Effects of App-Based Transitional Care on the Self-Efficacy and Quality of Life of Patients With Spinal Cord Injury in China: Randomized Controlled Trial

Abstract

Background Spinal cord injury (SCI) severely impairs the physical and mental health of patients, decreasing their self-efficacy in coping with daily life and quality of life (QOL). In China, a large gap remains between the complex long-term health needs of SCI patients and the current community care system. With the prevalence of mobile terminals, the usage of mobile health apps has the potential to fill this gap by extending qualified medical resources to the families of SCI patients. Our team developed the app Together for the transitional care of home-dwelling SCI patients in China. Objective This study aimed to evaluate the effects of app-based transitional care on the self-efficacy and QOL of SCI patients. Methods Through a three-round Delphi process, an Android app was designed. Both medical staff and patients could access the app. Medical staff used it for providing remote transitional care to SCI patients. Patients used it to view transitional care time and send messages to medical staff. Thereafter, a multicenter and assessor-blinded randomized controlled trial was conducted. Participants (n=98) who had SCI and lived at home following discharge were recruited and randomly assigned to a study group (n=49) and control group (n=49) using a randomized number list in four research centers. Patients in both groups received systematic discharge education before discharge. The study group received five follow-ups conducted by trained nurses through the app, which had four core functions, namely remote assessment, health education, interdisciplinary referral, and patient interaction, at weeks 2, 4, 6, 8, and 12 following discharge. The control group received a routine telephone follow-up conducted by nurses at week 12 following discharge. The outcome measures were the Moorong Self-Efficacy Scale (MSES) and 36-item Short-Form Health Survey (SF-36) scores. Data were collected before discharge (T0) and at weeks 12 (T1) and 24 following discharge (T2). Differences between the groups were tested by repeated measures analysis of variance and simple effect analysis. Results After the follow-up, the total MSES scores in the study group improved over time (T0=67.80, T1=71.90, and T2=76.29) and were higher than those in the control group (T2=64.49) at 24 weeks following discharge (simple effect analysis: F1=8.506, P=.004). Regarding the total SF-36 score, although it was higher in patients from the study group (T2=65.36) than those from the control group (T2=58.77) at 24 weeks following discharge, only time effects were significant (F2,95=6.671, P=.002) and neither the group effects nor the interaction effects influenced the change in QOL (group effects: F1,96=0.082, P=.78; interaction effects: F2,95=3.059, P=.052). Conclusions This study confirmed that app-based transitional care improves the self-efficacy of SCI patients. Nevertheless, QOL improvement is not yet evident. Future investigations with larger sample sizes and longer observation periods are warranted to further verify the effects. Trial Registration Chinese Clinical Trial Registry ChiCTR-IPR-17012317; http://www.chictr.org.cn/showproj.aspx?proj=19828

Questionnaire Survey-Based Quantitative Assessment of the Impact of Transitional Care on Self-Management of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

“…Of note, intervention time, caregiver type, and telephone visit may affect the outcomes of TC. For example, TC based on app increases self-efficacy of spinal cord injury patients, while it does not improve quality of life significantly [ 27 ]. In this investigation, we evaluated COPD patient's life quality via various questionnaires and found positive enhancement.…”

User experience of a self-management WeChat applet for patients with neurogenic bladder: A qualitative approach

“…The introduction of smart technology has promoted self-management in different diseases, such as hypertension [ 11 ], spinal cord injury [ 12 ], and chronic obstructive pulmonary disease (COPD) [ 13 ]. In particular, mHealth has contributed to the self-management of NGB adults in the United States and NGB children in England [ 14 , 15 ].…”

mHealth Physical Activity Intervention for Individuals With Spinal Cord Injury: Planning and Development Processes

“…Interestingly, most physical activity behavioral interventions for individuals with physical disabilities have been delivered in person or over the telephone, with few using digital platforms (eg, email, texting, and video) [12]. Although apps have been used to deliver other types of health interventions for individuals with SCI (eg, transitional care) [13], to the best of our knowledge, no physical activity interventions have been provided to individuals with SCI through a mobile health (mHealth) format. mHealth interventions offer a convenient way to deliver physical activity support to individuals with SCI, especially because of the sparse and geographically distant number of individuals with SCI who walk, which makes in-person interventions nearly impossible.…”

“…Interestingly, most physical activity behavioral interventions for individuals with physical disabilities have been delivered in person or over the telephone, with few using digital platforms (eg, email, texting, and video) [ 12 ]. Although apps have been used to deliver other types of health interventions for individuals with SCI (eg, transitional care) [ 13 ], to the best of our knowledge, no physical activity interventions have been provided to individuals with SCI through a mobile health (mHealth) format.…”