Psychosocial Aspects of Health-related Quality of Life and the Association with Patient-reported Bladder Symptoms and Satisfaction after Spinal Cord Injury

STUDY DESIGN: Prospective, multi-centered, observational OBJECTIVES: To characterize the relationship between psychosocial aspects of health-related quality of life (HRQoL) and patient-reported bladder outcomes. SETTING: Multi-institutional sites in the United States, cohort drawn from North America METHODS: We performed a cross-sectional analysis of data collected as part of the multicenter, prospective Neurogenic Bladder Research Group Spinal Cord Injury (SCI) Registry. Outcomes were: Neurogenic Bladder Symptom Score (NBSS), Neurogenic Bladder Symptom Score Satisfaction (NBSS-Satisfaction), and SCI-QoL Bladder Management Difficulties (SCI-QoL Difficulties). Adjusted multiple linear regression models were used with variables including demographic, injury characteristics, and the following psychosocial HRQoL measures; SCI-QoL Pain Interference (Pain), SCI-QoL Independence, and SCI-QoL Positive Affect and Well-being (Positive Affect). Psychosocial variables were sub-divided by tertiles for the analysis. RESULTS: There were 1479 participants, 57% had paraplegia, 60% were men, and 51% managed their bladder with clean intermittent catheterization. On multivariate analysis, higher tertiles of SCI-QoL Pain were associated with worse bladder symptoms, satisfaction, and bladder management difficulties; upper tertile SCI-QoL Pain (NBSS 3.8, p <0.001; NBSS-satisfaction 0.6, p <0.001; SCI-QoL Difficulties 2.4, p<0.001). In contrast, upper tertiles of SCI-QoL Independence and SCI-QoL Positive Affect were associated with improved bladder-related outcomes; upper tertile SCI-QoL Independence (NBSS −2.3, p=0.03; NBSS-satisfaction −0.4, p<0.001) and upper tertile SCI-QoL Positive Affect (NBSS −2.8, p<0.001; NBSS-satisfaction −0.7, p<0.001; SCI-QoL Difficulties −0.7, p<0.001). CONCLUSION: In individuals with SCI, there is an association between psychosocial HRQoL and bladder-related QoL outcomes. Clinician awareness of this relationship can provide insight into optimizing long-term management after SCI.