RESUMO
STUDY DESIGN: A process evaluation of a clinical trial. OBJECTIVES: To describe the roles fulfilled by peer health coaches (PHCs) with spinal cord injury (SCI) during a randomized controlled trial research study called 'My Care My Call', a novel telephone-based, peer-led self-management intervention for adults with chronic SCI 1+ years after injury. SETTING: Connecticut and Greater Boston Area, MA, USA. METHODS: Directed content analysis was used to qualitatively examine information from 504 tele-coaching calls, conducted with 42 participants with SCI, by two trained SCI PHCs. Self-management was the focus of each 6-month PHC-peer relationship. PHCs documented how and when they used the communication tools (CTs) and information delivery strategies (IDSs) they developed for the intervention. Interaction data were coded and analyzed to determine PHC roles in relation to CT and IDS utilization and application. RESULTS: PHCs performed three principal roles: Role Model, Supporter, and Advisor. Role Model interactions included CTs and IDSs that allowed PHCs to share personal experiences of managing and living with an SCI, including sharing their opinions and advice when appropriate. As Supporters, PHCs used CTs and IDSs to build credible relationships based on dependability and reassuring encouragement. PHCs fulfilled the unique role of Advisor using CTs and IDSs to teach and strategize with peers about SCI self-management. CONCLUSION: The SCI PHC performs a powerful, flexible role in promoting SCI self-management among peers. Analysis of PHC roles can inform the design of peer-led interventions and highlights the importance for the provision of peer mentor training.
Assuntos
Tutoria , Grupo Associado , Autogestão , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Comunicação , Humanos , Relações Interpessoais , Aprendizagem , Avaliação de Processos em Cuidados de Saúde , Pesquisa Qualitativa , Apoio Social , TelefoneRESUMO
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.
Assuntos
Úlcera por Pressão/terapia , Doenças da Medula Espinal/terapia , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Adulto , Idoso , Terapia Cognitivo-Comportamental , Interpretação Estatística de Dados , Depressão/etiologia , Depressão/psicologia , Pessoas com Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/terapia , Enfermeiras e Enfermeiros , Educação de Pacientes como Assunto , Projetos Piloto , Úlcera por Pressão/etiologia , Úlcera por Pressão/prevenção & controle , Qualidade de Vida , Fatores Socioeconômicos , Doenças da Medula Espinal/complicações , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/terapia , Inquéritos e Questionários , Resultado do TratamentoRESUMO
This paper describes an electric cart designed for an 11-month-old child born with multiple limb deficiencies. The device was intended to provide independently controlled mobility within the living environment and was designed to accommodate the child's growth until a commercial wheelchair would meet his mobility needs. The design provides a set of controls which can be operated by the child's partial left foot and his head. These controls are used in a manner that does not require extensive training, and which is appropriate for a child of this age.