title: A pilot study of a telehealth intervention for persons with spinal cord dysfunction.
abstract: METHODS
  Single-blind randomized controlled trial of 6 months' duration.
  
  
  OBJECTIVE
  To evaluate the efficacy of a novel telehealth intervention, 'CareCall', on reducing pressure ulcers and depression and enhancing the use of appropriate health care.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: New England Regional Spinal Cord Injury Center Model Systems Network, The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA. bvergo@bu.edu
authors.forename: B V
authors.initials: BV
authors.lastname: Houlihan
authors.forename: A
authors.initials: A
authors.lastname: Jette
authors.forename: R H
authors.initials: RH
authors.lastname: Friedman
authors.forename: M
authors.initials: M
authors.lastname: Paasche-Orlow
authors.forename: P
authors.initials: P
authors.lastname: Ni
authors.forename: J
authors.initials: J
authors.lastname: Wierbicky
authors.forename: K
authors.initials: K
authors.lastname: Williams
authors.forename: S
authors.initials: S
authors.lastname: Ducharme
authors.forename: J
authors.initials: J
authors.lastname: Zazula
authors.forename: P
authors.initials: P
authors.lastname: Cuevas
authors.forename: D
authors.initials: D
authors.lastname: Rosenblum
authors.forename: S
authors.initials: S
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy; D003627:Data Interpretation, Statistical; D003863:Depression / Q000209:etiology / Q000523:psychology; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications / Q000628:therapy; D009726:Nurses; D010353:Patient Education as Topic; D010865:Pilot Projects; D003668:Pressure Ulcer / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D011788:Quality of Life; D012959:Socioeconomic Factors; D013118:Spinal Cord Diseases / Q000150:complications / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000150:complications / Q000628:therapy; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000458:organization & administration* / Q000706:statistics & numerical data*; D016896:Treatment Outcome