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Arch Phys Med Rehabil. 2017 Jun;98(6):1067-1076.e1. doi: 10.1016/j.apmr.2017.02.005. Epub 2017 Mar 8.

Randomized Trial of a Peer-Led, Telephone-Based Empowerment Intervention for Persons With Chronic Spinal Cord Injury Improves Health Self-Management.

Author information

1
New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA. Electronic address: bvergo@bu.edu.
2
New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.
3
New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Rehabilitation Services and Outpatient Services, Spinal Cord Injury Program, Gaylord Hospital, Wallingford, CT.
4
Centre for Collaboration, Motivation and Innovation, Hope, British Columbia, Canada.
5
New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Hospital for Special Care, New Britain, CT.
6
New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Hartford Hospital, Hartford, CT.

Abstract

OBJECTIVE:

To evaluate the impact of "My Care My Call" (MCMC), a peer-led, telephone-based health self-management intervention in adults with chronic spinal cord injury (SCI).

DESIGN:

Single-blinded randomized controlled trial.

SETTING:

General community.

PARTICIPANTS:

Convenience sample of adults with SCI (N=84; mean time post-SCI, 9.9y; mean age, 46y; 73.8% men; 44% with paraplegia; 58% white).

INTERVENTIONS:

Trained peer health coaches applied the person-centered health self-management intervention with 42 experimental subjects over 6 months on a tapered call schedule. The 42 control subjects received usual care. Both groups received the MCMC Resource Guide.

MAIN OUTCOME MEASURES:

Primary outcome-health self-management as measured by the Patient Activation Measure (PAM). Secondary outcomes-global ratings of service/resource use, health-related quality of life, and quality of primary care.

RESULTS:

Intervention participants averaged 12 calls over 6 months (averaging 21.8min each), with distinct variation. At 6 months, intervention participants reported a significantly greater change in PAM scores (6mo: estimate, 7.029; 95% confidence interval, .1018-13.956; P=.0468) compared with controls, with a trend toward significance at 4 months. At 6 months, intervention participants reported a significantly greater decrease in social/role activity limitations (estimate, -.443; P=.0389), greater life satisfaction (estimate, 1.0091; P=.0522), greater services/resources awareness (estimate, 1.678; P=.0253), greater overall service use (estimate, 1.069; P=.0240), and a greater number of services used (estimate, 1.542; P=.0077). Subgroups most impacted by MCMC on PAM change scores included the following: high social support, white persons, men, 1 to 6 years postinjury, and tetraplegic.

CONCLUSIONS:

This trial demonstrates that the MCMC peer-led, health self-management intervention achieved a positive impact on self-management to prevent secondary conditions in adults with SCI. These results warrant a larger, multisite trial of its efficacy and cost-effectiveness.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT02878070.

KEYWORDS:

Peer influence; Rehabilitation; Spinal cord injuries; Telemedicine

PMID:
28284835
DOI:
10.1016/j.apmr.2017.02.005
[Indexed for MEDLINE]

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