Houlihan Bethlyn Vergo, Brody Miriam, Everhart-Skeels Sarah, Pernigotti Diana, Burnett Sam, Zazula Judi, Green Christa, Hasiotis Stathis, Belliveau Timothy, Seetharama Subramani, Rosenblum David, Jette Alan
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.
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.
Arch Phys Med Rehabil. 2017 Jun;98(6):1067-1076.e1. doi: 10.1016/j.apmr.2017.02.005. Epub 2017 Mar 8.
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.
评估“我的护理我的呼叫”（MCMC）这一由同伴主导、基于电话的健康自我管理干预措施对成年慢性脊髓损伤（SCI）患者的影响。
单盲随机对照试验。
一般社区。
SCI成年患者的便利样本（N = 84；SCI后平均时间9.9年；平均年龄46岁；73.8%为男性；44%为截瘫患者；58%为白人）。
经过培训的同伴健康教练对42名实验对象在6个月内按照逐渐减少的呼叫计划实施以患者为中心的健康自我管理干预。42名对照对象接受常规护理。两组均收到MCMC资源指南。
主要结局——通过患者激活量表（PAM）测量的健康自我管理。次要结局——服务/资源使用的总体评分、健康相关生活质量和初级保健质量。
干预组参与者在6个月内平均拨打12次电话（每次平均21.8分钟），存在明显差异。在6个月时，与对照组相比，干预组参与者报告的PAM评分变化显著更大（6个月：估计值7.029；95%置信区间，0.1018 - 13.956；P = 0.0468），在4个月时存在显著趋势。在6个月时，干预组参与者报告的社会/角色活动限制显著减少（估计值，-0.443；P = 0.0389），生活满意度更高（估计值，1.0091；P = 0.0522），服务/资源意识更强（估计值，1.678；P = 0.0253），总体服务使用更多（估计值，1.069；P = 0.0240），使用的服务数量更多（估计值，1.542；P = 0.0077）。受MCMC影响最大的PAM变化评分亚组包括：高社会支持、白人、男性、受伤后1至6年以及四肢瘫痪者。
本试验表明，MCMC同伴主导的健康自我管理干预对SCI成年患者的自我管理产生了积极影响，以预防继发疾病。这些结果值得对其疗效和成本效益进行更大规模的多中心试验。
