Telehealth Assessment and Skill-Building Intervention for Stroke Caregivers (TASK III)

项目摘要/摘要： 中风是导致严重、长期残疾的主要原因，而且发病非常突然。家庭通常是 在没有来自医疗保健提供者的足够培训的情况下被迫提供护理，不得不自己学习 提供关爱。研究表明，未经适当培训的照顾者可能对照顾者的身体有害 和精神健康，这可能会阻碍幸存者的康复，并导致制度化和更高的社会性 成本。与现有的中风护理人员干预不同，现有的中风护理人员干预需要昂贵的面对面互动，而且 主要关注幸存者的护理，由护士领导的电话评估和技能培养工具包(任务II)是 完全通过电话提供，并使照顾者能够同时处理自己和幸存者的 需要使用创新的技能培养战略。与当前的患者和护理人员指南保持一致，任务II 证明内容有效性、治疗忠诚度、照顾者满意度和降低 照顾者抑郁症状；然而，任务II显示需要更加注重自我管理 (SM)改善照顾者症状和健康的战略，以及加强使用其他远程保健模式 送货上门。在NINR资助的R21中，远程健康评估和技能培养工具包(任务III)得到了优化 通过创新地利用技术和SM战略来改善中风家庭照顾者 症状和健康。一份新的目标设定提示表促进照顾者自我管理 通过使用新的技能培养策略，改善症状和健康。护理者现在可以选择他们想要的方式 访问TASK III资源指南(邮寄硬拷贝、电子书、USB驱动器或互动网站 (https://www.task3web.com/)以及他们希望如何与护士互动(电话、FaceTime或 在线视频会议)。初步任务三的数据为征聘、留用、 74名随机分配到任务中的中风家庭照顾者的治疗保真度、高满意度和积极数据趋势 III(n=36)或信息、支持和转介(ISR)组(n=38)。拟议研究的目的是 为了测试短期(干预后8周立即)和长期(12、24和52周)的疗效 任务III干预，与ISR组相比，对296名中风照顾者进行了干预。主要结果是 照顾者的生活变化(即身体健康、身体功能、情绪健康、一般健康)作为 提供护理的结果。次要结果包括抑郁症状(在轻度到重度的照顾者中 抑郁症状)、其他症状(压力、疲劳、睡眠、疼痛、呼吸急促)、不健康的日子、SM 饮食/锻炼，以及自我报告的医疗保健利用率。理论上的调停者包括任务难度， 威胁评估和自我效能感。计划评估结果(满意度、技术评级)也将 分析过了。如果任务III在拟议的随机对照临床试验中被证明是有效的，我们的下一个 目标将是将任务III转化为持续的卒中护理系统；并对其进行调整，以供护理人员使用 其他衰弱/慢性病对公共卫生造成巨大影响。

Project Summary/Abstract: Stroke is a leading cause of serious, long-term disability, and has a very sudden onset. Families are often thrust into providing care without sufficient training from health care providers, having to learn on their own to provide care. Studies show that caregiving without proper training can be detrimental to caregiver’s physical and mental health, which can impede survivor rehabilitation and lead to institutionalization and higher societal costs. Unlike existing stroke caregiver interventions, which require costly face-to-face interactions, and that focus primarily on the survivor’s care, the nurse-led Telephone Assessment and Skill-Building Kit (TASK II) is delivered completely by telephone, and empowers caregivers to address both their own and the survivor’s needs using innovative skill-building strategies. Aligned with current patient and caregiver guidelines, TASK II demonstrated evidence of content validity, treatment fidelity, caregiver satisfaction, and efficacy for reducing caregiver depressive symptoms; however, TASK II revealed a need for a stronger focus on self-management (SM) strategies to improve caregiver symptoms and health, along with enhanced use of other telehealth modes of delivery. In an NINR-funded R21, the Telehealth Assessment and Skill-building Kit (TASK III) was optimized through the innovative leveraging of technologies and SM strategies to improve stroke family caregiver symptoms and health. A new goal setting tip sheet promotes caregivers’ self-management of their own symptoms and health through the use of novel skill-building strategies. Caregivers now choose how they want to access the TASK III Resource Guide (mailed hard copy, eBook, USB drive, or interactive website (https://www.task3web.com/) and how they would like to interact with the nurse (telephone, FaceTime, or online videoconferencing). Preliminary TASK III data provided evidence for feasibility of recruitment, retention, treatment fidelity, high satisfaction, and positive data trends in 74 stroke family caregivers randomized to TASK III (n=36) or to an Information, Support, and Referral (ISR) group (n=38). The purpose of the proposed study is to test short-term (immediately post-intervention at 8 weeks) and long-term (12, 24, and 52 weeks) efficacy of the TASK III intervention, compared with the ISR group, in 296 stroke caregivers. The primary outcome is caregiver life changes (i.e., physical health, physical functioning, emotional well-being, general health) as a result of providing care. Secondary outcomes include depressive symptoms (in caregivers with mild to severe depressive symptoms), other symptoms (stress, fatigue, sleep, pain, shortness of breath), unhealthy days, SM of diet/exercise, and self-reported healthcare utilization. Theoretically-based mediators include task difficulty, threat appraisal, and self-efficacy. Program evaluation outcomes (satisfaction, technology ratings) will also be analyzed. If TASK III is shown to be efficacious in the proposed randomized controlled clinical trial, our next goal will be to translate TASK III into ongoing stroke systems of care; and to adapt it for use among caregivers with other debilitating/chronic conditions providing a tremendous public health impact.