Recovering Together: Building resiliency in dyads of patients with an acute brain injury admitted to the Neuroscience Intensive Care Unit and their informal caregivers

共同康复：为神经科学重症监护室收治的急性脑损伤患者及其非正式护理人员建立复原力

• 批准号: 10618995
• 负责人: Ana-Maria Vranceanu
• 金额: $ 64.03万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-06 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10618995
• 关键词: Acute; Acute Brain Injuries; Adherence; Admission activity; Adult; Adverse effects; Anxiety; Attention; Caregivers; Chronic; Clinical; Clinical Data; Cognitive; Data; Diagnosis; Distress; Dose; Education; Educational process of instructing; Electronic Health Record; Eligibility Determination; Emotional; Enrollment; Event; Funding; General Hospitals; Geography; Goals; Home; Hospitalization; Hospitals; Individual; Infrastructure; Intensive Care Units; Interpersonal Relations; Intervention; Intervention Trial; Investigation; Manuals; Manuscripts; Massachusetts; Measures; Mediating; Mediation; Mediator; Medical; Mental Depression; Methodology; Neurologic; Neurosciences; Outcome; Participant; Patient Care; Patient Self-Report; Patients; Personal Satisfaction; Persons; Pilot Projects; Placebos; Population; Psychologist; Publishing; Quality of life; Randomized; Randomized, Controlled Trials; Recovery; Recovery of Function; Research; Risk; Sample Size; Sampling; Severity of illness; Single-Blind Study; Site; Stress; Stroke; Surveys; Survivors; Team Nursing; Testing; Time; clinical predictors; clinically relevant; clinically significant; comparison control; coping; demographics; effectiveness/implementation study; efficacious intervention; efficacy evaluation; efficacy outcomes; efficacy testing; efficacy trial; emotional distress; emotional functioning; emotional symptom; ethnic diversity; experience; follow-up; improved; individual patient; informal caregiver; medical complication; member; mindfulness; mortality; multidisciplinary; new technology; novel; post-traumatic stress; post-traumatic symptoms; predicting response; prevent; primary caregiver; primary outcome; programs; promote resilience; psychosocial; racial diversity; recruit; resilience; resilience factor; response; satisfaction; secondary outcome; skills; tumor

PROJECT SUMMARY Admission to the Neuroscience Intensive Care Unit (NICU) for an acute neurological illness (ANI; e.g., stroke, tumor, TBI) is often sudden and traumatic. Approximately 20-40% of survivors and their caregivers endorse clinically significant emotional distress and posttraumatic stress symptoms (PTS) at hospitalization, which tend to become chronic and negatively impact the recovery trajectory and overall quality of life. Unfortunately, there are no efficacious interventions to prevent chronic emotional distress in these patients and caregivers. With funding from NINR, our multidisciplinary team recently conducted a pilot study examining the delivery of a brief, 6-session ( 2 in person, 4 via live video) dyadic resiliency intervention (Recovering Together) to prevent chronic emotional distress in at risk survivors and caregivers. In a single blind RCT of Recovering Together versus a time, dose and attention matched educational control, we met a priori set markers of feasibility, acceptability, credibility and adherence. We also observed statistically and clinically significant effects of the active intervention on reduction in symptoms of emotional distress and PTS. Findings have been published in JAMA Network. For the proposed project, we seek to build on our prior positive findings by conducting a fully powered, efficacy, single blind randomized controlled trial (RCT) of the intervention in a larger sample of dyads of patients with ANI and their caregivers. The goals of this study are to:1) demonstrate the efficacy of Recovering Together for improving self- reported dyadic emotional distress (primary outcome), and PTS, mindfulness, coping, and interpersonal interaction variables (secondary outcomes); and 2) assess mechanisms (mediators and moderators) of improvement after intervention. We will enroll and randomly assign 194 at risk dyads (97 per study group) to receive either Recovering Together or the attention placebo educational control. The trial will take place at the Massachusetts General Hospital NICU using our established methodology successfully implemented during the R21. Study clinicians will deliver 6, 30 minute sessions (2 at bedside and 4 via live video after discharge) to each patient-caregiver dyad. All participants will complete measures at baseline, after completion of program (6 weeks) and 3 months later. Data from this R01 will ultimately serve as the basis to apply for funding for a large-scale, multisite hybrid effectiveness-implementation study followed by scalability of Recovering Together to other NICUs from across USA.

