Internet and Telephone Support Intervention for Stroke Caregivers

针对中风护理人员的互联网和电话支持干预

• 批准号: 8825965
• 负责人: CONSTANCE R. UPHOLD
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2016-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8825965
• 关键词: Activities of Daily Living; Address; Adherence; Attention; Award; Bed Occupancy; Caregivers; Caring; Data; Data Collection; Data Correlations; Day Care; Depth Perception; Development; Dose; E-learning; Emergency department visit; Enrollment; Evidence based intervention; Family member; Future; Geriatrics; Goals; Health; Health Care Costs; Health Personnel; Healthcare; Home environment; Institutionalization; Internet; Intervention; Interview; Lead; Learning; Long-Term Care; Long-Term Effects; Measures; Mental Depression; Methods; Modeling; Nurses; Nursing Services; Office Nursing; Online Systems; Outcome; Participant; Patient Education; Perception; Phase; Pilot Projects; Problem Solving; Procedures; Process; Provider; Publishing; Qualitative Methods; Randomized; Randomized Controlled Trials; Recommendation; Recovery of Function; Registered nurse; Rehabilitation therapy; Research; Resources; Sample Size; Sampling; Self Efficacy; Staging; Stress; Stroke; Survivors; Telephone; Testing; Time; Training; Treatment Efficacy; Update; Validity and Reliability; Veterans; Work; arm; base; caregiver education; caregiving; clinical practice; cost; depressive symptoms; design; disability; effective intervention; efficacy testing; experience; follow-up; hospital bed; hospital readmission; improved; indexing; instrument; intervention effect; novel; patient home care; post stroke; programs; response; skills; standard care; tool; web site

DESCRIPTION (provided by applicant): Background: Caregiver depression and burden are common following a family member's stroke and are major contributors of stroke survivors' functional recovery, resource use, and institutionalization. Previous studies reveal that problem-solving interventions are effective in improving caregiver and Veteran outcomes post-stroke. However, most of these studies were burdensome for caregivers and labor intensive because they involved multiple, face-to-face sessions. To overcome this shortcoming, our long-term goal is to implement caregiver programs that involve low-cost, evidence-based interventions that can be sustained in routine clinical practice. Our immediate objective is to pilot test a problem-solving intervention that uses telephone support plus the Internet (i.e., our team's previously developed and nationally available RESCUE website) to improve the quality of caregiving and the rehabilitation of Veterans. This pilot RCT simulates all aspects of a planned, future merit review proposal. This work builds on our team's extensive experience in caregiver education. Aim #1: To explore the impact of a 4-session and 8-session Internet and telephone support intervention on stroke caregiver and Veteran outcomes when compared to an attention-control condition and standard care. We will obtain preliminary data on effect estimates, group differences, and information on variability, correlations, and data ranges. Data will inform a sample size calculation for the largr trial and provide preliminary information on the impact of different doses of the intervention. Aim #2: To test the feasibility of the methods and procedures in our proposed project. This aim will uncover weaknesses in our project. These findings will help us circumvent problems in the future merit project. Aim #3: Determine caregivers' perceptions of the interventions and the attention control condition: Acceptability, facilitators/barriers, credibility of the nurse interventionists. We will learn the strengths and weaknesses of the project, thereby helping us make improvements in our future merit project. Methods: We will conduct a randomized controlled trial with three assessment points (baseline and two post- tests) and use mixed methods to determine caregivers' perceptions of the intervention and the attention control condition. We will enroll 48 stroke caregivers whose Veterans receive care in VISN8. Eligible caregivers will complete baseline measures and then will be randomized to four arms: 1) 4-session intervention, 2) 8-session intervention, 3) attention control condition, or 4) standard care. Two trained registered nurses will conduct the combined Internet and telephone intervention and the attention-control condition. The intervention is based on the relational/problem-solving model of stress originally developed by D-Zurilla and Nezu. We will modify the traditional, problem-solving intervention by adding web-based training using interactive modules, factsheets, and tools on our national RESCUE Stroke Caregiver website. (www.rorc.research.va.gov/rescue). For the first post-test, the research assistant (RA) will telephone caregivers to answer questions on instruments with established reliability and validity. A second post-test will be conducted four or five months after the baseline assessment to evaluate longer-term effects. Qualitative interviews will be conducted with 18 caregivers to obtain in-depth perceptions of the credibility of nurses, and value, facilitators, and barriers of he intervention and the attention control condition. Throughout all study phases, we will collaborate with VA partners (Offices of Nursing Service, Office of Geriatrics and Extended Care, My HealtheVet Program). Impact: Findings will lead to a merit award project to test an intervention that potentially will reduce caregiver depression, improve rehabilitation of Veterans post-stroke and reduce healthcare resource use. Another outcome will an updated, state-of-the art, nationally available website that healthcare providers can use for patient education, discharge planning, and rehabilitative home care. Long-term, the project will lead to an evidenced-base intervention that can be transportable for use in caring for Veterans with other disabilities.

