Functional and clinical outcomes of telemedicine in patients with spinal cord injury.

OBJECTIVE To compare the 6-month outcomes of telerehabilitation intervention with those of standard care for spinal cord injury (SCI). DESIGN Multicenter randomized controlled trial. SETTING Home, nursing, or unspecialized hospital care provided after discharge from a spinal cord unit. PARTICIPANTS Adult patients with nonprogressive, complete, or incomplete SCI discharged for the first time from the spinal cord unit to their homes (Belgium and Italy) or to their homes or another facility (England). INTERVENTIONS All patients received the standard care they would have normally received after discharge from the spinal cord unit. In addition, patients in the telemedicine group received 8 telemedicine weekly sessions in the first 2 months, followed by biweekly telemedicine sessions for 4 months. MAIN OUTCOME MEASURES Functional status at 6 months, clinical complications during the postdischarge period, and patient satisfaction. RESULTS No significant differences in the occurrence of clinical complications were found between the study groups. A higher improvement of functional scores in the telemedicine group was found only at the Italian site: FIM total score 3.38+/-4.43 (controls) versus 7.69+/-6.88 (telemedicine group), FIM motor score 3.24+/-4.38 (controls) versus 7.55+/-7.00 (telemedicine group; P<.05). Items contributing to this difference were grooming, dressing upper body, dressing lower body, and bed/chair/wheelchair transfer. Higher satisfaction with care was reported by patients in the telemedicine group across all sites. CONCLUSIONS Our study provides some of the first quantitative evidence, based on results from 1 site, that telerehabilitation may offer benefits to patients discharged from a spinal cord unit compared with standard care in terms of functional improvement. Further research is warranted to confirm or disprove this finding.