Motavasseli Damien, Chesnel Camille, Charlanes Audrey, Menoux Diane, Charoenwong Francis, Le Breton Frédérique, Amarenco Gérard
Neuro-urology Department Tenon Hospital, APHP East Hospital Group, Paris, France.
GRC-UPMC 01 GREEN, Paris 6, Pierre et Marie Curie University, Paris, France.
Int Neurourol J. 2018 Jun;22(2):133-141. doi: 10.5213/inj.1836054.027. Epub 2018 Jun 30.
To evaluate adherence to anticholinergic therapy (AT) and clean intermittent self-catheterization (CISC) in patients with multiple sclerosis (MS) and to identify factors associated with poor adherence.
This single-center study prospectively included 49 patients suffering from MS who had been prescribed AT and/or CISC. Adherence was evaluated using a self-report questionnaire. The Expanded Disability Status Scale (EDSS), Patient Global Impression of Improvement, Mini-Mental State Examination, Urinary Symptom Profile, and Hospital Anxiety and Depression (HAD) instruments were administered, and the number of daily anticholinergic pills and/or catheterizations was noted. Whether patients were receiving concomitant intradetrusor botulinum toxin injections was assessed, as were barriers to treatment, side effects, number of spontaneous micturitions, reasons for the prescription, satisfaction, and difficulties.
Only 38% of patients were adherent to AT. Experiencing side effects was related to nonadherence (P=0.02). Only 29% of patients were adherent to CISC. More intense voiding dysfunction (P<0.001), a higher frequency of CISC (P=0.03), and a higher EDSS score (P=0.02) were associated with better adherence. Conversely, the HAD score (P<0.001), depression (P<0.001), the persistence of spontaneous micturition (P<0.001), a blocking sensation during catheterization (P=0.04), and the need to adapt one's posture or gesture to perform catheterization (P=0.04) were associated with poorer adherence.
Adherence to AT and CISC was poor in patients with MS suffering from bladder dysfunction. Several factors related to nonadherence were identified in this study, and addressing these factors might help to improve treatment adherence.
评估多发性硬化症（MS）患者对抗胆碱能疗法（AT）和清洁间歇性自我导尿术（CISC）的依从性，并确定与依从性差相关的因素。
这项单中心研究前瞻性纳入了49例已被处方AT和/或CISC的MS患者。使用自我报告问卷评估依从性。采用扩展残疾状态量表（EDSS）、患者总体改善印象、简易精神状态检查表、尿路症状概况以及医院焦虑抑郁量表（HAD）进行评估，并记录每日抗胆碱能药物片数和/或导尿次数。评估患者是否同时接受膀胱逼尿肌内注射肉毒杆菌毒素，以及治疗障碍、副作用、自主排尿次数、处方原因、满意度和困难程度。
仅有38%的患者坚持AT治疗。出现副作用与不依从相关（P = 0.02）。仅有29%的患者坚持CISC治疗。更严重的排尿功能障碍（P < 0.001）、更高的CISC频率（P = 0.03）以及更高的EDSS评分（P = 0.02）与更好的依从性相关。相反，HAD评分（P < 0.001）、抑郁（P < 0.001）、自主排尿的持续存在（P < 0.001）、导尿时的阻塞感（P = 0.04）以及进行导尿时需要调整姿势或动作（P = 0.04）与较差的依从性相关。
膀胱功能障碍的MS患者对AT和CISC的依从性较差。本研究确定了几个与不依从相关的因素，解决这些因素可能有助于提高治疗依从性。
