title: Outcomes and Lessons Learned From a Randomized Controlled Trial to Reduce Health Care Utilization During the First Year After Spinal Cord Injury Rehabilitation: Telephone Counseling Versus Usual Care.
abstract: OBJECTIVE
  To describe the outcomes and lessons learned from a trial of telephone counseling (TC) to reduce medical complications and health care utilization and to improve psychosocial outcomes during the first year after spinal cord injury rehabilitation.
  
  
  METHODS
  Single-site, single-blind, randomized (1:1) controlled trial comparing usual care plus TC with usual care (UC).
  
  
  METHODS
  Two inpatient rehabilitation programs.
  
  
  METHODS
  Adult patients (N=168) discharged between 2007 and 2010.
  
  
  METHODS
  The TC group (n=85, 51%) received up to eleven 30- to 45-minute scheduled telephone calls to provide education, resources, and support. The UC group (n=83, 49%) received indicated referrals and treatment.
  
  
  METHODS
  The primary outcome was a composite of self-reported health care utilization and medical complications. Secondary outcomes were depression severity, current health state, subjective health, and community participation.
  
  
  RESULTS
  No significant differences were observed between TC and UC groups in the primary or secondary psychosocial outcomes.
  
  
  CONCLUSIONS
  This study had a number of strengths, but included potential design weaknesses. Intervention studies would benefit from prescreening participants to identify those with treatable problems, those at high risk for poor outcomes, or those with intentions to change target behaviors. Interventions focused on treatment goals and designed to work in collaboration with the participant's medical care system may lead to improved outcomes.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Psychology Department, Seattle University, Seattle, WA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Mackelprang
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA. Electronic address: jeanneh@uw.edu.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Hoffman
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Chris
authors.initials: C
authors.lastname: Garbaccio
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Bombardier
mesh_terms: D003376:Counseling / Q000379:methods*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods; D055502:Secondary Prevention / Q000379:methods*; D016037:Single-Blind Method; D013119:Spinal Cord Injuries / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation*; D013689:Telephone
keywords: Health services; Neurological rehabilitation; Randomized controlled trial; Rehabilitation; Spinal cord injuries; Telemedicine