Effects of Peer Mentoring on Self-Efficacy and Hospital Readmission After Inpatient Rehabilitation of Individuals With Spinal Cord Injury: A Randomized Controlled Trial

Published:March 22, 2017DOI:



      To investigate the effect of intensive peer mentoring on patient-reported outcomes of self-efficacy and unplanned hospital readmissions for persons with spinal cord injury/disease (SCI/D) within the first 6 months after discharge from inpatient rehabilitation.


      Randomized controlled trial.


      Nonprofit inpatient rehabilitation hospital specializing in care of persons with SCI/D and brain injury.


      Patients (N=158) admitted to the SCI/D rehabilitation program whose discharge location was a community setting. Participants (51% with paraplegia and 49% with tetraplegia) were 73% white and 77% men, with a mean age of 38 years.


      Participants in the experimental group received initial consult/introduction with a peer support program liaison and were assigned a peer mentor, who met with the participant weekly throughout the inpatient stay and made weekly contact by phone, e-mail, or in person for 90 days postdischarge. Participants also were encouraged to participate in regularly scheduled peer support activities. Nonexperimental group participants were introduced to peer support and provided services only on request.

      Main Outcome Measures

      General Self-efficacy Scale (adapted to SCI/D), project-developed community integration self-efficacy scale, and patient-reported unplanned rehospitalizations.


      Growth rate for self-efficacy in the first 6 months postdischarge was significantly higher for experimental group participants than nonexperimental group participants. Experimental group participants also had significantly fewer unplanned hospital days.


      This study provides evidence that individuals receiving intensive peer mentoring during and after rehabilitation for SCI/D demonstrate greater gains in self-efficacy over time and have fewer days of unplanned rehospitalization in the first 180 days postdischarge. More research is needed to examine the long-term effects of this intervention on health care utilization and the relation between improved health and patient-reported quality of life outcomes.


      List of abbreviations:

      GSES (General Self-efficacy Scale), SCI (spinal cord injury), SCI/D (spinal cord injury/disease)
      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


        • Krause J.
        • Saunders L.
        Risk of hospitalizations after spinal cord injury: Relationship with biographic, injury, educational, and behavioral factors.
        Spinal Cord. 2009; 47: 692-697
        • Barclay-Goddard R.
        • King J.
        • Dubouloz C.
        • Schwartz C.
        Building on transformative learning and response shift theory to investigate health-related quality of life changes over time in individuals with chronic health conditions and disability.
        Arch Phys Med Rehabil. 2012; 93: 214-220
        • Chen D.
        • Apple D.
        • Hudson L.
        • Bode R.
        Medical complications during acute rehabilitation following spinal cord injury-current experience of the model systems.
        Arch Phys Med Rehabil. 1999; 80: 1397-1401
        • DeJong G.
        • Tian W.
        • Ballard P.
        • et al.
        Rehospitalization in the first year of traumatic spinal cord injury after discharge from medical rehabilitation.
        Arch Phys Med Rehabil. 2013; 94: 87-97
        • Bandura A.
        Social learning theory.
        Prentice Hall, Englewood Cliffs1977
        • Lorig K.
        • Gonzalez V.
        The integration of theory with practice: a twelve year case study.
        Health Educ Q. 1992; 19: 355-368
        • Lorig K.
        • Stewart A.
        • Ritter P.
        • González V.
        • Laurent D.
        • Lynch J.
        Outcome measures for health education and other health care interventions.
        Sage Publications, Thousand Oaks1996
        • Lorig K.
        • Ritter P.
        • Stewart A.
        • et al.
        Chronic disease self-management program: 2-year health status and health care utilization outcomes.
        Med Care. 2001; 39: 1217-1223
        • Lorig K.
        • Sobel D.
        • Stewart A.
        • et al.
        Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial.
        Med Care. 1999; 37: 5-14
        • Sherman J.
        • DeVinney D.
        • Sperling K.
        Social support and adjustment after spinal cord injury: influence of past peer-mentoring experiences and current live-in partner.
        Rehabil Psychol. 2004; 49: 140-149
        • Veith E.
        • Sherman J.
        • Pellino T.
        • Yasui N.R.
        Qualitative analysis of the peer-mentoring relationship among individuals with spinal cord injury.
        Rehabil Psychol. 2006; 51: 289-298
        • Houlihan B.
        • Everhart-Skeels S.
        • Gutnick D.
        • et al.
        Empowering adults with chronic spinal cord injury to prevent secondary conditions.
        Arch Phys Med Rehabil. 2016; 97: 1687-1695
        • Newman S.
        • Gillenwater G.
        • Toatley S.
        • et al.
        A community-based participatory research approach to the development of a peer navigator health promotion intervention for people with spinal cord injury.
        Disabil Health. 2014; 7: 478-484
        • Gutnick D.
        • Reims K.
        • Davis C.
        • Gainforth H.
        • Jay M.
        • Cole S.
        Brief action planning to facilitate behavior change and support patient self-management.
        J Clin Outcomes Mgmt. 2014; 21: 17-29
        • Kennedy A.
        • Reeves D.
        • Bower P.
        • et al.
        The effectiveness and cost effectiveness of a national lay-led self care support porgramme for patients with long term conditions: a pragmatic randomized controlled trial.
        J Epidemiol Community Health. 2007; 61: 254-261
        • Struchen M.
        • Davis L.
        • Boqaards J.
        • et al.
        Making connections after brain injury: development and evaluation of a social peer-mentoring program for persons with traumatic brain injury.
        J Head Trauma Rehabil. 2011; 26: 4-19
        • Struchen M.
        • West D.
        • Cannon N.
        • et al.
        Making connections after brain injury: a guide for social peer mentors.
        Baylor College of Medicine, Houston2006
        • Ravesloot C.H.
        • Seekins T.
        • Cahill T.
        • Lindgren S.
        • Nary D.E.
        • White G.
        Health promotion for people with disabilities: development and evaluation of the Living Well with a Disability program.
        Health Educ Res. 2006; 22: 522-531
        • CARF International
        Medical rehabilitation standards manual.
        Commission on Accreditation of Rehabilitation Facilities, Tucson2015
        • Duchnick J.
        • Letsch E.
        • Curtiss G.
        Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: a randomized clinical trial.
        Rehabil Psychol. 2009; 54: 123-132
        • Ljunberg I.
        • Kroll T.
        • Libin A.
        • Gordon S.
        Using peer mentoring for people with spinal cord injury to enhance self-efficacy beliefs and prevent medical complications.
        J Clin Nurs. 2011; 20: 351-358
      1. Shepherd Peers. ShepherdSCIpeers. 2016. Available at: Accessed October 1, 2016.

