Original article| Volume 89, ISSUE 12, P2332-2341, December 2008

Functional and Clinical Outcomes of Telemedicine in Patients With Spinal Cord Injury


      Dallolio L, Menarini M, China S, Ventura M, Stainthorpe A, Soopramanien A, Rucci P, Fantini MP, on behalf of the THRIVE Project. Functional and clinical outcomes of telemedicine in patients with spinal cord injury.


      To compare the 6-month outcomes of telerehabilitation intervention with those of standard care for spinal cord injury (SCI).


      Multicenter randomized controlled trial.


      Home, nursing, or unspecialized hospital care provided after discharge from a spinal cord unit.


      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).


      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.


      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.


      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.

      Key Words

      List of Abbreviations:

      ANOVA (analysis of variance), CI (confidence interval), IRT (item response theory), LOS (length of stay), SCI (spinal cord injury), SCIM (Spinal Cord Independence Measure), SCIM II (Spinal Cord Independence Measure II), THRIVE (Telerehabilitation Through Interactive Video Endorsement)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Priebe M.M.
        • Chiodo A.E.
        • Scelza W.M.
        • Kirshblum S.C.
        • Wuermser L.A.
        • Ho C.H.
        Spinal cord injury medicine, 6: economic and societal issues in spinal cord injury.
        Arch Phys Med Rehabil. 2007; 88: S84-S88
        • Wyndaele M.
        • Wyndaele J.J.
        Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?.
        Spinal Cord. 2006; 44: 523-529
        • Post M.W.
        • Dallmeijer A.J.
        • Angenot E.L.
        • van Asbeck F.W.
        • van der Woude L.H.
        Duration and functional outcome of spinal cord injury rehabilitation in the Netherlands.
        J Rehabil Res Dev. 2005; 42: 75-85
        • Cardeanas D.D.
        • Hoffman J.M.
        • Kirshblum S.
        • McKinley W.
        Etiology and incidence of rehospitalization after traumatic spinal cord injury: a multicenter analysis.
        Arch Phys Med Rehabil. 2004; 85: 1757-1763
        • Phillips V.L.
        • Vesmarovich S.
        • Hauber R.
        • Wiggers E.
        • Egner A.
        Telehealth: reaching out to newly injured spinal cord patients.
        Public Health Rep. 2001; 116: 94-102
        • Hersh W.R.
        • Helfand M.
        • Wallace J.
        • et al.
        Clinical outcomes resulting from telemedicine interventions: a systematic review.
        BMC Med Inform Decis Mak. 2001; 26: 1-57
        • Haley D.
        • Roine R.
        • Ohinmaa A.
        Systematic review of evidence for the benefits of telemedicine.
        J Telemed Telecare. 2002; 8: 1-30
        • Whitten P.S.
        • Mair F.S.
        • Haycox A.
        • May C.R.
        • Williams T.L.
        • Hellmich S.
        Systematic review of cost effectiveness studies of telemedicine interventions.
        BMJ. 2002; 324: 1434-1437
        • Currell R.
        • Urquhart C.
        • Wainwright P.
        • Lewis R.
        Telemedicine versus face to face patient care: effects on professional practice and health care.
        Cochrane Database Syst Rev. 2000; 2 (CD002098)
        • Hersh W.
        • Hickam D.H.
        • Severance S.M.
        • Dana T.L.
        • Krages K.P.
        • Helfand M.
        Telemedicine for the Medicare population: update.
        Evid Rep Technol Assess (Full Rep). 2006; 131: 1-41
        • Barnett T.E.
        • Chumbler N.R.
        • Vogel W.B.
        • Beyth R.J.
        • Qin H.
        • Kobb R.
        The effectiveness of a care coordination home telehealth program for veterans with diabetes mellitus: a 2-year follow-up.
        Am J Manag Care. 2006; 12: 467-474
