Telephone Assessment and Skill-Building Intervention for Stroke Caregivers

描述(申请人提供)：中风是导致长期残疾的主要原因；家庭经常被迫在没有任何培训的情况下为中风幸存者提供护理。中风的家庭照顾者越来越重要，因为随着人口老龄化，中风的患病率可能会增加。然而，很少有基于证据的、易于提供的住院后后续计划来培训照顾者提供护理，也没有通过技能建设战略全面满足照顾者和幸存者需求的计划。研究表明，未经培训的照料可能损害照顾者的身心健康，这可能导致幸存者被制度化和更高的社会成本。本研究的目的是评估修订后的电话评估和技能建设工具包(TASK II)的有效性，这是一种由护士领导的综合干预措施，使照顾者能够根据对自己需求的评估来建立技能。中风幸存者(N=220)的家庭照顾者将被随机分到TASK II干预组或信息、支持和转诊(ISR)组，以确定TASK II干预在降低任务难度、增加乐观情绪和减少提供护理的威胁评估方面的相对有效性。主要结果是照顾者抑郁症状，与照看相关的负面生活变化，以及不健康的日子。在探索性目标中，将收集初步数据，以便对任务二干预进行经济评估。TASK II干预和ISR程序都包括8次电话会议，为期8周，其中一次是12周的强化会议。数据收集将在基线(出院后8周内)、8周(短期干预效果)、12周(强化治疗后)以及基线后24周和1年(干预效果的长期可持续性)进行。线性混合模型将被应用于重复测量数据以检验主要目标1和2的有效性。潜在增长模型将被用于检验干预效果的机制(探索性目标1)。将采用增量成本-效果比(ICER)来处理任务II干预和ISR组(探索性目标2)的比较成本和结果。

DESCRIPTION (provided by applicant): Stroke is the leading cause of long-term disability; families are often thrust into providing care for stroke survivors without any training. Stroke family caregivers are of increasing importance because the prevalence of stroke is likely to increase as the population ages. However, there are very few evidence-based, easy-to- deliver follow-up programs after hospitalization to train caregivers in providing care and none that comprehensively address both caregiver and survivor needs through skill-building strategies. Studies have shown that caregiving without training can be detrimental to caregiver's physical and mental health, which can lead to institutionalization of the survivor and higher societal costs. The purpose of this study is to evaluate the efficacy of the revised Telephone Assessment and Skill-building Kit (TASK II), a nurse-led comprehensive intervention that enables caregivers to build skills based on assessment of their own needs. Family caregivers of stroke survivors (N=220) will be randomized to the TASK II intervention or to an Information, Support, and Referral (ISR) group to determine the relative efficacy of the TASK II intervention for reducing task difficulty, increasing optimism, and reducing threat appraisal for providing care. Primary outcomes are caregiver depressive symptoms, caregiving-related negative life changes, and unhealthy days. In an exploratory aim preliminary data will be collected for an economic evaluation of the TASK II intervention. Both the TASK II intervention and ISR procedures involve 8 telephone sessions delivered over 8 weeks, with a booster session at 12 weeks. Data collections will occur at baseline (within 8 weeks of home discharge); at 8 weeks (short-term intervention effect), 12 weeks (after booster), and at 24 weeks and 1 year after baseline (long-term sustainability of intervention effect). Linear mixed models will be applied to the repeated-measures data to test efficacy for Primary Aims 1 & 2. Latent Growth Models using a Structural Equation Model approach will be applied to examine mechanism of intervention effect (Exploratory Aim 1.). An incremental cost-effectiveness ratio (ICER) will be employed to address the comparative costs and outcomes for the TASK II intervention and ISR group (Exploratory Aim 2).