Integrating Caregiver Support into MS Care

 描述（由申请人提供）： 随着多发性硬化症（MS）活动能力的丧失，护理人员协助的数量和类型增加，同时也增加了护理人员的负担（1）。事实上，对护理人员负担的影响可视为MS管理有效性的潜在指标（1），表明护理人员是MS治疗策略的适当和独立目标（2）。MS患者报告难以实施和继续进行家庭锻炼，活动和步行计划。这项可行性研究将测试成功的行为干预整合到临床实践中，以改善多发性硬化症（MS）退伍军人及其护理人员的功能。患有MS的退伍军人的护理人员将接受行为护理人员干预，旨在解决护理人员应对和管理患者问题，特别关注患者的移动性和行走。干预前后设计将比较退伍军人和护理人员的结果。对于退伍军人，干预措施将针对护理人员参与家庭退伍军人流动活动。退伍军人的结果将包括六分钟步行测试，定时启动测试（TUGT），自我效能和抑郁症。MS护理人员报告说，在照顾他们所爱的人时，特别是在行动能力下降时，他们的负担很重，压力很大，抑郁症也很严重（3-5），这些结果与患者的身体和情绪健康状况有关（2）。对于照顾者，干预措施将侧重于改善照顾者应对和管理MS相关问题。护理人员的结局将包括基线、3个月和6个月时测量的抑郁、负担、焦虑以及报告的退伍军人MS问题和安全警报数量。研究目的包括：1）测试护理人员干预是否可以整合到MS临床环境中。 2)确定护理人员的结果是否得到改善。 3)确定退伍军人的结果是否得到改善。 4)确定哪些类型的护理人员将受益最多。 5)确定哪些类型的退伍军人将受益最多。 6)为未来的临床研究、翻译和实施提炼材料。假设1：接受干预的护理人员的退伍军人将在包括六分钟步行测试、定时起身和行走测试（TUGT）、自我效能和抑郁症在内的结果方面有显著改善。假设二：护理人员参与者将在结果方面有显着改善，包括抑郁，负担，焦虑和退伍军人MS问题和安全警报报告的数量。

 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.