Results Summary
What was the research about?
A spinal cord injury, or SCI, can cause paralysis, or the loss of movement. People with an SCI need to learn new ways to manage daily life. Staff at rehabilitation, or rehab, facilities can teach patients how to care for themselves after their injury. Sometimes a peer who has had similar life experiences can also help patients learn to care for themselves.
In this study, the research team compared two ways to help patients with SCIs who were leaving a rehab facility to manage their care at home. Both programs used peer support. The first program was a one-on-one peer mentor program. It included a weekly meeting with a peer mentor at the rehab facility and continued for three months after patients went home. The second type, called general peer support, was a single meeting with a peer mentor at the rehab facility.
The research team looked at unplanned hospital visits, ability to function in social and work settings, depression symptoms, and life satisfaction.
What were the results?
In the six months after leaving the rehab facility, patients in both types of peer support had a similar number of unplanned hospital visits. But patients in the peer mentor program spent fewer days in the hospital during these visits than patients who had general peer support.
Compared with patients who had general peer support, patients in the peer mentor program had more confidence in taking care of themselves.
Patients in the two programs were similar in
- Ability to function on their own in social and work settings
- Depression symptoms
- Satisfaction with their lives
Who was in the study?
This study included 158 patients with an SCI who received care at one rehab facility in Georgia. Of these, 74 percent were white, and 26 percent were other races. The average age was 38, and 77 percent were men. Also, 76 percent had private insurance.
What did the research team do?
The research team assigned patients by chance to either the peer mentor program or general peer support. In the peer mentor program, the team matched peer mentors and patients based on injury level, age, gender, and interests. Each patient and mentor met every week during the rehab stay. When patients went home, they stayed in touch with their mentor for three months. Mentors gave patients information about community resources and invited them to join a Facebook group for people with SCIs. The mentors also encouraged patients to go to monthly peer-group activities.
Patients who received general peer support met with a peer mentor one time while they were in the rehab facility. Mentors gave patients information about available community resources. Upon request, patients could also keep working with a peer mentor, join the Facebook group, and go to monthly activities.
The research team called patients one, three, and six months after they left the rehab facility.
Patients with an SCI and their family members, doctors, nurse educators, and peer-support staff helped design the study.
What were the limits of the study?
Most patients in this study were male, white, and had private insurance. Future studies could include patients from other backgrounds.
How can people use the results?
Rehab facilities can use these results when deciding how to help patients with an SCI manage their care at home.
Professional Abstract
Objective
To compare the effectiveness of a one-on-one peer-mentoring program with general peer support on unplanned hospital readmissions for patients with a spinal cord injury (SCI) who are transitioning from inpatient rehabilitation to home
Study Design
| Design Elements | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 158 patients with an SCI who are transitioning from inpatient rehabilitation to home |
| Interventions/ Comparators |
|
| Outcomes |
Primary: unplanned hospital readmissions 30 days postdischarge Secondary: unplanned hospital readmissions 90 and 180 days postdischarge, self-efficacy, community participation, depressive symptoms, life satisfaction |
| Timeframe | 30-day postdischarge follow-up for primary outcome |
This randomized controlled trial compared the effectiveness of a one-on-one peer mentoring program versus general peer support in helping patients with an SCI manage their care after transitioning from inpatient rehabilitation to home. All peer mentors had an SCI and were either hospital-employed staff on the peer-support team or trained and certified volunteer peer mentors.
Researchers randomized 158 patients admitted to an SCI rehabilitation program in Georgia to receive either the peer-mentoring program or general peer support. Researchers matched patients and mentors based on similar injury level, age, gender, and interests. In the one-on-one peer mentoring program, patients met with peer mentors weekly during inpatient rehabilitation and then for 90 days postdischarge via phone or email. Peer mentors gave patients information about community resources, invited patients to the SCI peers Facebook page, and encouraged participation in monthly peer-sponsored activities.
In general peer support, peer mentors met just once with patients to provide information about available community resources. Upon request, patients could also receive additional peer mentoring, join the SCI peers Facebook page, and go to monthly peer-support activities.
Among patients, 73% were white and 26% were other races. The average age was 38, 77% were male, and 76% had private insurance.
To assess study outcomes, researchers called patients 30, 90, and 180 days postdischarge.
Patients and their family members, clinicians, nurse educators, and peer-support staff helped design, develop, and evaluate the peer-mentoring program.
Results
The two approaches did not differ in the percentage of patients rehospitalized at any assessment point. However, compared with general peer support, patients in the peer mentoring program had fewer cumulative days of unplanned hospital readmissions at 90 days (171 versus 76 cumulative days, p<0.001) and 180 days postdischarge (231 versus 119 cumulative days, p<0.001).
Patients in the peer mentoring program had an increase in self-efficacy at 180 days postdischarge (p=0.015), but not at 30 or 90 days.
The two approaches did not differ at any assessment point in community participation, depressive symptoms, or life satisfaction.
Limitations
Most patients in the study were white, male, and had private insurance. Results may be different for people with other backgrounds.
Conclusions and Relevance
Results suggest that the more extensive peer-support program may be effective in decreasing the length of stay during unplanned hospital readmissions postdischarge and promoting self-efficacy in patients with SCIs who are transitioning from inpatient rehabilitation to home.
Future Research Needs
Future research could focus on conducting similar studies with a more diverse sample of patients with SCIs.
Final Research Report
View this project's final research report.
Journal Citations
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Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:
- Reviewers noted that researchers adopted an unusual number of major protocol changes after the project began. These protocol changes may have diminished the rigor of the work but in some cases were due to factors beyond the researchers’ control. The report is explicit and detailed about protocol changes. The reviewers noted that the report acknowledged the study’s limitations and was cautious in its interpretations.
- Reviewers suggested that the analysis of patient-reported outcomes might have been better handled using Rasch Measurement Theory instead of Classical Test Theory, since the latter does not take ordinal data into account. The researchers acknowledged the growing use of Rasch Measurement Theory but explained that its use in this situation would still be an exception not the norm. The researchers noted that using Rasch Measurement Theory would have been another major modification to their original research plan.
- The reviewers noted that because the Shepherd Center, where they conducted this study is a national leader in rehabilitation of patients with severe spinal cord injury, the cohort may not be representative. The researchers agreed that the center may be unique and results may not be entirely generalizable. However, researchers noted that while the cohort had the advantage of being at a leading spinal cord injury treatment center, the patients at the center also tend to be more significantly impaired than patients with spinal cord injury who are typically admitted into inpatient rehabilitation.