Peer mentoring reduces unplanned readmissions and improves self-efficacy following inpatient rehabilitation for individuals with spinal cord injury

Abstract

Objective

Evaluate effectiveness of peer interventions on self-efficacy, unplanned hospital readmissions, and quality of life for patients with spinal cord injury (SCI) undergoing inpatient rehabilitation.

Design

Interrupted time-series analysis (ITSA) examined effects of peer interventions on unplanned readmissions. Intervention variables added to ITSA regression examined relationships with exposure to peer interventions. Heterogeneity of treatment effects (HTE) analysis examined differences in intervention effectiveness for patients with quadriplegia and paraplegia.

Setting

Rehabilitation hospital specializing in SCI and brain injury.

Participants

SCI inpatients (n = 1117) admitted for rehabilitation whose discharge location was home (77% male, 71% Caucasian, mean age 38.2 (SD 16.8)). A subsample of 799 patients participated in secondary analyses examining relationship between peer interventions, readmissions, changes in patient-reported outcomes, and HTE.

Interventions

One-to-one mentoring and participation in peer-led self-management classes.

Main outcome measures

Unplanned readmissions, general self-efficacy (GSE), and depressive symptoms 30, 90, and 180 days post discharge; satisfaction with life at 180 days.

Results

After implementing the peer interventions, we observed a significant decrease in both level and slope of number of patients readmitted, and level only of unplanned hospital days 30-days post-discharge. Reduction in the number of patients and unplanned hospital days was associated with number of peer visits but not peer-led education classes attended. Higher self-efficacy (GSE) was associated with greater exposure to peer mentoring, and a significant relationship between improvement in GSE and reduced hospital readmissions was observed.

Conclusions

One-to-one peer mentoring improves self-efficacy and reduces unplanned hospital readmissions following inpatient rehabilitation for persons with SCI.

Keywords:

• Mentors
• Peer group
• Rehabilitation
• Spinal cord injury

Acknowledgements

The authors wish to acknowledge contributions of the following to the work presented here: Dr Kate Lorig, PhD, for consultation on development of the peer-led education program and selection of outcome measures. Dr Richard Goldstein, PhD, for consultation in development and execution of the analytical and statistical approaches. All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of PCORI, its Board of Governors, or Methodology Committee, or of the Robert W. Woodruff Foundation.

Clinical trial registration number

NCT02746978

Additional information

Funding

This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Award # IH-12-11-5106 and the Robert W. Woodruff Foundation.