Activities of Daily Living Level is Associated With Recovery of Catheter-Free Urination Among Patients Hospitalized in an Acute Care Hospital.

INTRODUCTION

To examine the Activities of Daily Living (ADL) level required to achieve catheter-free urination in cases where a urinary catheter was inserted due to urinary retention, urination difficulty, or urinary incontinence in an acute care hospital.

METHODS

This study included patients who were originally capable of self-urination but required rehabilitative therapy and intervention by the multidisciplinary urination care team for difficulty in removal of indwelled Foley catheter during hospitalization. The primary outcome was catheter-free independent urination. Patients who achieved urinary independence through self-catheterization for prolonged neurogenic bladder dysfunction were excluded. ADL scores before and after the intervention were evaluated using the Functional Independence Measure (FIM), which was consisted of motor FIM (mFIM), cognitive FIM, and total FIM, with and without deduction for urinary control score (-UC). Logistic regression analyses were performed to identify factors associated with independent urination, and Receiver Operating Characteristic (ROC) curve analysis was conducted to determine the appropriate cutoff.

RESULTS

The study included 87 cases (72.8 ± 12.4 years old, male:female = 51:36). Catheter-free urination was achieved in 43 (49%) patients. There were no significant differences between the catheter-dependent and catheter-free groups in terms of gender, age, hospitalized departments, treatment methods, total duration of admission, duration of intervention, discharged destination, and comorbidities. At the end of the intervention, the FIM scores were all significantly higher in the catheter-free group than in the catheter-dependent group. To achieve catheter-free urination, mFIM-UC at the end of the intervention was the only statistically significant corelate (p < 0.001). In the ROC analysis, the AUC of mFIM-UC at the end of the intervention was 0.834, and the optimal cutoff value was 30 points (full score 84), with a sensitivity of 0.91 and specificity of 0.66.

CONCLUSION

ADL as represented by mFIM is a major correlate of catheter-free urination.