Urinary Bladder, Neurogenic Clinical Trial
Official title:
Applying Health Mechanics to Enhance Bowel and Bladder Health for Persons With SCI
This study will look at the use of a telehealth version of a self management program in
individuals with both new onset and chronic traumatic spinal cord injuries. The program is
called Health Mechanics. It is meant to enhance self management skills related to neurogenic
bladder and bowel management to prevent associated problems and improve Quality of Life
(QOL). This program is based on the needs and strengths of individuals with SCI. It focuses
on enhancing skills, encouraging positive health behaviors, empowering people within their
own environments, and recognizing that people differ in their resources and abilities. The
skills that are part of the intervention are: attitude, self-monitoring, problem-solving,
communication, organization and stress management. This study will address those skills in
the context of bladder and bowel health, with expectations that these skills to be useful in
other areas of life as well.
The investigators hypothesize that individuals in the Health Mechanics intervention group
will:
- show greater improvements in problem solving skills, healthy attitudes about disability
and knowledge of SCI management skills than will the control group
- have greater adherence to recommended bladder and bowel management behaviors than the
control group
- have fewer bladder and bowel complications than the control group
- have higher levels of QOL than the control group
In other words, this study will investigate the effectiveness of a telehealth version of
Health Mechanics to enhance self-management skills related to neurogenic bladder and bowel
management in an attempt to prevent associated complications and improve QOL.
Background and Overview
This study will evaluate the efficacy of a newly developed self-management program, Health
Mechanics, to develop and improve bladder and bowel management skills among persons with new
and chronic SCI. Program participation is expected to prevent bladder and bowel related
medical complications (e.g., constipation, leakage), leading to enhanced social participation
and QOL. Health Mechanics was designed by the study PI, Dr. Meade, between 2007 and 2009 with
funding from the Paralyzed Veteran's of America Education Foundation to assist persons with
SCI develop and transfer the necessary skills to keep their bodies healthy while managing the
many aspects of SCI care.
This study will investigate the effectiveness of a telehealth version of Health Mechanics to
enhance self-management skills related to neurogenic bladder and bowel management in an
attempt to prevent associated complications and improve QOL. The study makes a unique
contribution to rehabilitation by emphasizing the concepts of personal responsibility and
control over one's health and life as a whole. By selecting a telehealth approach (here
defined as telephone-based) for program implementation, the investigators also attempt to
address the high cost of care delivery and lack of health care access to underserved
populations with SCI living in remote areas of the State of Michigan.
The Health Mechanics program is designed based on the needs and strengths of individuals with
SCI while being responsive to identified gaps and challenges of health care provision in this
population. The program focuses on enhancing skills, encouraging positive health behaviors
and empowering people within their own environments, recognizing that people have different
resources and abilities. For this study, the Health Mechanics program has been adapted to
specifically focus on bladder and bowel management related concerns and to be administered
via telephone, thus better addressing the needs of the rural population and
transportation-related challenges.
By teaching skills to better manage bladder and bowel health, this self-management program
should not only reduce the occurrence of complications but it should also result in higher
levels of social integration and QOL. Since the skills taught - attitude, self-monitoring,
problem-solving, communication, organization and stress management - will be addressed in the
context of performing the behaviors necessary to enhance bladder and bowel health, we expect
them to generalize into other areas such that improvements in these skills result in better
overall health and participation.
Purpose and Objectives
The proposed study's overall purpose is to evaluate the effects of Health Mechanics in
preventing bladder and bowel complications and to improve QOL. The program specifically
targets newly injured individuals for early prevention of complications, as well individuals
with chronic injuries for later treatment and prevention of complications. Objectives are: 1)
to improve self-management skills, including problem-solving, knowledge of health behaviors,
and attitude about disability; 2) to increase adherence to recommended bladder and bowel
management behaviors; 3) to improve bladder and bowel health and related QOL; and 4) to
determine the extent that program improvements in terms of skills acquired are sustained over
time. Short-term refers to 3 and 6 months assessments while long-term refers to the 12 month
assessment. All hypotheses posit that, following the intervention, differences will exist
such that participants in the Health Mechanics program will perform better than the control
group (an assessment of between group differences) and that these differences will be
sustained over time (an assessment of within and between group differences). It is expected
that individuals with new injuries will improve over time regardless of group assignment,
while individuals with chronic injuries are stabilized prior to admission to the study.
Because of these naturally occurring differences in trajectory, we will be examining within
and between group differences.
Research Hypotheses
H1: Program participants will show greater improvements in problem solving skills, healthy
attitudes about disability and knowledge of SCI management skills than will the control
group; these improvements will be sustained over time within and between groups.
H2: Program participants will have greater adherence to recommended bladder and bowel
management behaviors than the control group; these improvements will be sustained over time
within and between groups.
H3: Program participants will have fewer bladder and bowel complications than the members of
the control group; these differences will be maintained over time within and between groups.
H4: Program participants will have higher levels of QOL than the control group; these
differences will be sustained over time within and between groups.
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