        • Shea S.
        • Weinstock R.S.
        • Starren J.
        • et al.
        A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus.
        Am Med Inform Assoc. 2006; 13: 40-51
        • Kobb R.
        • Hoffman N.
        • Lodge R.
        Enhancing elder chronic care through technology and care coordination: report from a pilot.
        Telemed J E Health. 2003; 9: 189-195
        • Noel H.C.
        • Vogel D.C.
        • Erdos J.J.
        Home telehealth reduces healthcare costs.
        Telemed J E Health. 2004; 10: 170-183
        • Fortney J.C.
        • Pyne J.M.
        • Edlund M.J.
        • et al.
        A randomized trial of telemedicine-based collaborative care for depression.
        J Gen Intern Med. 2007; 22: 1086-1093
        • Bosworth H.B.
        • Olsen M.K.
        • McCant F.
        • et al.
        Hypertension Intervention Nurse Telemedicine Study (HINTS): testing a multifactorial tailored behavioral/educational and a medication management intervention for blood pressure control.
        Am Heart J. 2007; 153: 918-924
        • Tsagaris M.J.
        • Papavassiliou M.V.
        • Chatzipantazi P.D.
        • et al.
        The contribution of telemedicine to cardiology.
        J Telemed Telecare. 1997; 3: 63-64
        • Vesmarovich S.
        • Walker T.
        • Hauber R.P.
        • Temkin A.
        • Burns R.
        Use of telerehabilitation to manage pressure ulcers in persons with spinal cord injuries.
        Adv Wound Care. 1999; 12: 264-269
        • Lapierre N.M.
        • Blackmer J.
        • Coutu-Wakulczyk G.
        • Dehoux E.
        Autonomic dysreflexia and telehealth.
        Can Nurse. 2006; 102: 20-25
        • Soopramanien A.
        • Pain H.
        • Stainthorpe A.
        • Menarini M.
        • Ventura M.
        Using telemedicine to provide post-discharge support for patients with spinal cord injuries.
        J Telemed Telecare. 2005; 11: 68-70
        • Hall K.M.
        • Cohen M.E.
        • Wright J.
        • Call M.
        • Werner P.
        Characteristics of the Functional Independence Measure in traumatic spinal cord injury.
        Arch Phys Med Rehabil. 1999; 80: 1471-1476
        • Lawton G.
        • Lundgren-Nilsson A.
        • Biering-Sørensen F.
        • et al.
        Cross-cultural validity of FIM in spinal cord injury.
        Spinal Cord. 2006; 44: 746-752
        • Catz A.
        • Itzkovich M.
        • Agranov E.
        • Ring H.
        • Tamir A.
        SCIM-spinal cord independence measure: a new disability scale for patients with spinal cord lesions.
        Spinal Cord. 1997; 35: 850-856
        • Itzkovich M.
        • Tripolski M.
        • Zeilig G.
        • et al.
        Rasch analysis of the Catz-Itzkovich spinal cord independence measure.
        Spinal Cord. 2002; 40: 396-407
        • Catz A.
        • Itzkovich M.
        • Tesio L.
        • et al.
        A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation.
        Spinal Cord. 2007; 45: 275-291
        • Dupont W.D.
        • Plummer W.D.
        Power and sample size calculations: a review and computer program.
        Control Clin Trials. 1990; 11: 116-128
        • Lam T.
        • Noonan V.K.
        • Eng J.J.
        • SCIRE Research Team
        A systematic review of functional ambulation outcome measures in spinal cord injury.
        Spinal Cord. 2008; 46: 246-254
        • Donnelly C.
        • McColl M.A.
        • Charlifue S.
        • et al.
        Utilization, access and satisfaction with primary care among people with spinal cord injuries: a comparison of three countries.
        Spinal Cord. 2007; 45: 25-36
        • Galea M.
        • Tumminia J.
        • Garback L.M.
        Telerehabilitation in spinal cord injury persons: a novel approach.
        Telemed J E Health. 2006; 12: 160-162