Clean intermittent catheterization (CIC) is the preferred bladder management method for people with chronic urinary retention, including those with spinal cord injury (SCI). Learning to manage this procedure takes time, and with rehabilitation lengths of stay shorter in recent years, people must learn to develop skill in the method when they return home, at the same time they are adjusting to the life changing event of an SCI. When people are not well prepared for CIC, they may resort to a long-term indwelling catheter or not adhere to optimal CIC frequency, both of which can contribute to urinary tract infection. In addition, decreased CIC capacity can limit their travel and contribute to less than full employment and lower quality of life. Though many are isolated from others with SCI, they are likely to have Internet access, and those using CIC should have enough hand dexterity to use a computer. People using CIC need well developed self-management skills;at a minimum they need to know how to: (1) adhere to their CIC regime;(2) self-monitor fluid intake;(3) notice early symptoms of urinary tract infectin (UTI);(4) perform CIC in a variety of situations with good technique;(5) choose optimal catheter, equipment, and lubrication;and (6) adapt to social needs. While self-management research has been done in people with other chronic conditions, no Web-based intermittent catheter self-management interventions have been developed and tested in people with SCI using CIC. This study will involve exploration, development and testing of a new Internet-based intervention for people with SCI who use CIC.
The Specific Aims are: (1) Design and develop a new CIC self-management Internet-based intervention to improve catheter-related outcomes and quality of life in people with SCI;(2) Conduct a Phase 1a/b randomized pilot study to assess the feasibility (i.e., acceptability and usability of the website application) and preliminay effectiveness of the Internet-based intermittent catheter self-management intervention;and (3) Develop and test the reliability of new/modified measures for the intervention related to CIC. The theoretical framework is based on the PI's current self-management intervention in long-term urinary catheter users combined with a conceptual and design framework of the Stanford Chronic Disease Self-management model. Specifically, we will teach awareness, self-monitoring and self-management strategies to CIC uses with SCI in an online format. Nurse telephone consultation for teaching self-management will be combined with peer leaders for online forums. Stages involve: (1) Develop an Internet-based intervention to improve self-management and outcomes related to CIC among people with SCI (2) Pretest the Internet application with five persons with SCI using CIC;and (3) Conduct a web-based six-month intervention pilot study in a randomized group of 30 with SCI using CIC (controls wait listed). Outcomes are: catheter-related adverse health outcomes (e.g., UTI, urine leakage), CIC self- management, CIC self-efficacy, health related expenditures and quality of life. Information from this study will be used to modify the Internet application for a future Phase 2 trial in a larger study.
This study will involve exploration, development and feasibility testing of a new Internet-based intervention for people with spinal cord injury who use intermittent urinary catheters. This new intervention was inductively derived from a qualitative and descriptive study by Dr. Wilde, and the study is modeled on her self- management intervention research in indwelling urinary catheter users. More effective self-management behaviors in this population may improve their health status outcomes, decrease heath care utilization, and enhance intermittent catheter-related quality of life.