Development and Assessment of SCI Model Systems Complicated UTI Consensus Guidelines: A Psychometrically Designed Mixed-Methods Protocol

Rochelle E Tractenberg; Suzanne L Groah

doi:10.46292/sci22-00002

Development and Assessment of SCI Model Systems Complicated UTI Consensus Guidelines: A Psychometrically Designed Mixed-Methods Protocol

Top Spinal Cord Inj Rehabil. 2022 Fall;28(4):1-11. doi: 10.46292/sci22-00002. Epub 2022 Nov 15.

Authors

Rochelle E Tractenberg^{1

2}, Suzanne L Groah^{3

4}

Affiliations

¹ Collaborative for Research on Outcomes and Metrics, Georgetown University Medical Center, Washington, DC.
² Departments of Neurology, Rehabilitation Medicine, and Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC.
³ MedStar National Rehabilitation Hospital, Washington, DC.
⁴ MedStar Georgetown University Hospital, Washington, DC.

Abstract

Background: Complicated UTI (cUTI) is highly prevalent among people with spinal cord injury and disease (SCI/D), but neither consistent nor evidence-based guidelines exist.

Objectives: We propose a two-phase, mixed-methods study to develop consensus around diagnostic and decision-making criteria for cUTI among people with SCI/D and the clinicians who treat them.

Methods: In phase 1 (qualitative), we will engage Spinal Cord Injury Model Systems (SCIMS) clinicians in focus groups to refine existing cUTI-related decision making using three reliable and validated Urinary Symptom Questionnaires for Neurogenic Bladder (USQNBs; intermittent catheterization, indwelling catheterization, and voiding) as points of departure, and then we will conduct a Delphi survey to explore and achieve consensus on cUTI diagnostic criteria among a nationally representative sample of clinicians from physical medicine and rehabilitation, infectious disease, urology, primary care, and emergency medicine. We will develop training materials based on these new guidelines and will deploy the training to both clinicians and consumers nationally. In phase 2 (quantitative), we will assess clinicians' uptake and use of the guidelines, and the impact of the guidelines training on consumers' self-management habits, engagement with the health care system, and antibiotic use over the 12 months after training.

Results: The output of this study will be diagnostic guidelines for cUTI among people with neurogenic lower urinary tract dysfunction (NLUTD) due to SCI/D, with data on uptake (clinicians) and impact (patients).

Conclusion: This mixed-methods protocol integrates formal psychometric methods with large-scale evidence gathering to derive consensus around diagnostic guidelines for cUTI among people with NLUTD due to SCI/D and provides information on uptake (clinicians) and impact (patients).

Keywords: Urinary Symptom Questionnaire for Neurogenic Bladder; clinical guidelines; complicated UTI; diagnostic criteria; mixed-methods protocol; neurogenic lower urinary tract dysfunction; urinary tract infection.

MeSH terms

Anti-Bacterial Agents
Consensus
Humans
Spinal Cord Diseases*
Spinal Cord Injuries* / complications
Urinary Bladder, Neurogenic*

Substances

Anti-Bacterial Agents

Grants and funding

Financial Support The contents of this article were developed under a grant from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR grant no. 90SIMS009-01). NIDILRR is a center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, and HHS, and you should not assume endorsement by the Federal Government.