Integrating Caregiver Support into MS Care

 描述(由申请人提供)： 随着多发性硬化症(MS)行动不便，照顾者援助的数量和类型增加，伴随而来的是照顾者负担的增加(1)。事实上，照顾者负担的影响可以被视为多发性硬化症治疗效果的潜在指标(1)，表明照顾者是多发性硬化症治疗策略的适当和独立的目标(2)。多发性硬化症患者报告在实施和继续实施家庭锻炼、行动和步行计划方面存在困难。这项可行性研究将测试将成功的行为护理干预整合到临床实践中，以改善患有多发性硬化症(MS)的退伍军人及其护理人员的功能。患有多发性硬化症的退伍军人的照顾者将接受行为照顾者干预，旨在解决照顾者应对和管理患者关切的问题，特别关注患者的机动性和行走。干预前的设计将比较退伍军人和照顾者的结果。对于退伍军人，干预将以护理者参与以家庭为基础的退伍军人流动活动为目标。退伍军人的结果将包括六分钟步行测试、计时起床和出发测试(TUGT)、自我效能和抑郁。MS照顾者报告说，照顾他们所爱的人涉及到高负担、压力和抑郁，特别是当行动能力下降时(3-5)，这些结果与患者的身体和情感健康状况有关(2)。对于照顾者，干预的重点将是改善照顾者的应对方式和管理多发性硬化症相关问题。照顾者的结果将包括抑郁、负担、焦虑、报告的退伍军人多发性硬化症问题和安全警报的数量，以基线、3个月和6个月衡量。研究目标包括：1)测试护理者干预是否可以整合到多发性硬化症临床环境中。2)确定照顾者的结果是否得到改善。3)确定退伍军人的结果是否有所改善。4)确定哪些类型的照顾者将受益最大。5)确定哪些类型的退伍军人受益最大。6)为今后的临床研究、翻译和实施提炼材料。假设与退伍军人和护理者有关：假设1：接受干预的护理者的退伍军人将在结果方面有显著改善，包括六分钟步行测试、计时起床和出发测试(TUGT)、自我效能和抑郁。假设2：护理者参与者将在结果方面有显著改善，包括抑郁、负担、焦虑，以及报告的老多发性硬化症问题和安全警报的数量。

 DESCRIPTION (provided by applicant): With loss of mobility in multiple sclerosis (MS) comes an increase in amount and types of caregiver assistance, with a concomitant increase in burden for the caregiver (1). In fact, effect on caregiver burden can be seen as a potential indicator of the efficacy of MS management (1), suggesting that the caregiver is an appropriate and independent target for MS therapeutic strategies (2). MS patients report difficulty implementing and continuing with home exercise, mobility, and walking programs. This feasibility study will test integration of a successful behavioral caregiving intervention into clinical practice to improve functioning of Veterans with multiple sclerosis (MS) and their Caregivers. Caregivers of Veterans with MS will receive a behavioral caregiver intervention designed to address caregiver coping and management of patient concerns, with special focus on patient mobility and walking. A pre-post intervention design will compare outcomes for Veterans and Caregivers. For Veterans, the intervention will target Caregiver participation in home-based Veteran mobility activities. Outcomes for Veterans will include the six minute walk test, timed up and go test (TUGT), self-efficacy, and depression. MS Caregivers report high burden, stress, and depression involved in caring for their loved ones, especially as mobility declines (3-5) and these outcomes are related to physical and emotional health status of the patient (2). For Caregivers, the intervention will focus on improving Caregiver coping and on managing MS-related problems. Outcomes for Caregivers will include depression, burden, anxiety, and number of Veteran MS problems and safety alerts reported, measured at baseline, 3 months, and 6 months. Study Objectives include: 1) Test whether a caregiver intervention can be integrated into an MS clinical setting. 2) Determine whether Caregiver outcomes are improved. 3) Determine whether Veteran outcomes are improved. 4) Determine which types of Caregivers will benefit most. 5) Determine which types of Veterans will benefit most. 6) Refine materials for future clinical research, translation and implementation. Hypotheses are related to both Veteran and Caregiver: Hypothesis 1: Veterans of Caregivers who receive the intervention will have significant improvement in outcomes including the six minute walk test, timed up and go test (TUGT), self-efficacy, and depression. Hypothesis 2: Caregiver participants will have significant improvement in outcomes including depression, burden, anxiety, and number of Veteran MS problems and safety alerts reported.