A Randomized Controlled Trial of an Innovative In-home Rehabilitation Program for Persons With TBI and Their Families: Home-based Occupational-therapy and Management of the Environment (HOME for Us)
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 281
- 试验地点
- 2
- 主要终点
- Quality of life in TBI scores on the QoL-TBI instrument for the person with TBI
研究概览
简要总结
This purpose of this study is to evaluate an innovative rehabilitation intervention for persons with chronic TBI-related symptoms (1 year or more post injury) and their families. The primary study aims are to 1) test the intervention's effects on patients' community reintegration, quality of life, and ability to manage self-identified TBI problems at the completion of the intervention and 2) test the intervention's effects on family caregivers' depressive symptoms, burden, and met family needs at the completion of the intervention.
Based on the person-environment fit framework, HOME (Home-based Occupational-therapy and Management of the Environment) for Us is a 4-month, 8-session intervention delivered by occupational therapists in the home. HOME targets the home environment (physical and social) to realign environmental demands to individual strengths and deficits. HOME engages persons with TBI and family caregivers in strategies to manage chronic TBI symptoms or related difficulties. It educates family members to reinforce and maintain intervention strategies, and addresses family needs. HOME is distinct from standard TBI rehabilitation with respect to who (persons with TBI and families), what (targeting the environment for intervention), when (chronic phase), and where (the home).
Patients with chronic TBI symptoms and their family caregivers represent a growing but underserved population. This study has the potential to benefit over 5.3 million persons who live with disabilities from TBI and their family caregivers and to transform the paradigm of care for TBI.
详细描述
Recognized as a major public health problem for civilian and military populations, traumatic brain injury (TBI) produces a broad range of cognitive, emotional, behavioral, and physical symptoms. These symptoms often impede community reintegration (participation in family, work, school, meaningful activities) and decrease quality of life (QoL). TBI also has a profound impact on family caregivers, who often struggle with depression, high levels of burden from caregiving demands, and many unmet needs.
Current approaches to TBI care typically provide post-acute rehabilitation for recent injuries (within 1 year after injury). Yet, years after injury, many individuals still experience chronic TBI symptoms that are difficult to manage and interfere with community reintegration (CR) and QoL. Standard post-acute TBI rehabilitation focuses on medical restoration to reduce specific deficits (e.g., memory loss) rather than on symptom management. Rehabilitation occurs in the clinic and assumes that learned strategies will be generalized to the home and community, despite evidence to the contrary. Families - widely acknowledged as essential to successful rehabilitation - are seldom systematically engaged in clinic-based care. Further, few rehabilitation approaches are delivered in the home, where daily functioning takes place, or target the home environment for intervention. Thus, a gap in practice and research exists concerning optimal approaches to patient and family management of chronic TBI sequelae.
The study tests an innovative rehabilitation approach for persons with chronic TBI-related symptoms (at least 1 year post injury) and their families, HOME (Home-based Occupational-therapy and Management of the Environment). Based on the person-environment fit framework, HOME targets the home environment (physical and social) to realign environmental demands to individual strengths and deficits. It engages persons with TBI and family caregivers in strategies to manage chronic TBI symptoms. Participants in the HOME group work with an occupational therapist (OT) on strategies to manage TBI-related symptoms or related difficulties in eight sessions taking place over four months.
The Primary Aims of the study are to:
- Test treatment effects on patients' community reintegration (primary outcome), quality of life, and ability to manage self-identified TBI problems, assessed at the completion of the intervention (T2).
- Test treatment effects on caregivers' depressive symptoms, burden, and met family needs at T2.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
盲法说明
Participants are assigned to an Arm (HOME treatment or Attention-control condition) after the first (T1) interview. The interviewers are blinded to the group assignment.
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •TBI Participant:
- •English speaking
- •18 years or older
- •Most recent TBI at least 1 year ago
- •Has participating family member living with person with TBI
- •Willing/able to provide informed consent
- •Meets criteria for mild, moderate, or severe TBI
- •Acknowledges TBI-related symptoms at screening
- •Family Member
- •Family member, partner, or significant other
- •Living with person with TBI
- •18 years or older
- •Actively involved in the person's life
- •English speaking
- •Willing/able to provide informed consent
排除标准
- •TBI Participant:
- •Dementia based on (a) physician diagnosis of dementia and/or (b) participant's difficulty in comprehending interview questions
- •History of recent violence
- •Recent psychosis
- •Family Member
研究组 & 干预措施
HOME for Us
The HOME intervention is the delivery of an in-home, family inclusive, rehabilitation intervention in eight sessions. Six of the sessions will occur in the home, and two will be over the phone. The in-home sessions will be about 1 ½ hrs. each, and the phone sessions will be about 15 minutes each. The sessions are delivered by an occupational therapist (OT).
