Department of Physical Medicine and Orthopedic Surgery, Ghent University Hospital, Ghent, Belgium -
Department of Urology, Ghent University Hospital, Ghent, Belgium.
Eur J Phys Rehabil Med. 2022 Jun;58(3):397-404. doi: 10.23736/S1973-9087.21.07104-5. Epub 2021 Oct 15.
Little is known about the relationship between sleep disruption due to nocturnal bladder emptying and Quality of Life in patients with spinal cord injury.
The aim of this study was to evaluate the possible influence of number of nocturnal bladder emptying, bladder emptying method and nocturnal incontinence on the Quality of Life of patients with spinal cord injury.
The design of this paper is a cross-sectional descriptive study.
The setting is in- and outpatient.
Seventy-nine patients aged between 18 and 77 years with SCI in a first rehabilitation period or follow-up.
Patients were asked to complete Short Form-36 and Incontinence Quality of Life questionnaires and a medical information form. Independent samples t-tests and ANOVA were used to compare scores between groups.
The response rate was 71 out of 79 (89%; 51 males and 20 females). 16 paraplegic and 4 tetraplegic patients were chronic, 29 paraplegic and 22 tetraplegic patients were in rehabilitation therapy or had finished this treatment recently. The paraplegic group had a significantly better Short Form-36 total score and emotional function score, while the tetraplegic group had a significantly better Incontinence Quality of Life total score and avoidance and limiting behavior score. The paraplegic patients with 0-1 nocturnal bladder emptying had better Short Form-36-derived Quality of Life than those with ≥2 emptying. Quality of Life score was not associated with gender, leg oedema, incontinence, or acute/chronic group. Incontinence Quality of Life score was significantly better for patients with incomplete spinal cord injury. Fully completed questionnaires were returned by 36 patients; at least 1 item was missing for 35 participants.
General Short Form-36-derived Quality of Life was better for the paraplegic population. Incontinence-related Quality of Life was better in tetraplegic patients, most of whom used suprapubic catheterization. Paraplegic patients had compromised sleep and Quality of Life when the patient had to wake up two or more times at night to empty the bladder by voiding or intermittent catheterization. The high number of incomplete responders indicates the shortcomings of Quality-of-Life questionnaires for wheelchair-bound patients with spinal cord injury.
The use of suprapubic catheterization should be considered to improve Quality of Life for tetraplegic patients. For paraplegic patients, we must focus urological policy on aiming to reduce the number of nighttime bladder emptying to one or none.
关于因夜间膀胱排空导致的睡眠中断与脊髓损伤患者生活质量之间的关系知之甚少。
本研究旨在评估夜间膀胱排空次数、排空方式和夜间尿失禁对脊髓损伤患者生活质量的可能影响。
本文设计为横断面描述性研究。
住院和门诊。
79 名年龄在 18 至 77 岁之间的首次康复或随访期的脊髓损伤患者。
患者需完成简明 36 项健康调查量表和尿失禁生活质量问卷以及一份医疗信息表。采用独立样本 t 检验和方差分析比较组间评分。
79 例患者中 71 例（89%；51 名男性和 20 名女性）做出了回应。16 例截瘫患者和 4 例四肢瘫患者为慢性，29 例截瘫患者和 22 例四肢瘫患者正在接受康复治疗或已完成治疗。截瘫组的简明 36 项健康调查量表总分和情绪功能评分明显更好，而四肢瘫组的尿失禁生活质量量表总分和回避及限制行为评分明显更好。夜间膀胱排空 0-1 次的截瘫患者生活质量优于排空 2 次或以上的患者。生活质量评分与性别、腿部水肿、尿失禁或急性/慢性组无关。不完全性脊髓损伤患者的尿失禁生活质量评分明显更好。36 名患者完整地完成了问卷；35 名参与者至少遗漏了 1 项。
截瘫人群的简明 36 项健康调查量表衍生的生活质量更好。使用耻骨上导管的四肢瘫患者的尿失禁相关生活质量更好。当患者必须夜间醒来两次或以上通过排尿或间歇性导尿排空膀胱时，截瘫患者的睡眠和生活质量会受到影响。大量不完全应答者表明，脊髓损伤的轮椅患者使用生活质量问卷存在缺陷。
应考虑使用耻骨上导管以改善四肢瘫患者的生活质量。对于截瘫患者，我们必须将泌尿科政策重点放在减少夜间膀胱排空次数至 1 次或无。
