Which is the best tool to predict outcome of clean intermittent self-catheterization training in patients with multiple sclerosis?

Haddad R1, Turmel N1, Chesnel C1, Le Breton F1, Amarenco G1, Hentzen C1

Research Type


Abstract Category


Abstract 428
Geriatrics and Special Population
Scientific Podium Short Oral Session 27
Conservative Treatment Multiple Sclerosis Voiding Dysfunction
1. Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Ho^pital Tenon, F-75020 Paris, France

Rebecca Haddad



Hypothesis / aims of study
Lower urinary tract symptoms, and especially voiding dysfunction are common in patients with multiple sclerosis (PwMS). Clean intermittent self-catheterization (CISC) is the reference treatment of urinary retention in PwMS. Outcome of CISC training depends on parameters related to both the patient and their environment. The patient's ability to perform CISC can be assessed using a variety of tools.  Two validated instruments, the FIM (Functional Independence Measure) and the PP-Test (Pencil and Paper Test), have been found to be associated with the success for learning CISC [1]. However, no study has determined the diagnosis performance of these tests. The objective of this study is to determine and compare the performance of these tools to predict the outcome of CISC training in PwMS.
Study design, materials and methods
All PwMS attending a tertiary neurourology department as eligible for CISC were included in this cross-sectional study. During the CISC training session, all patients were assessed by an occupational therapist and a physiatrist. Data recorded during this session included demographic and medical characteristics, as well as FIM and PP-Test scores by a continence nurse and a physiatrist. Success for learning CISC was recorded at the end of the session. Associations between FIM and PP-Test scores and success for learning CISC were assessed in univariate analysis. Diagnosis performances of FIM and PP-Test were estimated by calculating sensitivity, specificity and area under the receiver operating characteristics curve (AUC of ROC). AUC of these two tests were compared using a two-sided DeLong's test.
A total of 100 patients was included (mean age: 49.8(11.8) years; 68% of women). 44 % of these patients had a relapsing-remitting MS and the median Expanded Disability Status Scale score was 6. The most frequent urodynamic diagnoses were detrusor sphincter-dyssynergia (82%) followed by detrusor overactivity (75%).  At the end of the session, 90% of the patients succeed to learn CISC. PP-test and FIM scores were associated with success (Table 1). Optimal cut-off values for FIM and PP-Test scores were estimated, resulting in a sensitivity of 83% and 61% and a specificity of 80% and 90% respectively. AUC of ROC curves for FIM and PP-Test total scores were not significantly different (p=0.73; Figure 1).
Interpretation of results
Both FIM and PP-Test were associated with outcome after CISC training in eligible PwMS. FIM and PP-test scores were statistically significantly higher, meaning a better functioning, in the patients who succeed at the end of the CISC training session. Cut-off values of 101 and 12 respectively led to the same diagnosis performance measured by AUC.
Concluding message
FIM and PP-Test have the same diagnosis performance for the outcome of CISC training in PwMS. The choice between these tools should be guided by the assessor’s preference and the time required to perform them (PP-Test: 5’ vs FIM: 45’).
Figure 1 Figure 1. Receiver operating characteristics curves for FIM and PP-Test
Figure 2 Table 1. Association between FIM, PP-Test scores and outcome after CISC training in univariate analysis
  1. Haddad R et al. Is disability measured by FIM a predictor for successful self-intermittent catheterization in neurological patients? Ann Phys Rehabil Med. 2016;59:e103-4.
Funding None Clinical Trial No Subjects Human Ethics not Req'd 1. Non interventional study 2. Retrospective study 4. The data file has been declared to the CNIL (Commission Nationale de l'Informatique et des Libertés) according to French regulations. 5. The written consent of patients for this type of research is not required, they are informed of the possible use of their data and can oppose it. Helsinki Yes Informed Consent No
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