Enhancing Rehabilitation Participation in Patients With SCI/D Using Motivational Interviewing

We plan to conduct a multi-site randomized controlled trial of motivational interviewing (MI) training for physical therapists (PTs) and occupational therapists (OTs) who treat people with SCI during inpatient rehabilitation. We will test whether patients treated by MI trained PTs and OTs demonstrate greater participation in therapy sessions and better functional, social, and educational/occupational outcomes relative to patients treated by therapists without MI training. This stage of research is appropriate because a Neilsen Foundation funded pilot study that we recently completed had promising results. Study results showed that SCI patients treated by MI trained PTs and OTs participated significantly more actively in therapy sessions compared to controls. However, the study had several limitations that need to be addressed to produce a more definitive and influential trial. First, the study was conducted at a single site and results may not generalize to other sites. Second, we did not examine whether MI training and improved participation resulted in patients having better clinically meaningful outcomes such as higher likelihood of discharge to home or superior functional, social, or educational/occupational outcomes. Third, therapists trained in MI achieved only minimal competency in MI skills. We hypothesize that if therapists received ongoing coaching to improve their MI skills during the trial the positive impact on patient participation and other outcomes might be even more robust.

Therapist Inclusion Criteria:

• Inpatient therapist specializing in spinal cord injury patients for at least 3 months;
• Practicing at the designated SCI inpatient units at Shirley Ryan AbilityLab, Baylor Scott & White Institute for Rehabilitation and University of Washington-Harborview Medical Center;
• Willing to audio record conversations during regularly-scheduled rehabilitation therapy sessions with patients;
• Willing and able to participate in 16 hours of MI training; and
• Willing to receive feedback on MI skills.

Therapist Exclusion Criteria:

• Inability to speak and understand English
• Inpatient therapist specializing in spinal cord injury patients for less than 3 months; and
• Unwilling or unable to follow the study protocol

Patient Inclusion Criteria:

• Adults (18+)
• Presence of a traumatic or non-traumatic spinal cord injury
• Inpatient in the spinal cord injury unit of the three study sites
• Has a physical or occupational therapist who is a participant in the study

Patient Exclusion Criteria:

• Inability to speak and understand English
• Cognitive deficits
• Unwilling to allow for therapy sessions to be recorded