ORIGINAL RESEARCH
The Effects of APP-Based Intervention for Depression Among Community-Dwelling Individuals With Spinal Cord Injury: A Randomized Controlled Trial

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Highlights

  • •

    Depression of individuals with spinal cord injury (SCI) will worsen over time without additional support, especially after they discharge from hospitals.

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    Self-management intervention is a potential means to attain long-term benefits on depression in community-dwelling individuals with SCI.

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    Mobile application (APP) offers greater possibilities to provide sustainable self-management intervention for community-dwelling individuals with SCI.

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    A longer period of follow-up is needed to observe the long-term effect of APP-based self-management intervention on depression.

Abstract

Objective

To assess the effect of a self-management intervention delivered by mobile application (APP) for depression among community-dwelling individuals with spinal cord injury (SCI).

Design

Randomized controlled trial.

Settings

General communities in China.

Participants

Community-dwelling individuals with SCI who were diagnosed within 2 years were recruited in this study (N=98). It was a convenience sample with an average age of 41.71, 82.7% participants were men.

Interventions

Participants in the intervention group (n=49) received 5 sessions on self-management training provided by nurse-led multidisciplinary team via APP at the second, fourth, sixth, eighth, and 12th weeks, respectively, after they discharge from hospitals. Participants in the control group (n=49) received routine telephone counselling provided by follow-up nurses at the 12th week after they discharge.

Outcome Measure

The outcome of this study is depression, which is not the primary outcomes in the registration of this program. Depression was measured by version 2 of Beck Depression Inventory at discharge (T0), the 12th week after discharge from hospitals (T1), and the 24th week after discharge from hospitals (T2).

Results

There were 98 participants (49 in the intervention group and 49 in the control group) completing the intervention and data collection. Compared with the control group, the intervention group had lower level of depression at T2 (B=-5.76; 95% CI=-9.97, -1.54; P=.007). Small to moderate effect sizes on depression favoring the intervention were demonstrated at T1 (Cohen's d=-.178) and T2 (Cohen's d=-.535).

Conclusions

APP-based self-management support can be a potential intervention to reduce depression among community-dwelling individuals with SCI.

Section snippets

Study design

This study is a multi-center randomized controlled trial with a blind assessor. It was implemented simultaneously at 6 departments of 4 hospitals in Guangzhou, Chengdu, and Shiyan, China. The study was approved by the ethics committees of the 4 research centers, and the ethics committee of Sun Yat-sen University (No. 2017ZSLYEC-062). The program was registered in the Chinese Clinical Trial Registry, but depression was not included in the primary outcomes of the registration

Results

Figure 1 shows the recruitment process. A total of 108 patients met the inclusion criteria, 6 of them refused to participate in the study. Two patients in the intervention group did not finish the data collection at the 24th week, and 2 patients in the control group dropped out at the 12th and 24th weeks, respectively (see figure 1 for detailed reasons). The results of 98 patients (49 in the intervention group and 49 in the control group) were analyzed and described in this study.

Table 1

Discussion

Although depression did not decrease significantly during the intervention and follow-up periods in the intervention group, depression worsened progressively in the control group. Participants in the intervention group had statistically significant clinical benefits on depression than those in the control group at T2. These findings show the potential of APP-based self-management intervention to alleviate depression in community-dwelling individuals with SCI.

The effect of the APP-based

Conclusions

This study showed the effectiveness of self-management guidance provided via an APP in preventing the deterioration of depression after SCI. With the help of an APP, medical staff could improve the mental health of community-dwelling individuals with SCI by improving their ability to manage any disability and cope with daily living through online assessment and targeted guidance. With the rapid development of the Internet and the popularity of mobile terminals, medical services based on mobile

Acknowledgments

The authors express their gratitude to the software engineer, Bing Xie, for technical support in developing the APP. In addition, the authors thank the nurses, rehabilitation physicians, physiotherapists and occupational therapists, and patients who participated in this study.

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    • This study was supported by the Natural Science Foundation of Guangdong Province, China (grant 2021A1515011800), and National Natural Science Foundation of China (grant 71603293).

    Clinical Trial Registration: This study was registered on the Chinese Clinical Trial Registry (ChiCTR-IPR-17012317).

    Disclosures: none.

    1

    Yinnan Liu and Maiwuludai Hasimu contributed equally to this work.

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    © 2022 by the American Congress of Rehabilitation Medicine.