title: Randomized Trial of a Peer-Led, Telephone-Based Empowerment Intervention for Persons With Chronic Spinal Cord Injury Improves Health Self-Management.
abstract: 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).
  
  
  
  Single-blinded randomized controlled trial.
  
  
  
  General community.
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: 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.
authors.forename: Bethlyn Vergo
authors.initials: BV
authors.lastname: Houlihan
authors.affiliation: 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.
authors.forename: Miriam
authors.initials: M
authors.lastname: Brody
authors.affiliation: 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.
authors.forename: Sarah
authors.initials: S
authors.lastname: Everhart-Skeels
authors.affiliation: 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.
authors.forename: Diana
authors.initials: D
authors.lastname: Pernigotti
authors.affiliation: Centre for Collaboration, Motivation and Innovation, Hope, British Columbia, Canada.
authors.forename: Sam
authors.initials: S
authors.lastname: Burnett
authors.affiliation: 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.
authors.forename: Judi
authors.initials: J
authors.lastname: Zazula
authors.affiliation: New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Hospital for Special Care, New Britain, CT.
authors.forename: Christa
authors.initials: C
authors.lastname: Green
authors.affiliation: 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.
authors.forename: Stathis
authors.initials: S
authors.lastname: Hasiotis
authors.affiliation: New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Hospital for Special Care, New Britain, CT.
authors.forename: Timothy
authors.initials: T
authors.lastname: Belliveau
authors.affiliation: New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Hartford Hospital, Hartford, CT.
authors.forename: Subramani
authors.initials: S
authors.lastname: Seetharama
authors.affiliation: 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.
authors.forename: David
authors.initials: D
authors.lastname: Rosenblum
authors.affiliation: 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.
authors.forename: Alan
authors.initials: A
authors.lastname: Jette
mesh_terms: D000328:Adult; D003376:Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods; D010379:Peer Group; D011209:Power, Psychological; D011320:Primary Health Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D016037:Single-Blind Method; D012944:Social Support; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D013689:Telephone; D013997:Time Factors
keywords: Peer influence; Rehabilitation; Spinal cord injuries; Telemedicine