not proven causes or tested effects. The registry did not include cognitive function, grade level, parental education, health literacy, occupation, or whether catheterization was through a native or surgically created urethra. Only 25 (8.7%) patients had a non-MMC diagnosis, which may be too small to judge whether diagnosis affects independence. Social and cultural barriers were not analyzed in the present data.
Declared interests
The authors declared no financial conflicts of interest relevant to the manuscript. The publication types list NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that waiting until adolescence will make self-catheterization independence happen. In patients older than 10 years, age at last follow-up was not significantly associated with self-CIC, and the study did not test any intervention to improve independence.