Abstract
Study design:
Single-blind randomized controlled trial of 6 months’ duration.
Objectives:
To evaluate the efficacy of a novel telehealth intervention, ‘CareCall’, on reducing pressure ulcers and depression and enhancing the use of appropriate health care.
Setting:
General community, Massachusetts and Connecticut, United States
Methods:
‘CareCall’ is an automated, interactive voice response system that combines patient education, cognitive behavioral interventions, screening and referrals, with alerts to a nurse telerehabilitation coordinator for direct non-emergent phone follow up. Participants consisted of a convenience sample of 142 persons with multiple sclerosis or spinal cord injury using a wheelchair >6 h per day. The intervention group received CareCall (n=71) The control group received usual care (n=71). The main outcome measures were: The pressure ulcer scale for healing tool, Patient Health Questionnaire—9 depression scale, Cornell Services Index and Craig Hospital Inventory of Environmental Factors-Short Form Question 5.
Results:
CareCall achieved a reduction in presence of pressure ulcers at 6 months in women (P<0.0001). Among those with baseline depression, CareCall reduced 6-month severity of depression, adjusting for age and gender (P<0.047). CareCall did not have a significant impact on health-care utilization (OR=1.8, P=0.07), but did significantly improve participants’ report of health-care availability (OR=2.03, P<0.04).
Conclusion:
This is the first study to demonstrate the efficacy of a largely automated telehealth intervention for adults with spinal cord dysfunction. Future research needs to replicate this study in a larger, multisite trial.
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Acknowledgements
We thank Diana Pernigotti from the Gaylord Hospital in Wallingford, CT, for her enthusiastic commitment to the successful implementation of this project throughout New England; and Andrew Rossi from the Medical Information Systems Unit at Boston Medical Center for providing ongoing, reliable technical assistance. This project was made possible by funding from the Centers for Disease Control and Prevention, Grant no. 5R01DD000155, the Department of Health and Human Services; and the National Institute of Disability and Rehabilitation Research, Grant nos. H133N060024, H133N110019, and H133N120002, the Department of Education.
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Dr Friedman’s work has been funded by the National Institute of Disability and Rehabilitation Research (NIDRR). Dr Friedman has stock ownership and a consulting agreement with Infomedics, the company that owns commercial rights to the TLC technology used in the computerized intervention. He is also a member of its Board of Directors. The remaining authors declare no conflict of interest.
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Houlihan, B., Jette, A., Friedman, R. et al. A pilot study of a telehealth intervention for persons with spinal cord dysfunction. Spinal Cord 51, 715–720 (2013). https://doi.org/10.1038/sc.2013.45
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DOI: https://doi.org/10.1038/sc.2013.45
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