Outcomes and Lessons Learned From a Randomized Controlled Trial to Reduce Health Care Utilization During the First Year After Spinal Cord Injury Rehabilitation: Telephone Counseling Versus Usual Care

Abstract

ObjectivesTo describe the outcomes and lessons learned from a trial of telephone counseling (TC) to reduce medical complications and health care utilization and to improve psychosocial outcomes during the first year after spinal cord injury rehabilitation. DesignSingle-site, single-blind, randomized (1:1) controlled trial comparing usual care plus TC with usual care (UC). SettingTwo inpatient rehabilitation programs. ParticipantsAdult patients (N=168) discharged between 2007 and 2010. InterventionsThe TC group (n=85, 51%) received up to eleven 30- to 45-minute scheduled telephone calls to provide education, resources, and support. The UC group (n=83, 49%) received indicated referrals and treatment. Main Outcome MeasuresThe primary outcome was a composite of self-reported health care utilization and medical complications. Secondary outcomes were depression severity, current health state, subjective health, and community participation. ResultsNo significant differences were observed between TC and UC groups in the primary or secondary psychosocial outcomes. ConclusionsThis study had a number of strengths, but included potential design weaknesses. Intervention studies would benefit from prescreening participants to identify those with treatable problems, those at high risk for poor outcomes, or those with intentions to change target behaviors. Interventions focused on treatment goals and designed to work in collaboration with the participant's medical care system may lead to improved outcomes.