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We are conducting a randomized controlled trial of telemedicine with patients with spinal cord injuries in their own homes. Internet videoconferencing is used at a bandwidth of 128 kbit/s. Data collection began in March 2004. Twelve patients had entered the study by August 2004, but none had completed it. Preliminary results in one case suggest that telemedicine provided various benefits: (1) the patient received advice he would probably not have solicited; (2) it enabled an expert to view the entry site of a pin in the patient's halo brace, to determine whether the general practitioner should be contacted to arrange a swab; (3) it made it easier for the interviewer to understand family interactions during the session. Telemedicine offers an additional tool in the care of geographically widespread outpatients.

A randomized controlled trial was conducted in spinal treatment centres in three European countries to evaluate the effectiveness of using Internet-based video-link technology in the first six months after patients were discharged following spinal cord injury. Standardised measures were used with participants prior to randomization to either trial or control group. Both groups received standard post-discharge support, but in addition the trial group had regular videoconference sessions. Each participant received an assessment at two months’ and six months’ post-discharge. The 1 37 participants recruited over two years had a mean age of 42 years. Interim data analysis with 77 patients revealed a significant difference between the trial and control groups when quality of life intra-subject score differences between discharge and month 6 were compared (P = 0.025). Medical complications were not significantly different between trial and control groups. The video-link was well received by the trial group, who preferred to see the person they conversed with. Regular expert consultation using video-link technology benefited participants’ quality of life.