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A Telehealth Approach to Caregiver Self-Management Following Traumatic Brain Injury: A Randomized Controlled Trial
Janet M Powell1, Robert Fraser, Jo Ann Brockway
1Division of Occupational Therapy, Department of Rehabilitation Medicine (Dr Powell), Departments of Rehabilitation Medicine, Neurology, and Neurological Surgery (Dr Fraser), Department of Rehabilitation Medicine (Dr Brockway), and Departments of Neurological Surgery and Biostatistics (Dr Temkin), University of Washington, Seattle; and Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas (Dr Bell).
Objective:
To determine whether a telephone-based, individualized education and mentored problem-solving intervention would improve outcomes for caregivers of persons with traumatic brain injury (TBI).
Design:
Parallel group, randomized controlled trial with blinded outcome assessment.
Setting:
General community.
Participants:
A total of 153 caregivers (mean age = 49.7 years; 82% female; 54% spouses/partners, 35% parents) of persons with moderate to severe TBI who received acute and/or rehabilitation care at a level I trauma center. Eighty-two percent of participants were evaluated at 6-month follow-up.
Intervention:
Individualized education and mentored problem-solving intervention focused on caregivers' primary concerns delivered via up to 10 telephone calls at 2-week intervals.
Main Outcome Measures:
Composite of Bakas Caregiving Outcomes Scale (BCOS) and Brief Symptom Inventory (BSI-18) at 6 months post-TBI survivor discharge. Secondary measures included the Brief COPE.
Results:
Caregivers in the treatment arm scored higher on the BCOS-BSI composite (P = .032), with more active coping (P = .020) and less emotional venting (P = .028) as measured by the Brief COPE.
Conclusions:
An individualized education and mentored problem-solving approach delivered via telephone in the first few months following community discharge of the TBI survivor resulted in better caregiver outcomes than usual care. Consideration should be given to using this approach to augment the limited support typically offered to caregivers.
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