Background: Engaging patients in therapy is vital in rehabilitation, particularly for patients admitted into inpatient spinal cord injury (SCI) rehabilitation. Literature demonstrates that patients who have higher engagement in therapy tend to have greater functional independence. Certain skills used by occupational or physical therapists may improve patient engagement in therapy (e.g., skills to identify goals that are important to each patient, speaking in a manner that the patient can understand). To ensure that therapists learn and utilize these skills, we have developed a treatment intervention called Enhanced Medical Rehabilitation (EMR). The goal of EMR is to teach therapists a set of behavioral skills so that (1) therapy sessions are patient directed, (2) patients are more active in therapy, and (3) therapists provide more feedback to patients. We previously showed that EMR works to improve outcomes for older adults in nursing facilities. We do not yet know whether EMR works well in inpatient SCI units; thus, we decided to use a well-known adaptation method to customize the EMR program to the inpatient hospital and ensure that it is acceptable to patients with SCI.
Objectives: We propose to adapt the EMR program. We will then test if this adapted program improves therapy engagement and patient outcomes in inpatient SCI units.
Methods: We will randomly assign patients to one of two groups. In one, patients will receive therapy from therapists who are trained and supervised in EMR; in the second, patients will receive therapy from therapists using standard of care (SOC) therapy (i.e., therapists doing what they usually do).
Expected Outcomes: We believe that EMR can be adapted successfully and that the manual and materials can be customized for use in inpatient SCI units. We anticipate that EMR will bring better experiences and outcomes to patients. Patients will engage more and put more effort into therapy, and they will have more positive changes in daily function, mood, and satisfaction than the SOC group.
Significance: If successful, this study will help improve therapists’ skills in working with patients, resulting in more favorable SCI outcomes.
Patient Engagement Intervention in Inpatient Spinal Cord Injury Rehabilitation, Psychosocial Research (PSR) Pilot Grant, Craig H. Neilsen Foundation, USA (10/31/18-8/30/22, NCE: 8/30/23, Award #: 542448. PI: Alex Wong)