Transcript Making the Connection - Boston Medical Center

The Internet as a
Treatment Modality
New England Regional
Spinal Cord Injury Center at
Boston Medical Center
ASIA-ISCoS Meeting
Boston, MA
Learning Objectives
1) Participants will be able to identify
the evidence and rationale for use
of the Internet as a treatment
modality in the rehabilitation of
patients with SCI.
2) Participants will understand how to
design and implement a weekly
curriculum with patients with SCI in
his/her rehabilitation setting.
Introduction: Why the
Internet?
• The growing scope of
independence for people with
disabilities
• Internet access crucial to
societal participation and
functional independence
• Experts highlighting Internet’s
relevance to OT
Research Review:
Patient Education
• Nearly all with positive results
• Critical review of acceptability and
usefulness of computerized
interventions for pwd (Krishna et al,
1997)
– All diabetes: lowered blood glucose
• Inpatient breast cancer study w/
controls (N=162) (Lampe, 2004)
– Int grp: more home Internet use, helped
• Independent skin care promotion for
adults with paraplegia—acrosssubjects design (Pellerito, 2003)
Research Review: Psychosocial
Outcomes & Functional
Independence
• Small, randomized trial re: computer
access & training w/ older adults for
improved psychosocial outcomes
(White et al, 2002)
• TBI computer knowledge training for
improved daily function-nonexperimental (Ivanoff, 2002)
• Case-control study of computerassisted training improved
wheelchair mobility on obstacle
course (Webster et al, 2001)
Research on Relevant
Rehabilitation Topics
• Health information access
• Vocational training
• Social support and
communication
NERSCIC Internet
Projects
•
•
•
•
Pilot MSN TV* Study
National SCI Technology Survey
The SCI Guide Online
Internet Access Group Project
*Copyright: Microsoft Corporation
Pilot MSN TV Study:
Questions
1. How is quality of life [QoL]
affected by Internet use?
2. How do participants describe
the effects of Internet access?
MSN TV Study
Description
• Provided first-time Internet
access to people with SCI at
home (N=26)
• MSN TV: like a cable box, with
television as monitor
• Measured QoL at 3 and 6 months
• Analyzed qualitative comments
into domains by number and
frequency
MSN TV Study Results:
Question 1
How is QoL affected by Internet use?
• TRENDS seen by each QoL
component:
1. Global health: decline in physical
health; improvement in mental health
2. Social isolation: decrease in contact;
increase in romantic/sexual
relationships
3. Recreation: Statistically significant
decrease in solitary activities; increase
in social activities
MSN TV Study Results:
Q. 1
Table 3. Comparisons of baseline and follow - up interviews
Health-Related Quality of Life
Global Health
% Fair or poor health
Mean days in past 30 days physical health not good
Mean days in past 30 days mental health not good
Mean days sad, blue or depressed
Mean days worried, tense or anxious
Social Isolation
Mean days in past 30 days poor physical or mental health
kept person from doing usual activities
Mean number of friends and relatives contact per month
% Involved in romantic relationship
% During past 12 mo sexually active with another person
Recreation
Mean hours in recreation per week
Solitary activities (watching television, listening to music,
reading or writing)
Social activities (board games, going out, socializing)
Baseline
Overall
(N=23)
Follow - up
22%
1.7 (3.4)
4.7 (8.2)
6.8 (10.5)
6.7 (9.1)
26%
5.7 (9.2)
4.3 (7.7)
5.4 (8.1)
6.6 (9.6)
2.0 (3.8)
2.2 (4.5)
13.0 (11.5)
33%
48%
11.7 (9.5)
39%
52%
18.8 (16.8)
74%*
15.2 (17.6)
48%
39%
44%
*p<.05, for differences between baseline and exit using binomial test for proportions and paired T test for means
MSN TV Study Results:
Question 2
How do participants describe the
effects of Internet access
[benefits/risks]?
•
Has access to the Internet affected
you in any way?
1. Yes, a lot
2. Yes, somewhat
3. No, not much
4. No, not at all
For 1,2,or 3, how has it affected you?
•
Grouped by theme and ranked by
frequency
MSN TV Study Results:
Question 2
• Most important benefits of
Internet use (in order):
1.
2.
3.
4.
Improved Quality of Life
Ease of Access to Information
Social Connection
Quality Information Available
MSN TV Study Results:
Question 2
1. Improved Quality of Life
– “It’s a wonderful pastime. It actually
distracts my mind off some of my
discomfort. I don’t want medication, I’d
rather be distracted. I have spinal cord
pain, [the Internet] gets myself out of
myself.”
– “I have more to look forward to, it makes
me happier. It’s something different,
more than just the same old grind. I’ve
gotten more interested in what’s going
on.”
MSN TV Study Results:
Question 2
2. Ease of Access to Information
– “Anything that I’m interested in, I can
look up…I don’t get all stressed out. It’s
not easy for a quadriplegic to flip
through the Yellow Pages, so using the
[Internet] is easier.”
