Internet and Telephone Support Intervention for Stroke Caregivers

描述(由申请人提供)： 背景：家庭成员中风后，照顾者抑郁和负担是常见的，是中风幸存者功能恢复、资源利用和制度化的主要贡献因素。以前的研究表明，解决问题的干预措施在改善中风后照顾者和退伍军人的预后方面是有效的。然而，这些研究中的大多数对于照顾者和劳动密集型来说都是繁重的，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，包括低成本、循证的干预措施，这些干预措施可以在常规临床实践中持续下去。我们的直接目标是试行一种使用电话支持和互联网(即我们团队以前开发的、可在全国范围内使用的救援网站)来提高退伍军人护理和康复质量的问题解决干预措施。这一试点RCT模拟了计划的、未来的功绩审查提案的所有方面。这项工作建立在我们团队在照顾者教育方面的丰富经验基础上。目的#1：与注意力控制条件和标准护理相比，探讨4次和8次互联网和电话支持干预对卒中照顾者和退伍军人结局的影响。我们将获得关于效果估计、群体差异以及可变性、相关性和数据范围的信息的初步数据。数据将为大型试验的样本量计算提供信息，并提供关于不同剂量干预的影响的初步信息。目标 #2：测试我们提议的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规避未来功绩项目中的问题。目的#3：确定护理人员对干预措施和注意控制条件的看法：可接受性、促进者/障碍、护士干预者的可信度。我们将了解该项目的优点和缺点，从而帮助我们在未来的功绩项目中做出改进。方法：我们将进行一项有三个评估点(基线和两个后测)的随机对照试验，并使用混合方法来确定照顾者对干预和注意控制条件的感知。我们将招募48名中风护理人员，他们的退伍军人在VISN8接受护理。符合条件的照顾者将完成基线测量，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网络和电话相结合的干预和注意控制条件。这种干预是基于D-Zurilla和Nezu最初开发的压力关系/问题解决模型。我们将修改传统的、解决问题的干预措施，在我们的国家救援性中风护理人员网站上增加基于网络的培训，使用互动模块、情况说明书和工具。(www.rorc.research.va.gov/救援)。对于第一次后测，研究助理(RA)将打电话给照顾者，回答具有既定信度和效度的工具问题。将在基线评估后四到五个月进行第二次后测试，以评估较长期的效果。将与18名护理者进行定性访谈，以深入了解护士的可信度、价值、促进者、干预的障碍和注意力控制状况。在所有研究阶段，我们将与退伍军人管理局合作伙伴(护理服务办公室、老年医学和扩展护理办公室、My HealtheVet计划)进行合作。影响：调查结果将导致一个功绩奖励项目，以测试一种干预措施，该干预措施可能会减少照顾者抑郁，改善退伍军人中风后的康复，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，该项目将导致一种可移植的循证干预措施，用于照顾患有其他残疾的退伍军人。

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.