Abstract
BackgroundIndividuals with spinal cord injury (SCI) are at risk for secondary medical complications, such as urinary tract infections (UTIs) and pressure injuries, that could potentially be mitigated through improved self-management techniques. The Interactive Mobile Health and Rehabilitation (iMHere) mobile health (mHealth) system was developed to support self-management for individuals with disabilities.ObjectiveThe main objective of this study was to determine if the use of iMHere would be associated with improved health outcomes over a 9-month period. A secondary objective was to determine if the use of iMHere would be associated with improved psychosocial outcomes. Phone usage, app usage, and training time data were also collected to analyze trends in iMHere use.MethodsOverall, 38 participants with SCI were randomized into either the intervention group who used the iMHere system and received standard care or the control group who received standard care without any technology intervention. Health outcomes were recorded for the year before entry into the study and during the 9 months of the study. Participants completed surveys at baseline and every 3 months to measure psychosocial outcomes.ResultsThe intervention group had a statistically significant reduction in UTIs (0.47 events per person; P=.03; number needed to treat=2.11). Although no psychosocial outcomes changed significantly, there was a nonsignificant trend toward a reduction in mood symptoms in the intervention group compared with the control group meeting the threshold for clinical significance. Approximately 34 min per participant per month were needed on average to manage the system and provide technical support through this mHealth system.ConclusionsThe use of the iMHere mHealth system may be a valuable tool in the prevention of UTIs or reductions in depressive symptoms. Given these findings, iMHere has potential scalability for larger populations.Trial RegistrationClinicalTrials.gov NCT02592291; https://clinicaltrials.gov/ct2/show/NCT02592291.
Highlights
Spinal cord injury (SCI), an insult to the spinal cord that is most commonly traumatic, can be a life-changing diagnosis
The intervention group had a statistically significant reduction in urinary tract infection (UTI) (0.47 events per person; P=.03; number needed to treat=2.11)
No psychosocial outcomes changed significantly, there was a nonsignificant trend toward a reduction in mood symptoms in the intervention group compared with the control group meeting the threshold for clinical significance
Summary
Spinal cord injury (SCI), an insult to the spinal cord that is most commonly traumatic, can be a life-changing diagnosis. In the United States, approximately 17,000 new injuries occur each year, resulting in a prevalence of 285,000 [1]. While the primary characteristics of SCI include strength loss and sensory loss, these chronic complications can result in increased mortality, health care costs, treatments, and hospitalizations [1,2]. Two of the most common chronic complications are urinary tract infections (UTIs) and skin pressure injuries. Depression is prevalent in the United States in 1 out of every 5 individuals with SCI as compared with 1 out of 20 people without disabilities [6]. Individuals with spinal cord injury (SCI) are at risk for secondary medical complications, such as urinary tract infections (UTIs) and pressure injuries, that could potentially be mitigated through improved self-management techniques. The Interactive Mobile Health and Rehabilitation (iMHere) mobile health (mHealth) system was developed to support self-management for individuals with disabilities
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