– “Whenever I need something I’m not
sure of, it’s right there…It’s just opened
up doors…It’s opened my eyes…to things
and places I couldn’t have seen before.”
MSN TV Study Results:
Question 2
3. Social Connection
– “Being able to connect with people,
learn through people, make friends. The
Web allows me to trust other people
more without having to see them…
Communication, understanding people
better. I share more than through other
forms [of communication]. I share
intimacy, share problems and losses…It
helps unload frustration. I’m frustrated
with the scars on my face due to the
accident.”
MSN TV Study Results:
Question 2
4. Quality Information Available
(health, transportation, employment)
– “The more I look, the more I find. The
more I find, the more I learn. The more I
learn, the “more better” my life
becomes…I have found many sites which
send e-mail newsletter updates which I
further review, sort them out, and
discard and select. Then I put them to
use.”
Pilot MSN TV Study
Limitations
• Measures not adequate to capture
impact (ie. empowerment)
• Small numbers—difficult to interpret
quantitative results beyond “trends”
• High drop-out rate: 10/33 withdrew;
6/10 got computers for Internet
access instead
• Equipment failure
National SCI Technology
Survey
• Follow up to Pilot MSN TV Study
using large national sample (N=520)
• Cross-sectional survey re:
computer/Internet use
• Analyzed relationship between
frequency of use and QoL (selfperceived health status, satisfaction
with life, emotional well-being, social
integration)
Tech Survey Users vs.
Nonusers
• Significant difference by age,
race, education, employment
status, income
– Race
• Black=29%; Hispanic=32% vs.
White=62%
– Educational level
• <8th=9%; <H.S.=35%; H.S.=50%;
Assoc/Bach=79%; Grad=89%
Technology Survey vs
Pilot Results: Q. 1
How do people with SCI use the Internet?
MSN TV
• 10.6 hrs/wk for:
1. Email
2. Web Surfing
86%
80%
• Health Info
56%
• General Info 65%
• Entertainment
64%
3. Chat Rooms
26%
4. Shopping
35%
5. Employment Info 5%
•
Technology
62.4% use at least
monthly for:
1. Email
2. Web Surfing
•
•
•
80%
N/A
Health Info
35%
Other
47%
Entertainment 28%
3. Chat Rooms
9%
4. Shopping
32%
5. Employment Info 23%
Technology Survey
Results: Q. 2 vs Pilot
How is QoL affected
by Internet use?
• Significant correlation between
frequency of Internet use and:
–
–
–
–
–
Self-perceived health status
Satisfaction with life
Feeling down/depressed/hopeless
Contact with friends
Contact with businesses
• Only business contacts is significant
after adjusting for age, race, etc.
Technology Survey
Results: Other Findings
• Internet used for communication, info,
commerce
• Fairly high access (65%) and use
(62%)
• Certain subgroups w/more access
barriers—need outreach
• Pain is an important modifier
• Scientific study
– Control group or pre-post survey
– Specific intervention
Research Summary
• Internet used for communication, info,
commerce
• Fairly high access (65%) and use
(62%)
• Important HRQoL outcomes
• Certain subgroups w/ more access
barriers—need outreach
• Pain is an important modifier
• Scientific study needed
– Experimental design
– Specific intervention across rehab phases
The SCI Guide:
www.bu.edu/sciguide
• Goal: to connect users with SCI to
quality peer-reviewed resources on
the Internet, esp. newly injured and
technophobes
• Consumers evaluate Internet
resources
• Develop disability-specific rating
system for websites
• Create a comprehensive, analytical
guide for the SCI community that is
user-friendly and self perpetuating
Internet Access Group
Project
• Provide Internet training to
newly injured patients with SCI
during initial acute rehabilitation
stay
• Provide free Internet access in
patient’s home post-discharge
• Evaluate satisfaction and
physical and emotional health
Group Process
• Weekly 90-minute Group
• 4-5 Patients
• Led by OT Staff
• Learning Modules
• Open Lab
• Assessment
Patient Education
• Weekly Curriculum
– Anatomy of SCI and current
research projects
– Secondary medical conditions
– Life management tasks
– Sports, recreation, and leisure
– Christopher Reeve Paralysis
Resource Center and NSCIA
website review
Life Management Skills
•
•
•
•
•
Grocery Shopping
Banking
Education
Employment
Communication
Implementation
• Equipment
– Computers with Internet access,
work stations, assistive
technology, adaptive equipment
• Staffing
– One OT with SCI experience and 12 rehab aides or volunteers
• Scheduling
Adaptive Equipment and
Assistive Technology
Occupational Therapy
“Occupational therapy is skilled
treatment that helps individuals
achieve independence in all facets of
their lives. Occupational therapy
assists people in developing the
“skills for the job of living” necessary
for independent and satisfying lives.”
The American Occupational Therapy Association
Contact Information
Bethlyn Houlihan
Senior Project Manager
Room F511
(617) 638-7380
[email protected]
Claudine DeJoie, COTA/L
Program Coordinator
617-638-7389
[email protected]