Pilot Test of a SCI Virtual Coach to Improve Skin Care
1Latham N, 2Houlihan B, 3Ellis T, 4Trinh H, 4Shamekhi A, 3DeAngelis T, 3Ni P, 5Everhart Skeels S, 3Zazulu J, 3Sullivan N, 3Gross L, 6Bickmore T
1Brigham and Women's Hosptial, Boston, MA, USA; 2Spaulding New England Regional SCI Center (SNERSCIC), MGH Institute of Health Professions, Boston, MA, USA; 3Boston University, Boston, MA, USA; 4Northeastern University, Boston, MA, USA; 5Spaulding New England Regional SCI Center, MGH Institute of Health Professions, Boston, MA, USA; 6Northeastern, Boston, MA, USA
Objective: Virtual coaches are animated characters that people interact with on computers or other electronic devices. The objective of this project was to develop the first virtual coach for individuals with SCI. The SCI coach focused on behaviors to prevent pressure ulcers. The aim of this study was to determine the feasibility and acceptability of the SCI coach, and to explore preliminary evidence of efficacy. Design/Method: An iterative process was used to develop the coach, with input obtained from a peer panel of persons with SCI. Next, a series of lab-based tests were conducted on 10 people with SCI using a prototype version of the SCI coach. The coach was further modified after the lab-based testing. Finally, a phase I/II randomized controlled trial was conducted with a target enrollment of n=40 people who were 6 months to 10 years post SCI. People in the intervention group used the Virtual Coach in their home for 2 months, with the goal of using the coach at least 3 times per week. Adherence to the coach was monitored by the system itself. Skin care knowledge, behaviors, self-efficacy and other outcomes were assessed by a blinded outcome assessor at baseline and 2 month follow-up. Results: N=40 persons with SCI were recruited into the study. The participants were an average of 2.2 years post-injury and were evenly divided between people with paraplegia and tetraplegia. People used the coach mean 19.3 days out of the 60 days and mean 18.6 minutes per session. People who used the SCI Virtual Coach had a greater improvement in the Patient Activation Measure compared to the control group. The change in this measure was an average of 8.6 points higher (95%CI 4.1, 13.1) in the coach group compared to the control group. Changes in measures of skin care behavior and knowledge showed a trend of being higher in the intervention compared to the control group, but the findings were not statistically significant. Conclusion: The SCI Virtual Coach was used by the persons with SCI for 2 months in their home at the frequency and duration that we had prescribed. Although this is a small feasibility trial with people who were not recently injured, significant changes were observed in some outcomes of interest. We plan to expand the content of the coach based on feedback from participants, and to apply for funding to evaluate the coach further in a phase III RCT. Support: This project is funded by the Craig H. Neilsen Foundation.
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