Evaluation of the Veterans In-home Program for Veterans with TBI and Families

针对患有 TBI 的退伍军人及其家庭的退伍军人居家计划的评估

• 批准号: 8096195
• 负责人: Helene Joy Moriarty
• 金额: $ 17.36万
• 依托单位: PHILADELPHIA RESEARCH AND EDU FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8096195
• 关键词: Address; Afghanistan; Behavioral; Caregiver Burden; Caring; Characteristics; Clinic; Clinical; Cognitive; Communities; Community Integration; Complement; Development; Diagnosis; Education; Effectiveness; Effectiveness of Interventions; Emotional; Employment; Enrollment; Environment; Environmental Risk Factor; Evaluation; Evidence based intervention; Family; Family Caregiver; Family member; Focus Groups; Future; Goals; Grant; Group Interviews; Guidelines; Home environment; Individual; Injury; Intervention; Iraq; Learning; Life; Measures; Medical; Medical center; Modification; Moods; Occupational Therapist; Outcome; Outpatients; Participant; Patients; Persons; Philadelphia; Physical Function; Population; Problem behavior; Procedures; Protocols documentation; Quality of life; Randomized; Randomized Controlled Trials; Rehabilitation therapy; Research; Research Priority; Services; Site; Symptoms; TBI Patients; Telephone; Testing; Training and Education; Translating; Traumatic Brain Injury; Universities; Veterans; Waiting Lists; War; base; caregiver education; clinical application; clinical care; clinical practice; cognitive function; community reintegration; daily functioning; design; emotion regulation; evidence base; experience; improved; improved functioning; innovation; multi-site trial; novel; programs; psychosocial; satisfaction; skills; skills training; strength training; theories; tool; treatment as usual

DESCRIPTION (provided by applicant): An estimated 180,000 to 360,000 U.S. troops in the Global Wars on Terror have suffered war-related traumatic brain injuries (TBI), representing up to 20 percent. This population has significant unmet needs for nonpharmacological therapies, and a serious gap exists in evidence for the effectiveness of interventions. Through a partnership between Thomas Jefferson University and the Philadelphia VA Medical Center (PVAMC), we propose a two-group parallel randomized controlled trial (RCT) to evaluate the preliminary effectiveness and acceptability of the Veterans' In-home Program (VIP). The goal of this innovative intervention is to enhance community reintegration of veterans with mild to moderate TBI by improving person-environment fit. VIP's specific objects are optimizing physical, cognitive, and emotional/behavioral daily functioning through the introduction of (1) home modifications and adaptation strategies to support physical functioning, (2) compensatory strategies to enhance cognitive functioning, and (3) emotion-regulation strategies to manage behavioral and interpersonal difficulties. Additionally, family caregivers are trained to understand veterans' capabilities, manage limitations, and support their use of intervention strategies. The 8-session 3-month program is delivered by occupational therapists (OTs) in the veteran's home. As a home-based program, VIP complements current clinic-based medical interventions. It is based on psychosocial and environmental approaches previously used successfully with other populations that share important clinical characteristics with TBI patients. VIP targets home environmental modifications in order to create enabling conditions for the individual with TBI, is theory-driven, and combines best clinical practice with previously tested intervention components. To enhance its clinical applicability, it is reproducible and its components are reimbursable under current VA guidelines. The study will enroll 100 veterans with war-related TBI and a designated family member or partner. Veterans will be outpatients of the polytrauma service of the PVAMC. The VIP will be tested using a randomized two-group wait-list design in which participants are assigned to either the 3-month intervention or a usual care control condition. All are evaluated at baseline and 3 months (T2). Primary aims are to (1) establish acceptability and preliminary effectiveness for the impact of the intervention on functioning and community integration in TBI patients at 3-months and (2) evaluate VIP's acceptance by Veterans using both project evaluations and focus group discussion. Secondary aims are to (1) establish VIP's acceptability and preliminary effectiveness on caregiver burden and mood and (2) assess its acceptability to family members using project evaluations and focus groups discussions. This study will result in an innovative home-based treatment approach that can be tested in a larger multi-site randomized controlled trial. The intervention promises to have an immediate major impact by enhancing the abilities of veterans with TBI to reintegrate into their communities and function effectively in daily life and employment. PUBLIC HEALTH RELEVANCE: If proven effective, the Veteran's In-home Program (VIP) will represent the first evidence- based intervention that considers both the patient with mild-moderate traumatic brain injury (TBI) and family. This study is an important step towards filling a critical gap in services for individuals with mild-moderate TBI. Because VIP is designed to augment and extend current clinical care, it would substantially add to the clinical tools available for war- related TBI and also has the potential to benefit the 1.4 million U.S. civilians who annually sustain TBI.

