Abstract
Objective
To evaluate the clinical efficacy of a self‑management intervention programme based on symptom management theory for patients with neurogenic bladder (NB).
Methods
One hundred NB patients treated at a rehabilitation centre between May 2023 and May 2025 who met the inclusion criteria were randomly assigned to two groups (n = 50 each). The control group received routine nursing care, while the observation group received the theory‑based self‑management intervention. Outcomes included self‑management capability, quality of life, voiding parameters (bladder capacity, residual urine volume, daily voiding frequency), NB symptoms, anxiety/depression, and neurogenic bowel function.
Results
After 4 weeks, the observation group showed higher self‑management scores and bladder capacity than the control group [57 (49,66) vs. 35 (28,42) points; (376.18 ± 59.65) vs. (224.38 ± 38.13) mL], and lower quality‑of‑life scores, residual urine volume, and daily voiding frequency [(15.10 ± 5.12) vs. (22.02 ± 5.64) points; (103.56 ± 24.25) vs. (155.18 ± 57.43) mL; (9.72 ± 2.33) vs. (17.52 ± 2.87) times; all P < 0.05]. Symptom scores (NBSS, NBDS, SAS, SDS) were also lower in the observation group (P < 0.05).
Conclusion
The programme enhances self‑management, improves bladder function, alleviates symptoms, and increases quality of life in NB patients.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s13063-026-09894-y.
Keywords: Symptom management theory, Neurogenic bladder, Self‑management, Bladder management, Quality of life
Neurogenic bladder (NB) is a chronic, disabling condition caused by neurological lesions that disrupt bladder and urethral function. Its main clinical features include urinary retention, dysuria, and incontinence [1]. Without timely intervention, patients may develop severe complications such as urinary tract infections, vesicoureteral reflux, and renal failure [2].Patients with NB experience prolonged recovery and high caregiver dependency. Persistent reinforcement of the “patient role” reduces confidence in regaining personal capabilities, increases negative emotions, and undermines self-management motivation. Self-management is an effective health promotion strategy for chronic conditions [3]; it helps patients understand their disease, acquire relevant knowledge and skills, and promote recovery.
Symptom management theory is widely used in self-management programmes during hospitalisation and after discharge. It comprises three components: symptom experience, symptom management strategies, and management outcomes. By understanding patients’ symptom experiences, this model provides comprehensive interventions covering disease cognition, psychological support, sleep management, dietary guidance, abnormal urination management, assisted voiding, bladder training, and pelvic floor muscle exercises. This approach may enhance NB patients’ self-management capability and quality of life. The present study investigated the clinical efficacy of such a theory-based self-management intervention for NB patients, aiming to facilitate early social reintegration.
Data and methods
General data
This randomised controlled trial included 100 NB patients admitted to the Rehabilitation Department of Suining Central Hospital between May 2023 and May 2025. Participants were randomly allocated to a control group (n = 50) or an observation group (n = 50). Participant flow is shown in the CONSORT diagram (Fig. 1). No patients were lost to follow‑up during the 4‑week intervention. Adherence in the observation group was monitored with an intervention completion record card (Sect. 1.2). All 100 patients completed the full protocol.The study was approved by the Medical Ethics Committee (LLSLH20220119). All subjects gave written informed consent and participated voluntarily. Baseline characteristics did not differ significantly between groups (P > 0.05; Table 1). Inclusion criteria: ① meeting NB diagnostic criteria from the 2019 Chinese Medical Association’s Urological Guidelines; ② age ≥ 18 years; ③ conscious with normal communication; ④ able to provide informed consent and cooperate.Exclusion criteria: ① unstable condition with severe organ disease or complications; ② acute illness causing cognitive impairment or psychiatric communication barriers; ③ complete spinal cord injury with no S4-S5 saddle function.
Fig. 1.
CONSORT 2010 Flow Diagram
Table 1.