项目摘要 因急性神经系统疾病（ANI;例如，中风、肿瘤、TBI） 往往是突然的创伤性的大约20-40%的幸存者和他们的照顾者认可临床意义 住院时的情绪困扰和创伤后应激症状（PTS），这些症状往往会变成慢性和消极的 影响康复轨迹和整体生活质量。不幸的是，没有有效的干预措施来防止 这些病人和照顾者的慢性情绪困扰。在NINR的资助下，我们的多学科团队最近 进行了一项试点研究，检查了简短的6次会议（2次亲自参加，4次通过现场视频）的二元弹性交付 干预（共同康复），以防止在风险幸存者和照顾者的慢性情绪困扰。在单个 与时间、剂量和注意力匹配的教育对照组相比， 可行性、可接受性、可信性和遵守性的标志。我们还观察到统计学和临床显著性 积极干预对减少情绪困扰症状和PTS的影响。研究结果发表在 JAMA Network.就拟议项目而言，我们力求在先前积极调查结果的基础上， 在ANI患者的较大样本二对组合中进行干预的有效性、单盲随机对照试验（RCT） 和他们的照顾者。本研究的目的是：1）证明共同康复对提高自我的有效性， 报告的二元情绪困扰（主要结局），以及PTS、正念、应对和人际互动变量 （次要结果）; 2）评估干预后改善的机制（中介和调节）。我们将 入组并随机分配194对高危患者（每个研究组97人）接受共同康复或关注 安慰剂教育对照。试验将在马萨诸塞州综合医院NICU进行，使用我们已建立的 在R21期间成功实施的方法。研究临床医生将提供6个30分钟的会议（2个在床边 和4个在出院后通过实况视频）发送给每个患者-护理者二人组。所有参与者将在基线时完成测量， 完成课程后（6周）和3个月后。本R 01的数据最终将作为申请的依据 为一项大规模、多站点混合有效性-实施研究提供资金，随后进行恢复的可扩展性研究 与美国各地的其他NICU一起。

项目成果

A Live Video Dyadic Resiliency Intervention to Prevent Chronic Emotional Distress Early After Dementia Diagnoses: Protocol for a Dyadic Mixed Methods Study.

• DOI: 10.2196/45532
• 发表时间: 2023-09-20
• 期刊: JMIR RESEARCH PROTOCOLS
• 影响因子: 1.7
• 作者: Bannon, Sarah;Brewer, Julie;Ahmad, Nina;Cornelius, Talea;Jackson, Jonathan;Parker, Robert A.;Dams-O'Connor, Kristen;Dickerson, Bradford C.;Ritchie, Christine;Vranceanu, Ana-Maria
• 通讯作者: Vranceanu, Ana-Maria

Thematic Analysis of Psychosocial Stressors and Adaptive Coping Strategies Among Informal Caregivers of Patients Surviving ICU Admission for Coma.

因昏迷入住 ICU 的患者的非正式护理人员的心理社会压力源和适应性应对策略的主题分析。

• DOI: 10.1007/s12028-023-01804-3
• 发表时间: 2024
• 期刊: Neurocritical care
• 影响因子: 3.5
• 作者: Hwang,DavidY;Bannon,SarahM;Meurer,Kate;Kubota,Rina;Baskaran,Nithyashri;Kim,Jisoo;Zhang,Qiang;Reichman,Mira;Fishbein,NathanS;Lichstein,Kaitlyn;Motta,Melissa;Muehlschlegel,Susanne;Reznik,MichaelE;Jaffa,MatthewN;Creutzfeldt,
• 通讯作者: Creutzfeldt,

The Recovering Together study protocol: A single-blind RCT to prevent chronic emotional distress in patient-cargiver dyads in the Neuro-ICU.

• DOI: 10.1016/j.cct.2022.106998
• 发表时间: 2022-12
• 期刊: CONTEMPORARY CLINICAL TRIALS
• 影响因子: 2.2
• 作者: Vranceanu, Ana-Maria;Woodworth, Emily C.;Kanaya, Millan R.;Bannon, Sarah;Mace, Ryan A.;Manglani, Heena;Duarte, Brooke A.;Rush, Christina L.;Choukas, Nathaniel R.;Briskin, Ellie A.;Cohen, Joshua;Parker, Robert;Macklin, Eric;Lester, Ethan;Traeger, Lara;Rosand, Jonathan;Grunberg, Victoria A.
• 通讯作者: Grunberg, Victoria A.

Together from the start: A transdiagnostic framework for early dyadic interventions for neurodegenerative diseases.

• DOI: 10.1111/jgs.17801
• 发表时间: 2022-06
• 期刊: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
• 影响因子: 6.3
• 作者: Bannon, Sarah M.;Grunberg, Victoria A.;Manglani, Heena R.;Lester, Ethan G.;Ritchie, Christine;Vranceanu, Ana-Maria
• 通讯作者: Vranceanu, Ana-Maria