描述(由申请人提供)：据估计，在全球反恐战争中，约有18万至36万名美国士兵遭受了与战争有关的创伤性脑损伤(TBI)，占20%。这一人群对非药物疗法的需求尚未得到满足，而且在干预措施的有效性方面存在严重差距。通过托马斯·杰斐逊大学和费城退伍军人医疗中心(PVAMC)的合作，我们提出了一项两组平行随机对照试验(RCT)，以评估退伍军人居家计划(VIP)的初步有效性和可接受性。这一创新干预措施的目标是通过改善人与环境的匹配性，促进轻度至中度脑外伤退伍军人重新融入社区。VIP的具体目标是通过引入(1)支持身体功能的家庭修改和适应策略，(2)增强认知功能的补偿策略，以及(3)管理行为和人际困难的情绪调节策略，来优化身体、认知和情绪/行为的日常功能。此外，家庭照顾者还接受培训，以了解退伍军人的能力，管理限制，并支持他们使用干预策略。这项为期8个月的课程由退伍军人家中的职业治疗师(OTS)提供。作为一项以家庭为基础的计划，VIP是对目前以诊所为基础的医疗干预的补充。它基于之前在其他人群中成功使用的心理、社会和环境方法，这些人群与脑外伤患者具有重要的临床特征。VIP的目标是改善家庭环境，以便为脑外伤患者创造有利条件，是理论驱动的，并将最佳临床实践与先前测试的干预组件相结合。为了增强其临床适用性，它是可重复性的，其组成部分根据现行的VA指南是可以报销的。这项研究将招募100名患有战争相关脑外伤的退伍军人和一名指定的家庭成员或伴侣。退伍军人将是PVAMC多处创伤服务的门诊患者。VIP将使用随机两组等待名单设计进行测试，在该设计中，参与者被分配到为期3个月的干预或通常的护理控制条件。所有患者均在基线和3个月(T2)时进行评估。主要目的是(1)确定干预对3个月时脑外伤患者功能和社区融合的影响的可接受性和初步有效性，(2)使用项目评估和焦点小组讨论来评估退伍军人对VIP的接受程度。第二个目标是(1)建立VIP对照顾者负担和情绪的可接受性和初步有效性，以及(2)通过项目评估和焦点小组讨论来评估其对家庭成员的可接受性。这项研究将产生一种创新的基于家庭的治疗方法，可以在更大的多地点随机对照试验中进行测试。这项干预措施有望立即产生重大影响，提高患有脑外伤的退伍军人重新融入社区并在日常生活和就业中有效发挥作用的能力。 公共卫生相关性：如果证明有效，退伍军人家庭计划(VIP)将是第一个同时考虑轻、中度创伤性脑损伤(TBI)患者和家属的循证干预措施。这项研究是朝着填补轻中度脑外伤患者服务的关键缺口迈出的重要一步。由于VIP旨在增强和延长当前的临床护理，它将大大增加与战争相关的脑外伤可用的临床工具，并有可能使每年接受脑外伤治疗的140万美国平民受益。