Peer-supported self-management to facilitate community re-entry after discharge from spinal cord injury rehabilitation: Engaging peers as change agents and research partners

Objective Peer support is an important adjunct to clinical care for people with disabilities, and may help address barriers to community reintegration. Peers offer positive role models and the benefit of learning from shared experiences of living with disability. Despite potential benefits, peer support is not consistently integrated in the rehabilitation process. This presentation describes three interventions recommended by patients, and directed by peer mentors, to promote successful community transition after rehabilitation for traumatic spinal cord injury (SCI). The interventions were one-to-one peer mentoring, a peer-directed patient education program, and a patient-centered Internet portal, providing access to peers, educational materials, and healthcare professionals for continuation of care post-discharge. The initiatives were undertaken to improve patient engagement in the care process, and to instill self-efficacy in their ability to effectively manage their own care needs. Experimental and quasi-experimental studies were undertaken to evaluate the impact of the three interventions. Material/Patients and methods The research setting is a large hospital specializing in neurorehabilitation of traumatic SCI or brain injuries. Research participants were patients admitted for neurorehabilitation after SCI. Approximately 500 SCI patients are admitted annually. In study one, 158 patients were randomized to receive usual care or to receive intensive one-to-one peer mentoring during and after their hospital stay. Over 40 former patients were trained as certified peer mentors. Peers met with patients at least one hour per week throughout the hospital stay. Additional face-to-face or telephone contacts were continued for up to 90 days post-discharge. In study two, 208 patients participated in a trial comparing traditional, didactic, nurse-directed education to a novel, peer-directed and patient-focused education program emphasizing transformative learning. The new program was implemented step-wise over three class topics–bowel and bladder care, skin care, and managing health concerns common in SCI, in order to evaluate the effects on patient engagement and healthcare outcomes. Study three involves working with peer mentors to design and build an internet portal to provide a constant connection for the patient to healthcare professionals, personalized health information, educational resources, and peer support. An interrupted time-series analysis will evaluate the impact of the portal on self-efficacy at discharge and healthcare outcomes up to 6 months post-discharge. Results Results of these interventions have been dramatic in improving patient engagement and self-efficacy to manage their own care needs. Significant reductions in secondary complications and hospital readmissions post-discharge have also been noted. Discussion/Conclusion Peer-directed self-management strategies appear to be effective and cost-effective in promoting successful community reintegration. Moreover, these strategies have contributed to a broader change in the organization's culture of patient-centered care and rehabilitation.