Cardenas et al. 2004 USA
PEDro=5
RCT
Initial N=68; Final N=56

Population: Age = 20-77 yrs; Gender: males = 42, females = 14; Level of injury: C1-S4/5; Severity of injury: AIS A-D; Bladder Management: IC = 33, Condom Catheter = 11, Indwelling catheter = 11, spontaneous management = 1; Time since injury = 5 to 48 yrs.
Treatment: Specialized educational program for the prevention of UTIs vs no program.
Outcome Measures: Episodes of symptomatic UTI, white blood cell count, bacterial colony counts, # antibiotic treatments for UTI, UTI related symptoms, health belief questionnaire, multidimensional health locus of control, self efficacy.

• Significant changes in favour of treatment:
  • Fewer Urinary Colony Counts (p=0.009).
  • Fewer symptom reports (p=0.097).
  • Fewer episodes treated with antibiotics (p=0.232).
• No significant difference between the groups for NIDRR defined UTI.
• Increase in the perception of the severity of the UTI (p=0.042). 
• Higher locus of control (p=0.066).
• Lower self-efficacy (p=0.033).

Hagglund et al. 2005
USA
PEDro=4
Prospective controlled
trial
N=60

Population: Mean age = 39 yrs; Gender: males = 74%, females = 26%; Receiving personal assistance = 8 yrs.
Treatment: Based on geographic residence subjects were assigned to either i) treatment group: 6-hr training group workshop delivered by a SCI specialist physician addressing commonly occurring secondary conditions, prevention and treatment including an 8 minute video specific to UTIs followed by discussion or ii) control group with no education session.
Outcome Measures: Number of days/visits to hospital/ER and presence of UTIs via interview at baseline and 6 months later.

• Within treatment group significant reduction in UTI (p≤0.03) between baseline and 6 mths.
• Significantly fewer UTIs at 6 mths (p≤0.02) in the treatment vs control group for both those reporting and not reporting a UTI at baseline.
• Those reporting a UTI at baseline were significantly more likely to report one at 6 mths (p≤0.04).

Barber et al. 1999
USA
Downs & Black score=9
Pre Post
N=17

Population: SCI outpatients: Number of UTIs = 2.
Treatment: Intensive counselling by clinic nurse with respect to proper CIC technique, daily external catheter application and care, appropriate hygiene. If subjects continued to exceed 2+ UTIs in the following 6 months they were started on either nitrofurantoin or methenamine mandelate with ascorbic acid or given more instruction on proper techniques.
Outcome Measures: Compliance with regime, number of UTIs collected over 1000 days prospectively.

• 11/17 responders although 8 of these required multiple counselling sessions.
• 4/17 were placed on prophylactic methenamine mandelate and ascorbic acid with various treatment periods; 2/4 developed 1 UTI
• 3/17 were placed on prophylactic nitrofurantion for 1 to 2 3/4 yrs; none developed UTIs
• Compliance found to be a problem in patients in both medication regimes after 1 year of treatment.

Anderson et al. 1983 USA
Downs & Black score=8
Case control
N=75

Population: SCI inpatients.
Treatment: Urinary tract care education program (patient and staff training), 5 classes + manual.
Outcome Measures: Functional Impairment Scale for Bacteriuria, UTIs, UTI symptoms, time lost due to UTI assessed 6 months after discharge.

• Treatment vs Control following education:
  • No impairment: 71 vs 32%.
  • Symptomatic: 24 vs 57%
  • No time lost: 71 vs 50%
  • Time lost: 5 vs 23%
  • Recognition of symptoms: no difference
• No p values or between group stats tests conducted.