Comparison of patient demographic data
| Item | Control Group (n = 50) | Observation Group (n = 50) | t/χ2/ Z-value | P Value | |
|---|---|---|---|---|---|
| Age (years) | 43.68 ± 9.33 | 43.64 ± 7.85 | 0.0231 | 0.982 | |
| Duration of illness (days) | 46.64 ± 18.67 | 52.88 ± 18.46 | 1.6811 | 0.096 | |
| Gender | Male | 37 (74.00) | 34 (68.00) | 0.4372 | 0.509 |
| Female | 13 (26.00) | 16 (32.00) | |||
| Marital Status | Married | 39 (78.00) | 43 (86.00) | 1.4812 | 0.477 |
| Unmarried | 3 (6.00) | 1 (2.00) | |||
| Divorced | 8 (16.00) | 6 (12.00) | |||
| Educational attainment | Primary education or below | 11 (22.00) | 22 (44.00) | 2.2292 | 0.328 |
| Secondary school | 24 (48.00) | 18 (36.00) | |||
| College and above | 15 (30.00) | 10 (20.00) | |||
| Occupation | In employment | 43 (86.00) | 44 (88.00) | 0.0882 | 0.766 |
| Retired/Laid Off | 7 (14.00) | 6 (12.00) | |||
| Living Arrangements | Living Alone | 5 (10.00) | 6 (12.00) | 0.1022 | 0.749 |
| Living with family | 45 (90.00) | 44 (88.00) | |||
| Monthly household income | < 2000 | 15 (30.00) | 11 (22.00) | 0.8322 | 0.362 |
| ≥ 2000 | 35 (70.00) | 39 (78.00) | |||
| Primary Carer | Spouse | 34 (68.00) | 32 (64.00) | 2.3082 | 0.511 |
| Children | 3 (6.00) | 2 (4.00) | |||
| Caregiver | 11 (22.00) | 10 (20.00) | |||
| Other | 2 (4.00) | 6 (12.00) | |||
| Medical Expenses Payment Method | Medical Insurance | 31 (62.00) | 30 (60.00) | 0.0692 | 0.966 |
| Commercial Insurance | 10 (20.00) | 10 (20.00) | |||
| Self-funded | 9 (18.00) | 10 (20.00) | |||
| Cause of injury | Road traffic accident injury | 18 (36.00) | 20 (40.00) | 1.1532 | 0.764 |
| Fall injury | 16 (32.00) | 12 (24.00) | |||
| Violent injury | 12 (24.00) | 15 (30.00) | |||
| Non-traumatic factors | 4 (8.00) | 3 (6.00) | |||
| ADL | 40 (35, 75) | 52.5 (40,80) | 1.2383 | 0.216 |
1denotes t-value; 2denotes χ2-value; 3denotes Z-value
Sample size was calculated using G*Power 3.1 for a two‑independent‑samples t‑test (two‑tailed, power 0.90, α = 0.05, effect size d = 0.7). Minimum required was 44 per group; accounting for 10‑20% dropout, we enrolled 50 per group.
Randomisation: A random number sequence was generated with SPSS 29.0. Eligible participants were assigned to groups based on odd‑even numbers (simple randomisation). Numbers were generated by an independent person and sealed in opaque envelopes. Intervention providers and participants were not blinded, but outcome assessors were blinded to allocation.
Intervention method
Control group
Routine nursing care included disease education, distribution of urination diaries and hydration plans, guidance on diary recording, hydration management, intermittent catheterisation (with attention to hand and perineal disinfection, catheter lubrication, insertion and removal), and monitoring of urine colour, odour, and consistency.
Observation group: In addition to routine care, patients received a self‑management intervention based on symptom management theory, structured around “Symptom Experience → Symptom Management Strategies → Effectiveness Evaluation”. The detailed programme is shown in Fig. 2.
Fig. 2.
Self‑management intervention programme for NB patients based on symptom management theory
Fidelity measures
(1) All team members completed standardised training (1 week) and passed competency assessment; (2) an intervention manual specified content, timing, and duration; (3) daily completion was verified with a record card; (4) weekly team meetings reviewed adherence; (5) an independent auditor observed 20% of sessions (98% adherence). These steps support reproducibility.
Observation indicators
(1) Self-management capacity: assessed pre- and post-intervention using the NB Patient Self-Management Evaluation Scale [4] (knowledge, behaviour, attitude; higher score = better).
(2) Quality of life: assessed with the Short‑form Health Survey‑Qualiveen (SF‑Qualiveen) (disturbance, limitation, fear, sensation; higher score = worse).
(3) Voiding status: 24‑hour bladder capacity, residual urine volume, daily voiding frequency.
(4) NB‑related symptoms: Neurogenic Bladder Symptom Score (NBSS), Self‑Rating Depression Scale (SDS), Self‑Rating Anxiety Scale (SAS), Neurogenic Bowel Dysfunction Score (NBDS).
Statistical methods
SPSS 29.0 was used. Normality was assessed with Shapiro–Wilk test. Normally distributed data are presented as mean ± SD and compared using independent-samples t-tests (between groups) or paired t-tests (within group). Non-normally distributed data are presented as median (IQR) and compared with Mann–Whitney U (between) or Wilcoxon signed-rank (within). Categorical data are n (%) and compared with χ2 or Fisher’s exact test.
All analyses were modified intention-to-treat, including all randomised patients who completed at least one post-intervention assessment. No data were missing. Significance level α = 0.05 (two-tailed); no multiplicity adjustment for secondary analyses.
Results
Self-management capability
Before intervention, groups were similar (P > 0.05). After intervention, both groups improved, but the observation group showed significantly higher scores in knowledge, behaviour, attitude, and total score than the control group (P < 0.05). The control group’s attitude score did not change significantly (P > 0.05). See Table 2.
