Videoconferencing in the rehabilitation of spinal cord injured people Helen Pain Duke of Cornwall Spinal Treatment Centre currently at University of Southampton

Outline Spinal cord injury Telerehabilitation project Key outcomes Some conclusions Possibilities for the future

Spinal cord injury Specialised centres at regional level Risk of medical complications –Autonomic dysreflexia –Urine infections –Pressure sores Follow up for life –Costly due to large geographical area

The THRIVE project European project Randomised controlled trial Intervention group had one to one videoconferencing sessions –Regular sessions in first 6 months after discharge –Dedicated machine and bespoke software

Primary outcomes Quality of life (WHOQoL) Mood (HADS) Function (FIM, SCIM) Health (diary)

Method Outcome measures before discharge Randomisation Visited participant at 2 and 6 months post discharge Trial group had broadband provided and the kit was loaned for the 6 months

Technical Webcam and microphone provided 2 way real time audiovisual link One to one Data was encoded for transmission IT Consultant installed the kit and provided support to THRIVE team Kit was collected at 6 month visit

Key outcomes Most participants adapted well to using the kit Regular contact with the experts was valued Satisfaction in intervention group significantly higher than control

Key outcomes Cost of providing the service was very high A separate system not ideal for people with physical disabilities QoL, functioning and medical complications not significantly different between intervention and control groups

Some conclusions One size does not fit all NHS cannot provide general facilities, but could take more advantage of facilities patients already have Headsets were preferable to table top microphones

Possibilities for the future Introduce tele-services as service development rather than research Consider use of a secure portal to integrate advice, information, learning, peer support Expert support needed for health professionals and patients for many other neurological conditons

Acknowledgements Dr A Soopramanien, Duke of Cornwall Spinal Treatment Centre, Salisbury THRIVE project partners in Italy and Belgium

Tele-medicine sessions 1 st session within 7 days of discharge. Planned weekly contact for 8 weeks, alternating medical and therapy. Fortnightly after 8 weeks Total 16/17 sessions, each approx 20-30mins