Abstract
Individuals with spinal cord injury (SCI) must often travel long distances to see a rehabilitation specialist. While telemedicine (TM) for pressure ulcer management has been used in this population, real-time video telecommunication using iPad has never been described. The objective of this study was to provide specialized care for persons with SCI through TM consultation expediently in order to address medical needs, manage secondary complications, and to improve quality of life (QoL) of individuals with SCI. Ten individuals with SCI participated in the TM program using iPads for 6 months as a feasibility study at a single-center, county hospital. The participants contacted the project staff for SCI-related conditions and were then connected to an SCI-trained health-care provider within 24 hours via FaceTime. Main outcome measures included health-care utilization; QoL and psychosocial measures collected at baseline and at 6 months: Reintegration to Normal Living Index (RNLI), Life Satisfaction Index A (LSI-A), and Patient Health Questionnaire 9 (PHQ-9); and a Program Satisfaction Survey. Ten patients (seven with tetraplegia, three with paraplegia; eight males and two females) with an average age of 34.4 (18-54) years were enrolled. The average baseline and 6-month follow-up scores were RNLI-70.1 ± 19.7 and 74.7 ± 21.8, respectively; LSI-A-25.4 ± 7.4 and 26.4 ± 8.2, respectively; and PHQ-9 were 6.8 ± 7.2 and 8.6 ± 6.1, respectively. TM encounters included topics such as pain, bladder and skin management, medication changes, and lab results. The Program Satisfaction Survey yielded positive results with 100% of program completers stating they would recommend the program and would like to continue having TM. This is the first known successful project using iPad to provide TM in the SCI population. This study discusses the implementation of such a TM program in a health system including limitations. It describes the clinical viability of TM using iPads in the SCI population for care beyond that of just pressure ulcer management. This project provides evidence for using a tablet device like an iPad as an effective and efficient patient management tool.
Highlights
Spinal cord injury (SCI) is a devastating injury that causes paralysis and causes significant chronic morbidity due to secondary complications
Even with a small sample size of 10, our patient demographics match that of the general traumatic SCI population historically with a gender proportion of approximately 80% male, an average age of 30–40 at the time of injury, and with the most common cause of SCI being automobile accidents [1, 21, 22]
Even though telehealth has been in existence for approximately 40 years, it is still not fully implemented as standard of care
Summary
Spinal cord injury (SCI) is a devastating injury that causes paralysis and causes significant chronic morbidity due to secondary complications. Individuals with SCI face many challenges upon transition from acute inpatient rehabilitation Due to their medical complexity and high risk for secondary complications, they often require rehospitalizations and regular ongoing medical and psychological care for a variety of issues [2,3,4,5,6]. Many of these patients, as is true in general for persons with disabilities, live in rural areas without immediate medical care or rehabilitation specialists and must travel hours to see an SCI specialist [7]. Main outcome measures included health-care utilization; QoL and psychosocial measures collected at baseline and at 6 months: Reintegration to Normal Living Index (RNLI), Life Satisfaction Index A (LSI-A), and Patient Health Questionnaire 9 (PHQ-9); and a Program Satisfaction Survey
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