Table 2.
Comparison of self-management capabilities between groups
| Dimension | Group | Control Group (n = 50) |
Observation Group (n = 50) | Z | P |
|---|---|---|---|---|---|
| Knowledge | Pre | 1 (0, 2.25) | 2 (0, 3) | 0.862 | 0.389 |
| Post | 6 (4,7) | 7 (5,8) | 2.322 | 0.020 | |
| Z | 7.825 | 7.991 | |||
| P | 0.000 | 0.000 | |||
| Attitude | Pre | 9 (7, 13) | 9 (7, 12.25) | 0.173 | 0.862 |
| Post | 10 (7, 14.25) | 23.5 (16.75, 27) | 6.997 | 0.000 | |
| Z | 1.360 | 6.971 | |||
| P | 0.174 | 0.000 | |||
| Behaviour | Pre | 10 (7, 14) | 9 (7, 11.25) | 1.425 | 0.154 |
| Post | 18 (14, 25) | 28.5 (23.75, 33.5) | 4.961 | 0.000 | |
| Z | 6.012 | 8.047 | |||
| P | 0.000 | 0.000 | |||
| Total Score | Pre | 21 (17, 28) | 20 (18, 23.25) | 0.363 | 0.717 |
| Post | 35 (28, 42) | 57 (49, 66) | 6.564 | 0.000 | |
| Z | 6.524 | 8.477 | |||
| P | 0.000 | 0.000 |
Quality of life
Both groups improved post-intervention (within-group P < 0.05). The observation group improved more than the control group (P < 0.05; Table 3).
Table 3.
Comparison of quality of life between groups
| Control Group (n = 50) | Observation group (n = 50) | t | P | |
|---|---|---|---|---|
| Pre | 24.54 ± 4.76 | 25.50 ± 4.81 | 1.004 | 0.318 |
| Post | 22.02 ± 5.64 | 15.10 ± 5.12 | 6.423 | 0.000 |
| t | 2.416 | 10.466 | ||
| P | 0.018 | 0.000 |
Voiding parameters
All voiding parameters improved significantly in both groups (P < 0.05). The observation group had better bladder capacity, lower residual volume, and lower voiding frequency than the control group (P < 0.05; Table 4).
Table 4.
Comparison of urination status between groups
| Group | Bladder capacity (ml) | Residual Urine Volume (ml) | Daily Urination Frequency | |||
|---|---|---|---|---|---|---|
| Pre | Post | Pre | Post | Pre | Post | |
| Control group (n = 50) | 213.48 ± 35.42 | 345.44 ± 62.20* | 171.58 ± 56.62 | 139.74 ± 34.22* | 17.50 ± 2.82 | 12.16 ± 2.02* |
| Observation group (n = 50) | 224.38 ± 38.13 | 376.18 ± 59.65* | 155.18 ± 57.43 | 103.56 ± 24.25* | 17.52 ± 2.87 | 9.72 ± 2.33* |
| t | 1.481 | 2.522 | 1.438 | 6.099 | 0.035 | 5.59 |
| P | 0.142 | 0.013 | 0.154 | 0.000 | 0.972 | 0.000 |
Compared with pre-intervention values within the same group,*P < 0.001
Related symptoms
Before intervention, groups did not differ (P > 0.05). After intervention, the observation group had lower NBSS, NBDS, SAS, and SDS scores than the control group (P < 0.05). The control group showed significant reductions in NBDS, SAS, and SDS but not in NBSS (P > 0.05). See Table 5.
Table 5.
Comparison of relevant symptoms between groups
| Group | NBSS score (points) | NBD score (points) | SAS score (points) | SDS Score (Points) | ||||
|---|---|---|---|---|---|---|---|---|
| Pre | Post | Pre | Post | Pre | Post | Pre | Post | |
| Control group (n = 50) | 24.60 ± 4.77 | 23.48 ± 5.27 | 11.12 ± 4.36 | 8.38 ± 3.59* | 55.93 ± 7.19 | 51.91 ± 8.47* | 56.18 ± 6.95 | 53.42 ± 6.70* |
| Observation group (n = 50) | 24.26 ± 4.52 | 19.00 ± 3.67* | 10.58 ± 3.90 | 5.32 ± 3.20* | 56.41 ± 6.28 | 46.63 ± 8.61* | 58.71 ± 6.94 | 46.96 ± 7.54* |
| t | 0.366 | 4.933 | 0.653 | 4.504 | 0.352 | 3.089 | 1.820 | 4.535 |
| P | 0.715 | 0.000 | 0.516 | 0.000 | 0.726 | 0.003 | 0.072 | 0.000 |
Discussion
Improved self‑management capability
The observation group achieved significantly higher self‑management knowledge, behaviour, attitude, and total scores than the control group (P < 0.05), consistent with Sato‑Klemm et al. [5]. While the control group improved in knowledge and behaviour, their attitude did not change. This may be because primary nurses, applying symptom management theory’s three core components, conducted comprehensive pre‑intervention assessments (physiological, psychological, socio‑cultural, behavioural) and developed individualised programmes. Collaboration with rehabilitation therapists further enhanced patients’ independence in clean intermittent catheterisation and boosted confidence [6].
