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The Center for Rehabilitation Outcomes Research (CROR) has received a new, three-year $550,000 grant to investigate whether a form of coaching known as motivational interviewing (MI) can help patients with recent spinal cord injury participate more actively in their physical rehabilitation process. The funding from the Craig H. Neilsen Foundation in California will enable CROR Associate Director and Principal Investigator Linda Ehrlich-Jones, PhD, RN, to expand her previous pilot project looking into the same topic. That project found that the patients of physical and occupational therapists trained in motivational interviewing were more fully engaged with their rehabilitation therapy. That’s a good predictor of how much physical function and mobility they will be able to regain, spinal cord injury experts say.
The new study will take place at two sites: Shirley Ryan AbilityLab in Chicago, where CROR is located, and Baylor Scott & White Institute for Rehabilitation, a healthcare system in Dallas. The goal is to recruit 132 spinal cord injury patients, half at each location.
“This study is different,” says Ehrlich-Jones, a veteran investigator who has researched the effects of motivational interviewing in people living with chronic illnesses, including Parkinson’s disease, lupus and rheumatoid arthritis. “We will be following the participants longer, and we have a new instrument to measure function. We will be contacting people six months later to look at their level of participation in their communities.”
By using two sites and different physical and occupational therapists, six at each location, the researchers will be able to determine whether the positive outcome of the pilot study was “a Shirley Ryan AbilityLab effect or the result of the intervention,” Ehrlich-Jones says. Adds Project Manager Jenny Burns: “We had good results the first time with a fairly small sample. The intention here is to replicate the results at another site. That’s part of the research process, making sure you can repeat the same results at multiple places so you know the intervention is worth investing in.”
Motivational interviewing is a dynamic counseling approach where a therapist encourages a client to make behavioral changes. Motivational interviewing has been demonstrated to have positive effects on both physiological disorders and psychological ones, including substance-use disorders.
The manual laying out best practices for motivational interviewing has been revised since the first study was done based on new research findings. The Motivational Interviewing Treatment Integrity (MITI), is a way to assess the competency of those providing the motivational interviewing intervention. The MITI includes ratings to assess practitioners’ attention to the language used by clients and more rigorous standards for supporting client choice.
Participants in the new study will be randomly assigned to one of two groups, one where their therapist has been trained in motivational interviewing and the other with a therapist without such expertise. Ehrlich-Jones will train therapists at each site in motivational interviewing before the study begins. She will also coach the therapists during the study to make sure they are making full use of their new skills. With participants’ permission, the rehabilitation sessions will be audiotaped so Ehrlich-Jones can hear both sides of the interaction.
The study participants will be told that the researchers are looking at a new way for therapists to work with them but will not be informed about what exactly will differ from standard practice. An impartial observer, who is not aware of which therapists are using motivational interviewing, will sit in on the sessions and rate the patient’s level of participation. Participants will be given a functional assessment when they are discharged to gauge how much progress they have made in their rehabilitation therapy. In the first study, Ehrlich-Jones assumed that all patients would say that they were fully engaged in their rehabilitation sessions. “But we found that wasn’t true,” says Ehrlich-Jones. “Some acknowledged they could have been more engaged.”
CROR Research Assistant My Le will be one of the observers in the therapy sessions taking place at Shirley Ryan AbilityLab. She will be a “blinded observer,” which means she doesn’t know which therapists are using motivational interviewing. She also has been instructed not to research motivational interviewing so that she isn’t biased one way or the other. Her job is to objectively rate the patients’ level of participation using a measure known as the Pittsburgh Rehabilitation Participation Scale.
The Neilsen Foundation, the study’s funder, is dedicated to supporting scientific research that improves the quality of life for those living with spinal cord injuries. The foundation was created by Craig Neilsen, an entrepreneur and investor in casinos, who was severely injured and paralyzed after a 1985 collision with a truck. Despite requiring round-the-clock care for the rest of his life, Neilsen began redeveloping casinos in Nevada and eventually launched Ameristar Casinos as a public company. The foundation was created in 2002 and began supporting spinal cord injury research a few years later. “They’re an amazing organization,” says Ehrlich-Jones. “They keep doing more.”