Telewellness Support Systems for Spinal Cord Injury

PURPOSE: People with spinal cord injury (SCI) often require complex self-management routines to prevent complications that can lead to hospitalization, death, and expensive medical care. The Interactive Mobile Health and Rehabilitation (iMHere) system aims to improve self-management skills and prevent and detect secondary medical complications. The purpose of this study is to examine the clinical utility of using the iMHere system with people who have sustained a SCI. We hypothesize that the intervention group will experience improved medical and psychosocial outcomes as they utilize the iMHere system in their daily lives throughout the duration of the study compared with the control group receiving usual care.

BACKGROUND: Telehealth is the use of telecommunication technology to provide services to clients (American Occupational Therapy Association, 2013). Mobile health (mHealth) is a newly emerging form of telehealth, which aims to provide services to large populations of patients in a cost-efficient manner using a mobile device and applications (Dicianno et al. 2014). The secure and Health Insurance Portability and Accountability Act–compliant iMHere system connects a web-based clinician portal and a smartphone app with customizable modules. The iMHere system differs from other currently available telehealth applications by offering a client-centered approach (Parmanto et al., 2013).

DESIGN: This 2-yr project utilizes staggered enrollment. In this randomized controlled trial (RCT), participants randomized to the intervention group receive 9 mo of mHealth services via the iMHere system. Participants enrolled in the control group receive usual care. The study implements a repeated-measures design, gathering data every 3 mo.

PARTICIPANTS: Participants must be age 18 yr or older and have a SCI diagnosis, and they are screened before participation for the ability to use an Android Galaxy S5 (Samsung, 2015) smartphone. A total of 31 of 40 participants have been enrolled to date.

METHOD: The intervention group receives the smartphone to utilize the iMHere system in daily routines. A wellness coordinator monitors the self-care data tracked by iMHere app through the clinician portal and provides remote assistance as necessary.

ANALYSIS: Collection of medical variable outcomes, as well as functional and psychosocial outcomes, with the exception of incontinence, occurs over the course of enrollment, gathering the median number of occurrences per week. Analysis will involve comparison of the iMHere group with the usual-care group using repeated-measures analysis of variance statistics. In conjunction with the average associated costs, these data will determine the significance and clinical efficacy of the results (Portney & Watkins, 2009).

PRELIMINARY RESULTS (RESEARCH IN PROGRESS): A previous study completed utilizing the iMHere system with people diagnosed with spina bifida showed positive outcomes (McCoy et al., in press; Yih et al., in press). The iMHere system allows clinicians to remotely and efficiently monitor, communicate, and intervene with a large caseload. This system offers an innovative approach to improve medical and psychosocial outcomes, reduce health care usage and cost, and improve the users’ self-management skills. The current study will determine whether these findings are generalizable to persons with SCI. To date, 3 participants have completed the full intervention period of 9 mo. Twelve participants have completed 6 mo, and the remaining 16 have been enrolled for ≤3 mo.

DISCUSSION: Recruitment is ongoing. Participants have been receptive to adopting the technology into their daily lives and expressed appreciating the convenience of receiving care from professionals through the app. Although we cannot yet analyze this RCT’s outcomes using this repeated-measures design, these data will be available at the time of the conference proceedings.

IMPACT STATEMENT: Findings from this study have the potential to influence reimbursement policies for mHealth and remote delivery of occupational therapy services.

References

American Occupational Therapy Association. (2013). Telehealth. American Journal of Occupational Therapy, 67(Suppl. 6), S69–S90. http://dx.doi.org/10.5014/ajot.2013.67S69

Dicianno, B. E., Parmanto, B., Fairman, A. D., Crytzer, T., Yu, D. X., Pramana, G., Coughenour, D., & Petrazzi, A. A. (2014). Perspectives on the evolution of mobile (mHealth) technologies and application to rehabilitation. Physical Therapy, 95, 397–405. http://dx.doi.org/10.2522/ptj.20130534

McCoy, A., Dicianno, B. E., Fairman, A. D., McCue, M. P., Parmanto, B., Pramana, G., Yu, D. X., & Collins, D. M. (in press). Effects of the interactive mobile health and rehabilitation (iMHere) smartphone application system on the self-management and functional and psychosocial outcomes of individuals with spina bifida. American Journal of Physical Medicine and Rehabilitation.

Parmanto, B., Pramana, G., Yu, D. X., Fairman, A. D., Dicianno, B. E., & McCue, M. P. (2013). iMHere: A novel mHealth system for supporting self-care in management of complex and chronic conditions. JMIR Mhealth Uhealth, 1(2), e10. http://dx.doi.org/10.2196/mhealth.2391

Portney, L. G., & Watkins, M. P. (2009). Foundations of clinical research: Applications to practice (3rd ed.). Norwalk, CT: Appleton & Lange.

Samsung. (2015). Android Galaxy S5 specifications. Retrieved from http://www.samsung.com/us/mobile/cell-phones/SM-S902LZKATFN

Yih, E., Dicianno, B. E., Fairman, A. D., McCue, M. P., Parmanto, B., Pramana, G., Yu, D. X., & Collins, D. M. (in press). The effect of the interactive mobile health and rehabilitation (iMHere) system use on medical and utilization outcomes in patients with spina bifida. American Journal of Physical Medicine and Rehabilitation.