Longitudinal Trajectories of Clean Intermittent Catheterization Responsibility in Youth with Spina Bifida.

Abstract

PURPOSE\nClean intermittent catheterization (CIC) responsibility among youth with spina bifida is not well-studied. We sought to determine longitudinal trajectories of CIC responsibility to examine the transition of CIC responsibility from caregiver- to self-CIC.\n\n\nMATERIALS AND METHODS\nWe performed a secondary analysis of a prospective cohort study of youth with spina bifida. Participants ages 8-15 years old originally recruited from four hospitals and a statewide spina bifida association were followed every 2 years. Participants who required CIC were included. Group-based trajectory modeling was used to isolate distinct trajectories of CIC responsibility, which was the primary outcome and was graded from caregiver-CIC to shared-CIC to self-CIC. Predictors of trajectory group membership were entered into multivariate logistic regression models and included various demographic, clinical, and psychosocial characteristics, including CIC adherence and CIC mastery.\n\n\nRESULTS\nOf 140 youth in the original cohort study, 89 met eligibility criteria for this study. Mean age was 11 years old at enrollment; 93% had myelomeningocele. Two distinct trajectory groups emerged: 17% had a low-flat trajectory, and 83% had a high-increasing trajectory of CIC responsibility, with shared-CIC by age 8-9 years old and increasing self-CIC responsibility thereafter. Significant predictors of group membership in the high-increasing trajectory group included less severe spinal lesion levels, higher CIC mastery, and lower CIC adherence.\n\n\nCONCLUSIONS\nNearly 1 in 5 youth with spina bifida in our cohort persistently required caregiver-CIC over time, while the remainder achieved shared-CIC responsibility by age 8-9 years old with increasing self-CIC responsibility thereafter.