title: Which factors make clean intermittent (self) catheterisation successful?
abstract: OBJECTIVE
  To explore which factors determine successful intermittent catheterisation.
  
  
  BACKGROUND
  Intermittent catheterisation is a safe, effective treatment and is associated with improved quality of life, although negative issues are reported. Factors which determine adherence are largely unknown. An additional qualitative study was conducted to gain insight into patient's experience with intermittent catheterisation in everyday life.
  
  
  METHODS
  A prospective multicentre study was conducted between March 2012-March 2013 with one year follow-up.
  
  
  METHODS
  Patients with a variety of diagnoses referred to the outpatient clinic, ≥18 years, performed catheterisation at least once a day for ≥3 months were included. Data were obtained by patients' specific questionnaire Visual Analog Scale of quality of life regarding voiding problems, a questionnaire about catheterisation in daily practice, King's Health questionnaire, and a short questionnaire after one year.
  
  
  RESULTS
  Of the 129 (72 male) patients, mean age 62 (22-86) years, seven died and 63 stopped, 32/63 (50%) due to recovered bladder function. Fifty-nine (47%) continued to perform catheterisation after one year. Forty-seven (86%) patients reported catheterisation had become part of their life or had a positive effect on their life. A weak correlation was found between increasing age and cessation of catheterisation. Visual Analogue Scale - score on quality of life improved for the total group. The King's Health questionnaire identified in the total group that the impact of the bladder problem in daily life, limitations in daily activities and negative emotions decreased over time.
  
  
  CONCLUSIONS
  Adherence of successful intermittent catheterisation can be influenced negatively by increasing age. However, we think catheterisation should be considered as an option for older patients. We could not conform that if intermittent catheterisation was beneficial for the patient, it would positively influence adherence. Further prospective studies on adherence of intermittent catheterisation in larger groups need to be undertaken.
  
  
  CONCLUSIONS
  After implementation of the national guideline in 2008, we were able to perform a multicentre study. This prospective study gives insight into patients who were undertaking intermittent catheterisation and which factors determine successful intermittent catheterisation adherence. After following the national guideline, we found no factors for additional interventions in assessment or coaching intermittent catheterisation. Post void residual volume turned out to be not a predictor for the necessity of intermittent catheterisation. A large group of patients could discontinue intermittent catheterisation during follow-up due to bladder function recovery. Although a weak correlation was found between increasing age and ceasing of catheterisation, we think the older can benefit from intermittent catheterisation. In the first period, additional support, for example given by a district nurse, may be necessary for this group to achieve better outcomes.
authors.affiliation: Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Hanny
authors.initials: H
authors.lastname: Cobussen-Boekhorst
authors.affiliation: Department of Rehabilitation, Sint Maartenskliniek, Ubbergen, The Netherlands.
authors.forename: Joke
authors.initials: J
authors.lastname: Beekman
authors.affiliation: Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: Edith
authors.initials: E
authors.lastname: van Wijlick
authors.affiliation: Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Schaafstra
authors.affiliation: Department of Rehabilitation, Sint Maartenskliniek, Ubbergen, The Netherlands.
authors.forename: Dirk
authors.initials: D
authors.lastname: van Kuppevelt
authors.affiliation: Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: John
authors.initials: J
authors.lastname: Heesakkers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009736:Nursing Process; D010353:Patient Education as Topic; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care; D001745:Urinary Bladder Diseases / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D014546:Urinary Catheterization; D055815:Young Adult
keywords: adherence; clean intermittent catheteri(s)zation; education; elderly; intermittent urethral catheteri(s)zation; nursing; patient compliance; quality of life; quantitative research; self-catheteri(s)zation urethral; teaching; urology