Bladder Emptying Strategies, Active Follow-up Adherence and Barriers in Post-Discharge Spinal Cord Injury individuals: A Multiple Center Cross-Sectional Study

Hongxia Pan,1,2,* Liang Zhu,1,2,* Jingfei Xu,1,2 Mingfu Ding,1,2 Haidan Lin,3 Yang Chen,4 Xin Sun,1,2 Chengqi He,1,2 Quan Wei1,2 1Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People’s Republic of China; 3Rehabilitation Medicine Center of The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 4Sichuan China 81 Rehabilitation Center (Sichuan Provincial Rehabilitation Hospital), Chengdu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Quan Wei, Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China, Email [email protected]: Adherence plays a crucial role in the long-term management of chronic conditions, including neurogenic lower urinary tract dysfunction (NLUTD) in individuals with spinal cord injury (SCI). Poor adherence can lead to complications, reduced quality of life, and increased healthcare costs.Purpose: This study aimed to evaluate the post-discharge bladder-emptying practices and adherence to follow-up in SCI individuals with NLUTD, identifying key factors influencing adherence to improve long-term care strategies.Methods: A cross-sectional survey was conducted in Southwest China from May 1 to September 30, 2023. Online questionnaires were employed to collect data on sociodemographic characteristics, bladder emptying methods, active follow-up adherence and related barriers.Results: Out of 412 fully completed questionnaires, as for bladder-emptying method, 70.15% of respondents opted for clean intermittent catheterization (CIC) as their primary or preferred mode. CIC usage was more prevalent among participants with thoracic and lumbar SCI, while those with cervical SCI demonstrated a higher reliance on indwelling catheterization (IDC) and cystostomy. A significant 63.55% did not engage in regular hospital follow-ups participants with thoracic SCI had the lowest adherence rate (49.79%), followed by lumbar (72.62%) and cervical (77.59%) groups. Preferences for medical consultation were highest for rehabilitation physicians at 65.68%, with neurourologists following at 33.83%. Key barriers to follow-up adherence were identified as the more severity of SCI, lack of disease knowledge, increasing age, and reliance on adult children for care. In contrast, positive predictors of follow-up adherence were ample financial support and previous medical consultation experiences.Conclusion: This study revealed insufficient follow-up adherence among SCI individuals with NLUTD, with CIC emerging as the preferred method for bladder emptying strategy. Age and injury level significantly influenced adherence. To improve long-term management of NLUTD, future initiatives should focus on enhancing health education accessibility, optimizing healthcare services, and providing comprehensive financial support to high-risk groups.Keywords: neurogenic lower urinary tract dysfunction, bladder-emptying methods, surveillance, follow-up