Background Individuals with spinal cord injury (SCI) are at high risk of experiencing secondary conditions like pressure injuries. Self-management programs may reduce the risk of complications, but traditional programs have proven to be insufficiently tailored to the needs of people with SCI. To overcome barriers to self-management support, a web-based, self-management program was developed for Canadians with SCI called SCI & U. Objective This study aims to evaluate the feasibility and potential impact of the SCI & U program in the context of a mixed methods pilot study. Methods The study followed an explanatory, sequential mixed methods design. Participants (N=11) were Canadians with SCI who had been living in the community for more than 1 year. Each took part in a self-paced, six-session self-management program guided by a trained peer health coach. During sessions, participants could discuss a health topic with their coach from a predefined list (eg, skin or bowel management). Quantitative data were gathered before and after program participation to assess program feasibility and impact. Feasibility measures included attrition rates, frequency of topics selected, and recorded goals, whereas impact measures included measures of self-efficacy (University of Washington Self-Efficacy Scale [UW-SES]), mood (Personal Health Questionnaire Depression Scale [PHQ-8]), secondary conditions (Spinal Cord Injury Secondary Conditions Scale [SCI-SCS]), and resilience (Spinal Cord Injury Quality of Life Resilience Scale [SCI-QOL-R]). Qualitative measures were based on postintervention interviews; these were designed to confirm and expand on quantitative Results Of the 11 participants, 10 completed pre- and postassessments, and 6 coaching sessions. Sessions lasted between 31 and 81 min (average 55, SD 13), and the duration of the program ranged from 35 to 88 days (average 56, SD 23). Diet and exercise were selected as topics 40% (20/50 sessions with topics) of the time, whereas topics such as mental health, bladder management, pain, and bowel management were chosen less frequently. Results gathered before and after the pilot study demonstrated improvements with moderate effect sizes on the UW-SES and the electronic health literacy scale (ie, Hedges g>0.5). Effect sizes for measures of resilience (SCI-QOL-R), depression (PHQ-8), and secondary conditions (SCI-SCS) were small (ie, Hedges g>0.3). Qualitative results confirmed a common focus on diet and exercise, and defined coaches as sources of accountability, information, reassurance and affirmation, and emotional and technical support. Conclusions Results demonstrated that a web-based self-management program is feasible and acceptable by Canadians with SCI. Results also indicated a web-based, peer-led self-management program may impact resilience, self-efficacy, mood, and secondary complications. Finally, results illuminated the role of the coach in facilitating behavior change. Future work seeks to validate results in the context of a randomized controlled trial.

Study design Type II hybrid effectiveness-implementation trial protocol. Objectives To (1) evaluate the implementation of coordinated physical activity (PA) coaching delivered by physiotherapists and spinal cord injury (SCI) peers during the transition from in-hospital care to living in a community (implementation objective) and (2) assess the effect of coaching on PA behaviour and psychosocial predictors among people with SCI (effectiveness objective). Setting Rehabilitation hospital and home/community settings in British Columbia, Canada. Methods Implementation objective: PA coaches (physiotherapists and SCI peers) receive an implementation intervention including training, monitoring, feedback, and champion support. A Theoretical Domains Framework-based questionnaire is collected at baseline, post-training, 2, and 6 months follow-up and semi-structured interviews conducted at 6 months. Effectiveness objective: Using a quasi-experimental design, 55 adults with SCI are allocated to intervention (PA coaching, n = 30) or control (usual care, n = 25) groups. Participants in the intervention group are referred by physiotherapists to receive 11 SCI peer-delivered PA coaching sessions in the community. Control participants received usual care. Questionnaires assessing PA behaviour and psychosocial predictors are administered at baseline, 2-months, 6-months, and 1-year. Semi-structured interviews are conducted to assess intervention satisfaction at 6 months. Analyses include one-way (implementation objective) and two-way (effectiveness objective) repeated measures ANCOVAs for questionnaire-reported outcomes and thematic content analysis for interview data. Data are summarised using the reach effectiveness adoption implementation maintenance (RE-AIM) framework. Ethics and dissemination The University of British Columbia Clinical Research Ethics Board approved the protocol (#H19-02694), clinicaltrials.gov registration NCT04493606. Documentation of the adoption process will inform implementation in future sites.

BACKGROUND Individuals with spinal cord injury (SCI) have a high risk of experiencing secondary conditions like pressure injuries. Self-management programs may reduce the risk of such complications, but traditional programs have proven to be insufficiently tailored to the needs of people with SCI. To overcome barriers to self-management support, an online self-management program was developed for Canadians with SCI called “SCI&U”. OBJECTIVE To evaluate the feasibility and potential impact of the “SCI&U” program in the context of a mixed-methods pilot study. METHODS The study followed an explanatory sequential mixed-methods design. Participants (N=11) were Canadians with SCI who had been living in the community for more than 1 year. Each took part in a self-paced, 6-session self-management program guided by a trained peer health coach. During most sessions participants could elect to discuss a health topic with their coach from a pre-defined list (e.g. Skin or Bowel Management). Quantitative data was gathered before and after program participation to assess program feasibility and impact; feasibility measures included attrition rates, frequency of health topics selected and recorded goals, while impact measures included measures of self-efficacy (UW-SES), mood (PHQ-8), secondary conditions (SCI-SCS) and resilience (SCI-QOL-R). Qualitative measures were based on post-intervention interviews; these were designed to confirm and expand upon quantitative results. Synthesis of quantitative and qualitative results was conducted at the reporting and interpretation level. RESULTS Of 11 participants, 10 completed pre- and post-assessments and 6 coaching sessions. Sessions lasted between 31 and 81 minutes (average 55 minutes) and the duration of the program ranged from 35 to 88 days (average 56 days). Diet and exercise were selected as health topics 40% of the time; mental health, bladder, pain and bowel management topics were chosen but less frequently. Pre- and post results demonstrated improvements with moderate effect sizes on the UW-SES and eHEALS (i.e. Hedges’ g > 0.5). Effect sizes for measures of resilience (SCI-QOL-R), depression (PHQ-8) and secondary conditions (SCI-SCS) were small (i.e. Hedges’ g > 0.3). Qualitative results confirmed a common focus on diet and exercise and defined coaches as sources of accountability, information, reassurance/affirmation, emotional and technical support. CONCLUSIONS Results demonstrate an online self-management program to be feasible and acceptable by Canadians with SCI. Results also indicate the potential for online, peer-led self-management programs to impact resilience, self-efficacy, mood and secondary complications. Finally, results illuminate the role of the coach in facilitating behaviour change. Future work seeks to validate these results in the context of a randomized controlled trial. CLINICALTRIAL

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