FUNCTIONALITY OF TELEMEDICINEPLATFORM IN FEMALES WITH SPINAL CORD INJURY TO MANAGE NEUROGENICBLADDER AND PREVENT URINARY TRACT INFECTIONS
L. STOTHERS 1, M. K. NIGRO1, B. SHADGAN 1, E. G. DEEGAN2,A. J. MACNAB 1, A. KAVANAGH 1;
1UrologicSciences, University of British Columbia, Blusson Spinal Cord Ctr. -Intl. Collaboration on Repair Discoveries, Vancouver, Canada,2Experimental Medicine, University of British Columbia,Blusson Spinal Cord Ctr. - Intl. Collaboration on Repair Discoveries,Vancouver, Canada.
Introduction: Urinary tractinfection (UTI) is the most frequent secondary health complicationfollowing spinal cord injury (SCI).1 It is associated withsepticemia, resistant organisms, autonomic dysreflexia, and reducedquality of life.2 In the SCI population access tospecialists is impeded by distance of clinics, economic burden andtraveling with assisted ventilation. The SCI community has identifiedUTI as a priority area for their healthcare improvement.3
Objective:Determine feasibility of home-based monitoring using telemedicine toimprove management of neurogenic bladder and prevent UTIs in SCIindividuals. Outcome measures to determine feasibility are: (1)participant compliance (2) functionality of telemedicine software (3)user satisfaction and (4) incidence of UTIs pre and post telemedicineintervention.
Methods: A prospective cohort study includingSCI participants presenting to a specialty ambulatory care centrewith history of symptomatic UTIs in the past year. Participantsserved as their own controls for a 6-month run in, then participantswere brought in to clinic for assessment and telemedicine account setup. Participants required internet access and a personal computerdevice to use telemedicine at home. At this time participants wereinstructed on how to operate telemedicine software and given suppliesto facilitate home monitoring of neurogenic bladder. These suppliesincluded a blood pressure cuff, thermometer and urine dipsticks. Onceat home participants coordinated with study personnel to arrangetelemedicine appointments online. Standardized telemedicineappointments were conducted monthly for 6-months. Upon initiation andcompletion of telemedicine appointments validated symptom scores wereperformed; The Neurogenic Bladder Symptom Score, SF-36 andQualiveen-30. Feasibility assessment included: number of completedvisits, satisfaction survey (Likert scale 6) and 6 aspects ofsoftware functionality (Likert scale 6). Participants experiencingUTIs during telemedicine intervention collected additional samples,which upon confirmation of positive culture, were frozen for geneticanalysis.
Results: Total study population of N = 54, 14 ofwhich are female. Of these 14 female subjects 9 have SCI (7 ASIA-A, 1ASIA-B, 1 ASIA-E), 3 have multiple sclerosis and 2 have spina bifida,as their cause of neurogenic bladder. 1 subject used adaptive mouthtechnology to operate computer and run telemedicine software. 3participants were required to travel over a distance 100km to accessspecialty urological care for their neurogenic bladder. 4 subjectshave completed the telemedicine intervention, 2 are activelyparticipating, 6 are still in control phase and 2 withdrew from studyafter initial contact. Of 37 telemedicine appointments scheduled withfemale participants, 34 were completed, yielding 92% compliance rate.Only 3 telemedicine appointments failed due to participants notsigning in online for scheduled appointments, yielding 8%non-compliance rate. When compared to male participants there is nostatistically significant difference in compliance rates. Of thecompleted telemedicine appointments with females, 79% had nooperational challenges, 21% required troubleshooting, 15% requiredassistance with telephone, 29% had poor audio video quality and 9%had software incompatibility issues. The video component allowedstudy personnel to guide participants through proper home-monitoringof blood pressure, temperature, urine dipsticks and urine samplecollection. Telemedicine satisfaction survey found all femaleparticipants agreed or strongly agreed that: discussions on UTIprevention was helpful, telemedicine increased motivation to monitortheir health, would recommend it to others, and would consider it forfuture health services. 100% agreed or strongly agreed that they wereoverall satisfied with telemedicine home-based monitoringservice.
Conclusions: The telemedicine platform wassuccessful in female participants with regards to compliance,software functionality and high user satisfaction. Telemedicine waseven successful for high quadriplegics requiring adaptive mouthtechnology to operate computers. Based on these findings telemedicinecould be an effective tool to promote better neurogenic bladdermanagement through home-based monitoring and increase accessibilityto healthcare for the SCI population. Further analysis is required todetermine actual effectiveness of reducing UTI incidence. Areasidentified for software improvement based on participant feedbackinclude simplified login and reminder prompts for completing followup assessment tasks such as blood pressure and bladderdiaries.
References: 1.DOI: 10.1007/s11908-011-0208-62.DOI: 10.1097/01.WON.0000319132.29478.17 3.DOI: 10.1038/sc.2009.142