Enhancing Spinal Cord Injury Rehabilitation

Our researchers found that pairing allied health clinicians with people with lived experience of spinal cord injury (peer coaches) to facilitate the therapy sessions of newly injured young men filled a gap in allied health expertise and increased the real-world applicability of therapy sessions.

The project was a collaboration between BehaviourWorks Australia, Austin Health, AQA and the Victorian Transport Accident Commission (TAC).

‍

Pocket Change is a series of pocket-size videos about a key aspect of behaviour change.  Each episode features a BehaviourWorks Australia Researcher explaining their area of expertise in a clear and simple manner.  

Transcript:

Geoff

Hi, everyone. This time, I'm talking to Alyse Lennox about the work she has done with spinal cord injury. Alyse, welcome.

Alyse

Thank you Geoff.

Geoff

So let's begin with the whole idea of spinal cord injury and how BehaviourWorks Australia was involved in this project.

Alyse

So a spinal cord injury is a really catastrophic, unexpected, and life changing injury that impacts on all elements of a person's life as well as the lives of those around them. So in Victoria, each year, around 100 people will sustain a spinal cord injury and around 35% of those are young men under the age of 35. and despite being overrepresented, the health system really struggles to engage these young men in decisions about their health and lifestyle'

Geoff

So why is it important to reach out to young men under the age of 35, in this particular cohort?

Alyse

Despite being overrepresented in the presentation of spinal cord injuries, health care systems really find it difficult to engage this cohort of people living with spinal cord injury. So young men face, you know, really unique challenges in seeking help. And often that's tied up in things like masculinity and self-identity and stigma. And so health care practitioners and social support systems really need to think differently about how do we engage these young men in decisions about their health and lifestyle moving forward.

Geoff

So tell us about the project itself and BehaviourWorks Australia's involvement in that research and what you discovered along the way.

Alyse

We really wanted to inject new thinking into how to engage young men living with spinal cord injury. And we really wanted to consider the life journey and think about the reestablishment of daily routines, think about the decisions people need to make around how work or education and things are looking differently than they might have expected. And so what we did was we partnered with Austin Health and AQA and one of the key things that they do is, providing support for people living with spinal cord injury. And this project was also funded by the Victorian Transport Accident Commission, the TAC. And they really took a leap of faith with this project and really allowing us to take a step back and explore the problem really broadly and think about considering that life journey and injecting new ways of thinking into this issue and thinking about how we could adapt current practices, implement new interventions, and also think about how we can shift from the traditional medical model of care towards a more social model of care.

Geoff

How do you start with a project like that? You're trying to reach out to this particular cohort that is often resistant, to making that sort of content. How do you begin?

Alyse

we started really broadly with this project and actually looked to other sectors. We looked completely outside of spinal cord injuries to other sectors who were also engaging young men and thinking about how they did it. So we, we started with a literature and practice review, looking at the barriers and facilitators to engaging young men in general. then we conducted a stakeholder dialog with people working with young men in other sectors, to really understand how they, thought about engagement. And that's when we sort of funnelled in and then, tried to see how we could translate those learnings into the spinal cord injury space.

Geoff

In terms of interventions, what did you come up with and how did you come up with those particular interventions?

Alyse

Once we moved into the spinal cord injury space, we conducted interviews with young men living with spinal cord injury and those who support them to really understand the drivers and barriers of engagement. And one of the key things that we found was that there was a lack of people living with spinal cord injury, working in the hospital and the rehabilitation settings. Another key finding was that young men often struggled to relate to able bodied professionals who are trying to model skills or provide support.

Geoff

What was the intervention? How do you overcome those barriers?

Alyse

What we did was we actually paired allied health clinicians. So in this case physios and occupational therapists with peer coaches. So they were people with at least five years of lived experience. And they were already working as peer support workers with either Austin Health or AQA. And they had undertaken training the trainer programs. That was sort of at that elevated level of providing peer support. And so we paid them up to co facilitate the allied health therapy sessions of newly injured young men.

