Int Neurourol J.  2018 Jun;22(2):133-141. 10.5213/inj.1836054.027.

Adherence to Anticholinergic Therapy and Clean Intermittent Self-Catheterization in Patients With Multiple Sclerosis

• Motavasseli D
• Chesnel C
• Charlanes
• Menoux D
• Charoenwong F
• Le Breton
• Amarenco G

• KMID: 2417786
• DOI: http://doi.org/10.5213/inj.1836054.027

Abstract

PURPOSE
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.

Keyword

Multiple sclerosis; Compliance; Intermittent urethral catheterization; Cholinergic antagonists

MeSH Terms

Anxiety
Botulinum Toxins
Catheterization
Catheters
Cholinergic Antagonists
Compliance
Depression
Gestures
Humans
Intermittent Urethral Catheterization
Multiple Sclerosis*
Posture
Prescriptions
Prospective Studies
Sensation
Urinary Bladder
Urination
Botulinum Toxins
Cholinergic Antagonists