Gassaway Julie, Jones Michael L, Sweatman W Mark, Hong Minna, Anziano Peter, DeVault Karen
Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA.
Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA.
Arch Phys Med Rehabil. 2017 Aug;98(8):1526-1534.e2. doi: 10.1016/j.apmr.2017.02.018. Epub 2017 Mar 23.
To investigate the effect of intensive peer mentoring on patient-reported outcomes of self-efficacy and unplanned hospital readmissions for persons with spinal cord injury/disease (SCI/D) within the first 6 months after discharge from inpatient rehabilitation.
Randomized controlled trial.
Nonprofit inpatient rehabilitation hospital specializing in care of persons with SCI/D and brain injury.
Patients (N=158) admitted to the SCI/D rehabilitation program whose discharge location was a community setting. Participants (51% with paraplegia and 49% with tetraplegia) were 73% white and 77% men, with a mean age of 38 years.
Participants in the experimental group received initial consult/introduction with a peer support program liaison and were assigned a peer mentor, who met with the participant weekly throughout the inpatient stay and made weekly contact by phone, e-mail, or in person for 90 days postdischarge. Participants also were encouraged to participate in regularly scheduled peer support activities. Nonexperimental group participants were introduced to peer support and provided services only on request.
General Self-efficacy Scale (adapted to SCI/D), project-developed community integration self-efficacy scale, and patient-reported unplanned rehospitalizations.
Growth rate for self-efficacy in the first 6 months postdischarge was significantly higher for experimental group participants than nonexperimental group participants. Experimental group participants also had significantly fewer unplanned hospital days.
This study provides evidence that individuals receiving intensive peer mentoring during and after rehabilitation for SCI/D demonstrate greater gains in self-efficacy over time and have fewer days of unplanned rehospitalization in the first 180 days postdischarge. More research is needed to examine the long-term effects of this intervention on health care utilization and the relation between improved health and patient-reported quality of life outcomes.
探讨强化同伴指导对脊髓损伤/疾病（SCI/D）患者出院后头6个月内自我效能感及非计划住院再入院情况等患者报告结局的影响。
随机对照试验。
一家专门护理SCI/D患者和脑损伤患者的非营利性住院康复医院。
纳入SCI/D康复项目且出院后返回社区的患者（N = 158）。参与者中截瘫患者占51%，四肢瘫患者占49%，73%为白人，77%为男性，平均年龄38岁。
实验组参与者接受同伴支持项目联络人的初次咨询/介绍，并被分配一名同伴导师，该导师在住院期间每周与参与者会面，并在出院后90天内通过电话、电子邮件或亲自联系等方式每周与参与者保持联系。还鼓励参与者参加定期安排的同伴支持活动。非实验组参与者仅在有需求时才被介绍同伴支持并提供服务。
一般自我效能量表（改编用于SCI/D）、项目开发的社区融入自我效能量表以及患者报告的非计划再入院情况。
出院后头6个月，实验组参与者自我效能感的增长率显著高于非实验组参与者。实验组参与者的非计划住院天数也显著更少。
本研究表明，SCI/D患者在康复期间及康复后接受强化同伴指导，随着时间推移自我效能感提升更大，且出院后前180天非计划再入院天数更少。需要更多研究来考察这种干预对医疗保健利用的长期影响以及健康改善与患者报告的生活质量结局之间的关系。
