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Changes in bladder emptying during inpatient rehabilitation after spinal cord injury and predicting factors: data from the Dutch Spinal Cord Injury Database


Study design

Secondary analysis of multicentre prospective observational data.


To describe methods of bladder emptying at admission and discharge in patients with recently acquired spinal cord injury (SCI) and to describe predictors of bladder emptying methods at discharge.


First inpatient rehabilitation in specialised rehabilitation centres in the Netherlands.


Data from the Dutch Spinal Cord Injury Database collected between 2015 and 2019 were used. McNemar-Bowker test was used to evaluate if bladder emptying methods differed over time; One-Way ANOVA and Chi-Square tests to see if bladder emptying methods differed by demographic and injury-related characteristics. Binary logistic regression was used to predict the type of bladder emptying at discharge with demographic and injury-related characteristics measured at admission.


Of 1403 patients, 44.1% had cervical, 38.4% thoracic and 17.5% lumbosacral lesions at admission. AIS classification was mostly D (63.8%). The method of bladder emptying changed significantly (p < 0.001) from admission to discharge: decrease of clean intermittent assisted catheterisation (17.1% to 4.1%) and indwelling catheter (33.4% to 16.3%) and increase in clean intermittent self-catheterisation (CISC, 7.8% to 22.2%) and normal voiding (40.2% to 56.1%). Age, sex, SCI level, AIS classification and level of independence predicted the method of bladder emptying at discharge (all p < 0.001).


During first inpatient rehabilitation, the method of bladder emptying changed resulting in more patients discharged with normal voiding and CISC. Age, sex, SCI level, AIS classification and level of independence in self-care were all confirmed as factors playing a role in this change.

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Data availability

The data analysed for this study are available from the corresponding author, upon reasonable request.


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The Dutch Spinal Cord Injury Database (DSCID) is a collaboration of the Dutch-Flemish Spinal Cord Society (DuFSCOS), including Adelante: J. Hermans, C.C.M. van Laake-Geelen; Rehabilitation Centre De Hoogstraat: C.A. Dijkstra, J.M. Stolwijk-Swüste; Rehabilitation Centre Heliomare: W.X.M. Faber, D. Gobets; Rehabilitation Centre Het Roessingh: N. Jacobs, E.M. Maas, J. Snijders-Schuttevaar; Rehabilitation Centre Reade: J.J.E. Adriaansen, W.J. Achterberg-Warmer; Rehabilitation Centre Sint Maartenskliniek: H. Bongers-Janssen, I.J.W. van Nes, M. Vos-van der Hulst; Rijndam Rehabilitation: D.C.M. Spijkerman, R. Osterthun, T. Sluis; and UMCG Centre for Rehabilitation: G.E. van der Wal, E.H. Roels, M. Tepper. The DSCID project management group consists of C.A.M. van Bennekom, J. Nachtgaal, R. Osterthun, M.W.M. Post, E.H. Roels, E.W.M. Scholten and J.M. Stolwijk-Swüste.


Quality Funds Foundation of Dutch Medical Specialists (SKMS; grant no. Z69044861).

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Authors and Affiliations



CP writing the paper with input from all authors. CP, ES, MP conceiving and designing the analysis. CP, ES analysing data. CP, ES, MW, MP, JS interpreting results. ES, MW, MP, JS feedback on the report. JS supervised.

Corresponding author

Correspondence to Janneke M. Stolwijk-Swüste.

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Competing interests

The authors declare no competing interests.

Ethical approval

The DSCID did not need formal ethical approval because this type of study does not fall within the scope of the Dutch law on Medical Research [29]. Nevertheless, the local ethical committees and boards of all participating centres approved the provision of anonymized data on their patients for the DSCID. This study was conducted according to the Helsinki II declaration.

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Poublon, C.G., Scholten, E.W.M., Wyndaele, M.I.A. et al. Changes in bladder emptying during inpatient rehabilitation after spinal cord injury and predicting factors: data from the Dutch Spinal Cord Injury Database. Spinal Cord 61, 624–631 (2023).

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