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

Publication Date: 
Mar 12, 2017

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 84 adults with SCI (X= 9.9 years post-SCI); X=46 years old; 73.8% male; 44% with paraplegia; and 58% White.

INTERVENTIONS: Trained Peer Health Coaches (PHC) 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 (HRQOL); and Quality of Primary Care.

RESULTS: Intervention participants averaged 12 calls over 6 months (averaging 21.8 minutes each), with distinct variation. At 6 months, intervention participants reported significantly greater change in PAM scores (6 mos: Est: 7.029; 95%CI: 0.1018,13.956; p=0.0468) compared to controls, with a trend towards significance at 4 months. At 6 months, intervention participants reported a significantly greater decrease in social/role activity limitations (Est: -0.443; p=0.0389); greater life satisfaction (Est: 1.1091, p=0.0522); greater services/resources awareness (Est: 1.678; p=0.0253); greater overall service use (Est: 1.069; p=0.0240); and greater number of services used (Est: 1.542; p=0.0077). Subgroups most impacted by MCMC on PAM change scores included: high social support, White, males, 1-6 years post-injury, and tetraplegic.

CONCLUSION: 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, multi-site trial of its efficacy and cost-effectiveness.