Geoff

Were there any pre-existing relationships that you could draw in?

Alyse

Yeah, absolutely. So the Victorian spinal cord service within Austin Health, had an existing partnership with AQA to enable peer support workers to contribute to various components of a patient's rehabilitation experience. And we had anecdotal evidence that this was beneficial, but it was really reliant on personal relationships between select clinicians and available peers. So we really wanted to shift this beyond those personal relationships and increase the availability of peer support to the broader allied health team in order to formally evaluate this approach.

So the intervention was about, identifying a gap, so to speak, realising that, there were successful relationships in a pretty ad hoc fashion. Yeah. And trying to actually formalise those relationships in, you know, and scale it up in a way.

Geoff

So tell us about the behavioural reflection tool.

Alyse

Basically that was designed to be really sure. You know, we know these health professionals are time poor, but we wanted to have something that, really prompted the allied health clinician and the peer coach to reflect on the sessions that they had and think about what they could do differently next time.  So really trying to strengthen that partnership at the same time. So we asked questions like, what went well during the session, what they think they gained by working together, what something that they could do differently next time. And then we actually asked them to set an implementation intention and list something that they intended to do differently next time, and then in subsequent tools, we asked whether they had tried what they had intended to try and how that went.

Geoff

What's the behavioral science be behind a written intention to do something? Why does that work?

Alyse

So when we write something down and really sort of commit to doing that in our minds, we're more likely to to follow through with that behaviour.

Geoff

So what was the feedback from this intervention?

Alyse4

This approach was really well received by all types of participants allied health clinicians, peer coaches and newly injured young men. So we had five allied health clinicians, three peer coaches and three newly injured young men participate in this intervention. And the allied health clinicians really appreciated the structure that had been given to the previously ad hoc approach. and the peer coaches found the role a lot more rewarding. So their traditional role was, you know, sort of cold going up into people's rooms and trying to start a conversation, whereas, through this approach, they were able to have conversations about skills in context. So they did things like cooking and dressing transfers, whereas previously their involvement had been quite limited to wheelchair skills.

And really it is connecting people with lived experience for those suddenly in that world with that lived experience and bringing that, much more kind of equal relationship in a way. And it also really sort of enhanced the real world applicability of these sessions. So the allied health clinicians really acknowledged the limitations of what they were able to provide. So we had someone talk about, being able to provide the textbook version, but, the the peer coaches were able to provide, alternative ways of doing things based on the real world experience. And, you know, the allied health clinicians experience is very limited to the rehab setting. So this helps to, broaden their thinking around what, what things might actually look like out in the community.

Geoff

And it's not just the healthcare professionals. The actual participants themselves found this a very successful program.

Alyse

Yeah, absolutely. One of the participants talked about how they were really skeptical about being involved in the beginning. You know, they didn't want someone else coming into their sessions and seeing what they could or couldn't do. But once they did get over that and were happy to have a coach involved in their sessions, they really appreciated it. They learned things that they wouldn't have thought about otherwise

Geoff

So what about the future?

Alyse

There was a real desire to expand this approach to other disciplines. So things like bedside education with nurses, involving social work, even thinking about how, psychology could be, involved. And we also acknowledged that this approach could benefit other ages and genders, despite focusing on young men in this instance. So we'd really like to do a larger trial, that's open to everyone,

Geoff

There is also economic benefits to this if it works.

Alyse

Yeah, potentially. So we're looking to do a larger trial and also include health economists in that. So conducting an economic evaluation to try and establish what those economic benefits might be in terms of things like independence, whether this helps people return to work earlier increases engage rental participation in the community, you know, potentially reducing representation to hospital, reducing, length of stay, things like that,

at least.

Geoff

Alyse Lennox, thank you very much.

Alyse

Thanks, Geoff.