Feasibility of a Theory-Based Online Hip Fracture Resource Center for Caregivers

描述(申请人提供)：保持和提高功能能力对老年人的生活质量至关重要。在美国，每年约有34万老年人经历髋部骨折，导致死亡率增加、长期残疾和随后的髋部骨折。然而，与其他令人衰弱的疾病不同，髋部骨折是一种急性发作；通过适当的干预，老年人可以恢复到基线水平。此外，髋部骨折可以作为一个独特的机会，通过改善健康行为和实施环境安全措施来防止进一步的残疾。髋部骨折后，许多老年人立即变得更加依赖非正式的照顾者(例如，家庭)。护理者在康复期间的作用尤其重要，因为他们是老年人遵循康复养生法和改善其健康行为的重要动力来源。虽然有多种致衰性疾病(如阿尔茨海默病)的照顾者可以获得大量资源，但髋部骨折患者的照顾者几乎没有资源可用。随着在线用户数量的增加，在线资源计划可能是为这些照顾者提供必要支持的有效方法。在R21的探索性/发展性应用中，研究人员提出了一项研究，该研究将(1)为护理者开发一个基于理论的在线髋部骨折资源中心(OHRC)，以及(2)测试OHRC干预的可行性，以进行未来的随机对照试验(RCT)，该试验将检查该计划对护理者和患者的影响。OHRC是一个为期8周的项目，包括自学模块、主持的讨论板、询问专家和一个虚拟图书馆。这项研究的创新之处在于：(1)OHRC的开发将遵循两个强有力的理论(即压力、评估和应对理论/自我效能理论)；(2)它将专注于最大化照顾者-照顾者之间的照顾关系，目标是为照顾者提供支持，并防止髋部骨折患者进一步残疾。一旦建立了OHRC，我们将对33个照顾者-护理接受者对偶进行可行性研究，包括两个数据收集点(基线、治疗结束[EOT，8周])。OHRC计划的可行性将根据使用量、参与者对OHRC内容的评论及其可用性进行评估。将通过执行该议定书来评估OHRC议定书在未来试验中的可行性。主要分析方法为描述性分析和内容分析。此外，我们将计算在这项研究中试点的结果测量的推断统计，以确定从基线到EOT评估的变化是否具有统计学意义，并估计未来试验的最佳样本量。这些发现将作为未来RTC的前期工作。如果OHRC被证明是有效的，它可以作为对照顾者和患者的补充干预。此外，OHRC中使用的方法也可以作为其他程序的借鉴。这项拟议的研究重点是为髋部骨折(一种令人衰弱的伤害)的老年人的照顾者使用交互式在线资源计划。通过提供特定的信息和心理社会支持，该计划将帮助照顾者应对照看情况，并成为他们的照顾者改善康复的动力和信息的来源。考虑到在线用户数量的增加和人口老龄化，这一创新计划具有巨大的潜力，可以作为一种实用和可访问的方法来促进老年人及其照顾者的健康，并为其他老年人在线照顾者计划树立榜样。

DESCRIPTION (provided by applicant): Maintaining and improving functional abilities are vital for the quality of life of older adults. In the United States, approximately 340,000 older adults experience hip fractures yearly, leading to increased mortality, prolonged disabilities, and subsequent hip fractures. Unlike other debilitating illnesses, however, hip fracture is an acute episode; with proper interventions, older adults can recover to their baseline. Moreover, a hip fracture can serve as a unique opportunity to prevent further disabilities through improving health behaviors and implementing environmental safety measures. Immediately after hip fracture, many older adults become more dependent on informal caregivers (e.g., family). The role of caregivers is particularly important during recovery because they are a significant source of motivation for older adults to follow their rehabilitation regimens and to improve their health behaviors. While extensive resources are available to the caregivers of persons with several debilitating illnesses (e.g., Alzheimer's disease), few resources are available to the caregivers of hip fracture patients. With the increasing number of online users, an online resource program could be an effective method for providing necessary support to these caregivers. In this R21 exploratory/ developmental application, the investigators propose a study that will (1) develop a theory-based Online Hip Fracture Resource Center (OHRC) for caregivers, and (2) test the feasibility of the OHRC intervention for a future randomized controlled trial (RCT) that will examine the effects of the program on both caregivers and patients. The OHRC is an 8-week program that includes self-learning modules, moderated discussion boards, Ask the Experts, and a virtual library. This study is innovative in that (1) the OHRC will be developed in conformance with two strong theories (i.e., the stress, appraisal, and coping theory/self-efficacy theory); and (2) it will focus on maximizing the care relationship in the caregiver-care recipient dyad, with the goals of providing support to caregivers and preventing further disabilities in hip fracture patients. Once the OHRC is developed, we will conduct a feasibility study on 33 caregiver-care recipient dyads with two data collection points (baseline, end- of-treatment [EOT, 8 wks]). The feasibility of the OHRC program will be assessed by the amount of usage, participant comments about the OHRC content and its usability. The feasibility of the OHRC protocol for the future trial will be assessed by implementing the protocol. The main analysis will be descriptive and content analysis. Additionally, we will compute inferential statistics for outcome measures piloted in this study to ascertain whether changes from baseline to the EOT assessment are statistically significant and to estimate an optimal sample size for the future trial. The findings will serve as preliminary work for the future RTC. If the OHRC proves effective, it can be used as a supplementary intervention for caregivers and patients. Moreover, the method used in the OHRC may serve as a model for other programs. This proposed study focuses on the use of an interactive online resource program for caregivers of older adults who have had a hip fracture, a debilitating injury. Through provision of specific information and psychosocial support, this program will help caregivers cope with caregiving situations and become a source of motivation and information for their care recipients to improve their recovery. Considering the increasing numbers of online users and the aging population, this innovative program has significant potential as a practical and accessible method to promote health in older adults and their caregivers and is a model for other online caregiver programs for older adults.