        • Faul F.
        • Erdfelder E.
        • Lang A.
        • Buchner A.
        G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Raudenbush S.
        • Bryk A.
        Hierarchical linear models: applications and data analysis methods. Vol 1. Sage Publishing, Thousand Oaks2002
      2. Moore M, Terrell S, Joyce L. What does person-centered planning mean for the IL paradigm? Paper presented at: National Council on Independent Living; July 28, 2014; Washington (DC).

        • Technical Assistance for CILs and SILCs in Independent Living Networks
        What is Consumer Control for CILs and SICLs?.
        2015 (Available at:) (Accessed February 10, 2017)
        • Naylor M.
        • Aiken L.
        • Kurtzman E.
        • Olds D.
        • Hirschman K.
        The importance of transitional care in achieving health reform.
        Health Affairs. 2011; 30: 746-754
        • Steinbrook R.
        Health care and the American recovery and reinvestment act.
        New Engl J Med. 2009; 360: 1057-1060
      3. American Recovery and Reinvestment Act (ARRA) of 2009, Pub. L. No. 111-5, 123 Stat. 115, 516 (Feb. 19, 2009).

        • Griffiths C.
        • Motlib J.
        • Azad A.
        • et al.
        Randomized controlled trial of a lay-led self-management program for Bangladeshi patients with chronic disease.
        Br J Gen Pract. 2005; 55: 831-837
        • Jerant A.
        • Moore M.
        • Lorig K.
        • Franks P.
        Perceived control moderated the self-efficacy-enhancing effects of a chronic illness self-management intervention.
        Chronic Illn. 2008; 4: 173-182
        • Bouchard L.
        • Montreuil M.
        • Gros C.
        Peer support among inpatients in an adult mental health setting.
        Issues Ment Health Nurs. 2010; 31: 589-598
        • Cook J.
        • Copeland M.
        • Corey L.
        • et al.
        Developing the evidence base for peer-led services: changes among participants following Wellness Recovery Action Planning (WRAP) education in two statewide initiatives.
        Psychol Rehabil J. 2010; 34: 113-120
        • Corrigan P.
        Impact of consumer-operated services on empowerment & recovery of people with psychiatric disabilities.
        Psychiatr Serv. 2006; 57: 1493-1496
        • Davidson L.
        • Bellamy C.
        • Guy K.
        Peer support among persons with severe mental illnesses: a review of evidence and experience.
        World Psychol. 2012; 11: 123-128
        • Gladwell M.
        Little, Brown and Company, Boston2008

      Linked Article

      • Correction
        Archives of Physical Medicine and RehabilitationVol. 98Issue 11
        • Preview
          In Gassaway et al, “Effects of peer mentoring on self-efficacy and hospital readmission following inpatient rehabilitation of individuals with spinal cord injury: a randomized controlled trial,” (Arch Phys Med Rehabil 2017;98:1526-34), we found a slight error in scoring of the self-efficacy tool. Please note the following corrected versions of Table 4 and Figure 2 due to changes in the coefficients, standard error, and P values. These changes are minor and do not affect text descriptions of results or conclusions.
        • Full-Text
        • PDF