Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Aug 3, 2020
Date Accepted: Mar 8, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effects of App-based Transitional Care on 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 patients with SCI and the current community care system. With the prevalence of mobile terminals, the usage of mobile health applications (apps) has the potential to fill this gap by extending the qualified medical resources to the families of patients with SCI. Our team developed an app, named Together, for the transitional care of home-dwelling patients with SCI at home in China.
Objective:
This study aimed to evaluate the effects of the app-based transitional care on self-efficacy and QOL of patients with SCI in China.
Methods:
A multicenter and assessor-blinded randomized controlled trial was conducted. Participants (n=98) who lived at home following discharge were recruited and randomly assigned to the study group (n=49) and control group (n=49) using the randomized number list in four research centers. Patients in both groups received systematic discharge education prior to 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 and the 36-item Short Form Health Survey. Data collection was implemented prior to discharge, and at weeks 12 and 24 following discharge. Differences between the two groups were tested by repeated-measure analysis of variance and simple effect analysis.
Results:
The Moorong Self-efficacy Scale scores did not reveal differences between the two groups in time and group effects (all P>.05). However, differences in the interaction effects were statistically significant (all P<.001). After the simple effect analysis, the total scores and three-factor structure scores at 24 weeks following discharge were significantly higher than those of the control group (all P≤.010). Based on the 36-item Short Form Health Survey scores, differences in the time effects of total scores and physical component summary scores were statistically significant (both P<.05). However, there was no difference between the two groups in the time effects in the mental component summary, interaction effects, and group effects (all P>.05).
Conclusions:
This study confirmed that app-based transitional care improves the self-efficacy of patients with SCI; nevertheless, improvement in QOL is not yet evident. Future investigations with larger sample sizes and longer observation periods are warranted to further verify the effects of app-based transitional care. Clinical Trial: Chinese Clinical Trial Registry ChiCTR-IPR-17012317; www.chictr.org.cn/index.aspx
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