Nevertheless, previous studies report that NB patients may lose self‑management skills after discharge due to family environment, gender, economic constraints, physical dysfunction, and an underdeveloped rehabilitation system [7–9]. Thus, China’s rehabilitation system should be further optimised, for instance by using internet technology and medical apps to establish continuity‑of‑care platforms led by specialist nurses [10].
Improved quality of life
Guo et al. [11] noted that professional rehabilitation guidance to enhance self‑bladder management is key to returning to normal life. Our observation group had significantly higher self‑management ability and quality of life than controls, in line with Ou [12] and Soghrati et al. [13]. Theory‑based nursing involved comprehensive patient assessment and timely plan adjustments. Pelvic floor muscle training (repeated contraction/relaxation) restored muscle strength [14], prevented atrophy and stiffness, and ultimately improved quality of life.
Improved bladder function
The observation group had greater bladder capacity, lower post‑void residual volume, and lower daily voiding frequency than controls (P < 0.05), consistent with Xu et al. [15]. The multidisciplinary team, after systematic training, provided comprehensive rehabilitation including health education, psychological care, dietary and sleep guidance, behavioural training, perineal skin care, bladder training, assisted voiding, pelvic floor exercises, self‑monitoring, and continuity of care [16]. These interventions stimulated reflex bladder contractions, enhanced peripheral neuromuscular excitability, improved bladder contractility and relaxation, and achieved functional bladder‑urethral balance.
Alleviation of NB‑related symptoms
The observation group had significantly lower NBSS (including incontinence, storage/voiding, and consequences domains), NBDS, SAS, and SDS scores than controls (P < 0.05), matching Lacroix et al. [17], Chen et al. [18], and Przydacz et al. [19]. Early bladder function assessment allowed timely removal of indwelling catheters, targeted nursing, appropriate medication, and multidisciplinary collaboration for effective bladder emptying.
Conversely, many control group patients did not receive early, standardised rehabilitation. Some thoracic spinal cord injury patients mistakenly regarded leakage as normal voiding and used Credé manoeuvre instead of early intermittent catheterisation, increasing intravesical pressure, detrusor overactivity, sphincter incoordination, vesicoureteral reflux, and upper urinary tract infection risk.
Anxiety and depression affect 15‑32% and 19‑26% of NB patients respectively [20, 21], impairing rehabilitation adherence. Our theory‑based nursing included early psychological assessment and targeted interventions, reducing negative emotions and improving psychological status.
Bowel dysfunction (constipation ~ 80%, faecal incontinence) is often overlooked [22]. Our observation group had significantly lower NBDS than controls (P < 0.05), consistent with Bernardi et al. [23]. Early bowel function assessment and interventions (health education, dietary guidance, pelvic floor training) [24] enhanced patients’ disease understanding, bowel rehabilitation, and social/family support.
Summary
The symptom management theory‑based rehabilitation nursing intervention significantly improved bladder function, urodynamic parameters, self‑management ability, and quality of life, and reduced NB‑related symptoms in patients with neurogenic bladder.
Limitations
This was a single‑centre study, which may introduce bias. The intervention effect was observed only at 4 weeks; long‑term dynamic effects are unknown.
Trial status
Protocol version V1.0, 27 December 2022. Recruitment: 1 May 2023–1 May 2025.
Supplementary Information
Acknowledgements
The authors would like to thank the patients and their families for participating in this study.
Clinical trial registration
Chinese Clinical Trial Registry (ChiCTR2400092962, 26 November 2024). https://www.chictr.org.cn.
Authors’ contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed byChun Li,Wei Lin. The first draft of the manuscript was written by Xiaomei Li and all authors commented on previous versions of the manuscript. Xixi Li read and approved the final manuscript.
Funding
Supported by 2025 Zigong City Key Research Base of Philosophy and Social Sciences, Sports and Health Innovation Research Center Project (YDJKY25-19) and 2022 Suining Central Hospital Hospital-level Research Project (2022ypj18). China (National/Provincial) Key Clinical Specialty.
Data availability
The datasets generated and/or analyzed during the current study are not publicly available due to privacy concerns but are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Approved by Suining Central Hospital Medical Research Ethics Committee (LLSLH20220119). Written informed consent obtained.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated and/or analyzed during the current study are not publicly available due to privacy concerns but are available from the corresponding author on reasonable request.