This National Capital - Spinal Cord Injury Model System (NC-SCIMS) application targets people with spinal cord injury (SCI) and neurogenic lower urinary tract dysfunction (NLUTD) and the clinicians who care for them. Our vision is to meaningfully advance the research and clinical care around complicated urinary tract infection (cUTI) among people with SCI with a novel intervention, and the development of critical guidelines for identification of cUTI to strengthen clinical and self-management decision-making. The NC-SCIMS have an enduring impact on the SCI community, inclusive of consumers, clinicians and scientists, and will support anti-microbial stewardship. The NC-SCIMS will leverage expertise and strengths in the areas of: rehabilitation research and clinical care; clinical trial design and conduct; outcome development and implementation; SCI research; advocacy; consumer engagement in research and knowledge translation; nationwide active involvement from clinicians with experience and expertise in our research target area; online education development; and knowledge translation and dissemination. Because of our close proximity to national elected officials and policymakers, this SCIMS site can also be a particularly compelling advocate for persons with SCI.
Led by MedStar National Rehabilitation Hospital (MedStar NRH), whose credo is to “Add Life to Years”, the NC-SCIMS is a collaboration of MedStar NRH with Georgetown University (GU), United Spinal Association, United Spinal Washington DC Chapter, and two Independent Living Centers (serving our DC, VA and MD communities), and clinicians/scientists from the Infectious Diseases Society of America and the Neurogenic Bladder Research Group. MedStar NRH is an ideal home for this NC-SCIMS because MedStar Health is the primary provider of medical (including rehabilitation) clinical services within the Baltimore - Washington corridor, and together MedStar Health and GU represent one of the strongest academic–research-clinical infrastructures in the country.
We propose one site specific research project (SSRP) and one module project (MP), both at the intervention efficacy (stage c) stage of research. Our SSRP and MP each squarely meet SCIMS and NIDILRR priorities. In our SSRP, we assess our novel intervention, self-managed intravesical instillation of Lactobacillus probiotic in a randomized, controlled comparative effectiveness clinical trial as (a) a treatment for the most common urinary symptoms experienced by people with SCI who use intermittent catheters; and (b) prophylaxis to prevent urinary symptoms and their sequelae (such as interactions with the health care system, and time lost from activities). The proposed MP will leverage the NC-SCIMS strengths and the authoritative power of the SCIMS centers with a collaborative mixed methods study that builds on our existing Urinary Symptom Questionnaires and their decision-making algorithms. We propose to integrate expertise from a range of clinicians (Physical Medicine & Rehabilitation, Infectious Disease, Urology, Primary Care, and Emergency Medicine) to develop SCIMS cUTI Consensus Guidelines. We will then develop online training materials for both consumers and clinicians and then implement these materials in a prospective study of consumers (assessing impact) and clinicians (assessing uptake). Consumer Experts (people with SCI or caregivers of people with SCI) have been and will continue to be integrated with all research, knowledge translation, and dissemination to ensure that our research activities are relevant and impactful for the community of people with SCI, NLUTD and cUTI.
In sum, the NC-SCIMS is poised to transform patient care and science around cUTI. The research activities comprise two rigorous research projects, with collaborations from consumers, advocacy organizations, and professionals nationwide, that will profoundly shift research, care, and self-management paradigms around urinary symptoms and cUTI among p