Article

Single-blind randomized controlled trial of 6 months' duration.
OBJECTIVES: To evaluate the efficacy of a novel telehealth intervention,
'CareCall', on reducing pressure ulcers and depression and enhancing the use of
appropriate health care. SETTING: General community, Massachusetts and
Connecticut, United States METHODS: 'CareCall' is an automated, interactive voice
response system that combines patient education, cognitive behavioral
interventions, screening and referrals, with alerts to a nurse telerehabilitation
coordinator for direct non-emergent phone follow up. Participants consisted of a
convenience sample of 142 persons with multiple sclerosis or spinal cord injury
using a wheelchair >6 h per day. The intervention group received CareCall (n=71)
The control group received usual care (n=71). The main outcome measures were: The
pressure ulcer scale for healing tool, Patient Health Questionnaire-9 depression
scale, Cornell Services Index and Craig Hospital Inventory of Environmental
Factors-Short Form Question 5. RESULTS: CareCall achieved a reduction in presence
of pressure ulcers at 6 months in women (P<0.0001). Among those with baseline
depression, CareCall reduced 6-month severity of depression, adjusting for age
and gender (P<0.047). CareCall did not have a significant impact on health-care
utilization (OR=1.8, P=0.07), but did significantly improve participants' report
of health-care availability (OR=2.03, P<0.04). CONCLUSION: This is the first
study to demonstrate the efficacy of a largely automated telehealth intervention
for adults with spinal cord dysfunction. Future research needs to replicate this
study in a larger, multisite trial.

Langue : ANGLAIS