描述（由申请人提供）： 背景资料：照顾者抑郁和负担在家庭成员中风后很常见，并且是中风幸存者功能恢复、资源使用和机构化的主要贡献者。以往的研究表明，解决问题的干预措施是有效的，在改善照顾者和退伍军人中风后的结果。然而，这些研究中的大多数对护理人员来说都是繁重的，而且劳动密集型，因为它们涉及多个面对面的会议。为了克服这一缺点，我们的长期目标是实施护理人员计划，这些计划涉及低成本，基于证据的干预措施，可以在常规临床实践中持续。我们的近期目标是对使用电话支持和互联网（即，我们的团队以前开发的和全国可用的RESCUE网站），以提高退伍军人的康复和康复质量。该试点随机对照试验模拟了计划中的未来绩效审查提案的所有方面。这项工作建立在我们团队在护理人员教育方面的丰富经验之上。目标一：探讨与注意力控制条件和标准护理相比，4次和8次互联网和电话支持干预对卒中护理人员和退伍军人结局的影响。我们将获得关于效应估计、组间差异的初步数据，以及关于变异性、相关性和数据范围的信息。数据将为largr试验的样本量计算提供信息，并提供有关不同剂量干预影响的初步信息。目的 #2：测试我们建议项目中方法和程序的可行性。这一目标将揭示我们项目中的弱点。这些发现将有助于我们在未来的优点项目规避问题。目标3：确定护理人员对干预措施和注意力控制状况的看法：可接受性，促进者/障碍，护士干预者的可信度。我们将了解项目的优点和缺点，从而帮助我们在未来的优秀项目中做出改进。研究方法：我们将进行一项随机对照试验，有三个评估点（基线和两个后测），并使用混合方法来确定照顾者对干预和注意力控制条件的看法。我们将招募48名中风护理人员，他们的退伍军人在VISN 8中接受护理。合格的护理人员将完成基线测量，然后随机分为四组：1）4次干预，2）8次干预，3）注意力控制条件，或4）标准护理。两名训练有素的注册护士将进行互联网和电话综合干预以及注意力控制条件。干预是基于关系/问题解决模型的压力最初开发的D-Escherilla和根津。我们将修改传统的，解决问题的干预措施，增加基于网络的培训，使用交互式模块，情况说明书，和我们的国家救援中风护理网站上的工具。（www.rorc.research.va.gov/rescue）。对于第一个后测试，研究助理（RA）将电话照顾者回答问题的仪器与既定的可靠性和有效性。第二次后测试将在基线评估后4或5个月进行，以评估长期效果。本研究将对18位照顾者进行质性访谈，以深入了解照顾者对护理人员的信任度、价值观、促进者、干预障碍和注意力控制状况。在整个研究阶段，我们将与VA合作伙伴（护理服务办公室，老年病和扩展护理办公室，我的HealthVet计划）合作。影响：调查结果将导致一个优秀奖项目，以测试一种干预措施，这种干预措施可能会减少照顾者的抑郁症，改善中风后退伍军人的康复，并减少医疗资源的使用。另一个成果将是一个更新的、最先进的、全国可用的网站，医疗保健提供者可以使用该网站进行患者教育、出院计划和康复家庭护理。从长远来看，该项目将导致一种基于证据的干预措施，可以用于照顾其他残疾的退伍军人。