Factors affecting continuation of clean intermittent catheterisation in people with multiple sclerosis: results of the COSMOS mixed-methods study

Doreen McClurg, Carol Bugge, Andrew Elders, Tasneem Irshad, Suzanne Hagen, Katherine N. Moore, Brian Buckley, Mandy Fader

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Background: Clean Intermittent self-catheterisation (CIC) is often recommended for people with MS.
Objectives: To determine the variables that affect continuation or discontinuation of the use of CIC.
Methods: A 3-part mixed method study (prospective longitudinal cohort (n=56), longitudinal qualitative interviews (n=20) and retrospective survey (n=456) was undertaken which identified the variables that influenced clean intermittent self-catheterisation continuation/discontinuation. The potential explanatory variables investigated in each study were the individual’s age, gender, social
circumstances, number of urinary tract infections bladder symptoms, presence of co-morbidity, stage of multiple sclerosis and years since diagnosis, as well as clean intermittent catheterization teaching method and intensity.
Results: For some people with multiple sclerosis the prospect of undertaking clean intermittent catheterisation is difficult and may take a period of time to accept before beginning the process of using clean intermittent catheterisation. Ongoing support from clinicians, support at home and a perceived improvement in symptoms such as nocturia were positive predictors of continuation. In many cases, the development of a urinary tract infection during the early stages of clean intermittent catheterisation use had a significant detrimental impact on continuation.
Conclusions: Procedures for reducing the incidence of urinary tract infection during the learning period (i.e. when being taught and becoming competent) should be considered, as well as the development of a tool to aid identification of a person’s readiness to try clean intermittent catheterization.
Original languageEnglish
Pages (from-to)727-739
Number of pages13
JournalMultiple Sclerosis Journal
Issue number5
Early online date23 Apr 2018
Publication statusPublished - 1 Apr 2019



  • quality of life
  • rehabilitation
  • symptomatic treatment
  • clean intermittent catheterisation
  • multiple sclerosis
  • CIC

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