干预措施: HOME for Us (Behavioral)
Attention Control
The Attention-control condition is the delivery of educational materials over 8 contacts. Three of the contacts are by video conferences or phone calls and last 1 to 2 hours each. Two of the contacts are mailings of educational materials for discussion during the longer sessions. Three of the contacts are phone calls lasting about 10-15 minutes each to check for general updates, health care utilization/access, and study reminders.
干预措施: Attention-control condition (Behavioral)
结局指标
主要结局
Quality of life in TBI scores on the QoL-TBI instrument for the person with TBI
时间窗: four months and ten months
Quality of life in TBI will be measured by The QoL-TBI instrument, a 37-item patient-centered measure that captures the individual's perception of his/her health-related quality-of-life in the domains of cognition, self-care, daily life and autonomy, social relationships, emotions, and physical functioning. Scores are summed and range from 0 to 148. Higher scores indicate better quality of life. It will be administered at the Baseline interview (T1), Month 4 interview (T2), and Month 10 interview (T3).
Community reintegration (CR) scores on PART-O-17 for the person with TBI
时间窗: four months and ten months
Community reintegration will be measured by the Participation Assessment with Recombined Tools-Objective (PART-O-17). This 17-item tool is an objective measure of social functioning, developed from 3 existing community reintegration measures. It uses 6-point Likert scales from 0 to 5. A mean score is computed. Higher scores indicate greater community reintegration. It will be administered at the Baseline interview (T1), Month 4 interview (T2), and Month 10 interview (T3).
Family needs scores on the Family Needs Questionnaire (FNQ)-Revised
时间窗: four months and ten months
The 37-item Family Needs Questionnaire-Revised (FNQ-R) measures the extent to which family needs are met. Factor analytically derived scales include: Health Information, Emotional Support, Instrumental Support, Professional Support, Community Support Network, and Involvement with Care. Participants are first asked whether the item is a need for them now, and if it is, the extent to which the need has been met. This uses a 3-point scale (yes=1, partly=2, no=3). Scores are summed and can range from 37 to 111, with higher scores indicating that fewer needs are met. It will be administered at the Baseline interview (T1), Month 4 interview (T2), and Month 10 interview (T3).
Depressive symptom scores on the CES-D for the family member
时间窗: four months and ten months
Depressive symptoms will be measured by The Center for Epidemiologic Studies Depression Scale short form (CES-D). The CES-D is a well-established 10-item screening instrument that shows strong psychometric properties in TBI populations. Each question is followed by a four-point Likert scale (0=never or rarely, 3=most or almost all the time). Scores are summed and range from 0 to 30, with higher scores indicating greater depression. It will be administered at the Baseline interview (T1), Month 4 interview (T2), and Month 10 interview (T3).
Patient-identified problems: symptom management and self-efficacy
时间窗: four months and ten months
Patient-identified problems are patient-centered measures, using questions to elicit the most serious TBI-related problems as articulated by participants themselves. Questions are (1) "What is the #1 (then #2/#3) problem that TBI has caused you within the last month?" (2) symptom management difficulty ("How difficult is it to manage this problem?" and (3) self-efficacy ("How confident are you in your ability to manage the problem?") on 5-point Likert scale, from 0 to 4, with 4 indicating highest difficulty and highest self-efficacy, respectively. These measures yield both qualitative and quantitative information and were sensitive to intervention effects in our previous study. A mean will be computed combining ratings of the 3 problems. It will be administered at the Baseline interview (T1), Month 4 interview (T2), and Month 10 interview (T3).
Caregiver burden scores on the Caregiver Burden subscale of the Caregiver Assessment Scale (CAS) for the family member
时间窗: four months and ten months
The 15-item burden subscale of the standard CAS instrument defines burden as the subjective perceptions of psychological distress, fatigue, anxiety, depression, poor health, social isolation, loss of freedom, feeling trapped, and resentment that are attributed directly to caregiving. A five-point Likert scale from 1 (strongly disagree) to 5 (strongly agree) is used. A mean score is computed. Higher scores indicate more burden. It will be administered at the Baseline interview (T1), Month 4 interview (T2), and Month 10 interview (T3).
次要结局
未报告次要终点