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Powell et al. (2016)
USA
RCT
N=153
PEDro=6
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Population: TBI Caregivers; Control Group (n=76): Mean Age=51.1yr; Gender: Male=14, Female=62; Relationship to Patient: Spouse/Partner=36, Child=31, Other=9. Intervention Group (n=77): Mean Age=48.2yr; Gender: Male=13, Female=64; Relationship to Patient: Spouse/Partner=46, Child=23, Other=8.
Intervention: TBI caregivers in the Intervention Group received a maximum of 10 telephone calls at 2wk intervals after discharge of the TBI patient in addition to usual care. The telephone calls combined education and mentored problem-solving on topics relevant to caregiving associated with TBI recovery and management. Participants in the control condition received usual care.
Outcome Measures: Bakas Caregiving Outcome Scale (BCOS), Brief Symptom Inventory (BSI-18), Participation Assessment with Recombined Tool-Objective (PART-O), Modified Caregiver Appraisal Scale (MCAS), TBI Survivor Measures, Other Prespecified Caregiver Outcomes.
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1. A composite outcome measure of BCOS and BSI-18 showed a significant between-group difference in favour of the Intervention Group at 6mo (p=0.032). For the BSI-18 alone, emotional well-being was significantly better in the Treatment Group compared to controls at 6mo (p=0.031). Between-group differences for the BCOS assessment were non-significant.
2. There were no significant between group differences in PART-O or MCAS scores.
3. None of the TBI survivor measures tested (BSI, Life Satisfaction Scale) were significantly different between groups.
4. For other pre-specified caregiver outcomes, the Intervention Group differed significantly from the Control Group in feelings that they can get support from friends and family (p=0.019), and healthcare providers (p=0.027), taking care of their own health (p=0.046), receiving help with caregiving from more people (p=0.015), more active coping (p=0.020), less emotional venting (p=0.028), and less use of humour (p=0.011). |
| Kreutzer et al. (2015)
USA
RCT
PEDro=4
Ninitial=137, Nfinal=104 |
Population: Caregivers Of Individuals With TBI; Median Age=51.4 yr; Gender: Male=38, Female=99; Relation: Parents=51, Spouses=56, Other=30.
Intervention: Caregivers of individuals with TBI were randomized into the Brain Injury Family Intervention (BIFI) program which includes family education, skill building, and psychosocial support (treatment, n=80) or a waitlist (Control, n=24). The BIFI group completed 5 sessions over 10 wk. Assessments took place at baseline, 10 wk and 3mo.
Outcome Measures: Family Needs Questionnaire (FNQ), Service Obstacles Scale (SOS), Zarit Burden Inventory (ZBI). |
1. There was a significant improvement in Health Information (p=0.003), Emotional Support (p=0.0001), Professional Support (p=<0.0001) and Community Support (p=0.0179) subscales of the FNQ from baseline to 10 wk for the BIFI group; however, there was no significant difference in Instrumental Support (p=0.5292) or Care Involvement (p=0.0646).
2. Only Emotional Support (p=0.0184) and Professional Support (p=0.0022) subscales of the FNQ remained significant at 3mo follow-up for the BIFI group.
3. Both SOS and ZBI scores improved in the BIFI group from baseline to 10 wk (p=0.0036 and p=0.0007, respectively).
4. There was no significant difference in FNQ, SOS or ZBI scores in the Control Group from baseline to 10 wk (all p>0.05). |
| Kreutzer et al. (2009)
USA
Pre-Post
N=53 |
Population: Caregivers Of Individuals With ABI; Mean Age=50.22yr; Gender: Male=18, Female=35; Relation: Spouse=29, Parent=15, Other=9.
Intervention: Caregivers and patients participated together in the Brain Injury Family Intervention (BIFI) program (2 hr sessions 5x/wk over 10 wk) based on family systems theory and cognitive behavioural therapy. The program consists of education, skill building, and psychosocial support.
Outcome Measures: Family Needs Questionnaire (FNQ), Service Obstacles Scale (SOS), Family Assessment Device (FAD), Brief Symptom Inventory (BSI), Satisfaction with Life Scale (SWLS). |
1. Scores on all FNQ subscales changed significantly from pre to post (p≤0.0346) and pre to 3 mo follow-up (p≤0.0024).
2. Scores on the FAD assessment tool did not change over time, whereas scores on the SOS did change significantly over time (p=0.0004).
3. Results of the BSI and the SWLS did not show any significant changes over time. |
| Smith et al. (2006)
United Kingdom
Case Control
N=41 |
Population: Caregivers For Individuals With ABI; Relation: Parent=18, Partner=23; Gender: Male=9, Female=32. Community Group (n=17): Mean Age=48.3 yr; Outpatient Group (n=24): Mean Age=49.3 yr.
Intervention: Caregivers of individuals who attended a community rehabilitation service were compared to caregivers whose individual with ABI attended a traditional outpatient service.
Outcome Measures: Family Assessment Device-General Functioning (FAD-GF), Family Needs Questionnaire, General Health Questionnaire, Acceptance and Action Questionnaire. |
1. The mean proportion of met family needs was significantly different between the Outpatient Group (30.63) and the Community Group (61.12, p=0.02).
2. The mean FAD-GF score for the Outpatient Group was significantly higher than the Community Group (2.03 vs. 1.74; p=0.04), indicating higher levels of maladaptive familial interaction in the Outpatient Group. |
| Bowen et al. (2001)
United Kingdom
PCT
N=96 |
Population: Caregivers Of Individuals With TBI; Age Range=26-50 yr; Gender: Male=14, Female=82; Relation: Partner=45, Parent=36, Other=15.
Intervention: Caregivers received early (pre-discharge, n=41), or late (post-discharge, n=28) head injury team (HINT) intervention, or no intervention (Control, n=27). The HINT was composed of health professionals, an administrative assistant and a clinical coordinator. Outcomes were assessed at 6 and 12 mo. Existing services were offered to all participants.
Outcome Measures: Wimbledon Self-Report Scale. |
1. At 6mo post injury, 63-89% of Controls felt poorly informed compared to 46-64% of the Early Group, and 46-81% of the Late Group (p>0.01).
2. A clinically significant level of distress was reported by 52% of Controls, compared to 29% of the Early Group and 18% of the Late Group (p<0.01).
3. Compared to Controls, the Early Group was more prepared for caring after discharge (p=0.02), had more resources available at discharge (p=0.03), and felt better equipped to adjust to long term outcomes (p=0.03) and personality changes (p=0.01).
4. Compared to Controls, the Late Group felt more informed on personality changes (p=0.03). |
| Kreutzer et al. (2010)
USA
PCT
NInitial=152, NFinal=152 |
Population: ABI=76, Caregivers Of Individuals With ABI=76. Individuals with ABI: Mean Age= 43.2±14.80yr; Gender: Male=45, Female=31; Mean Time Post Injury=30.2±42.84mo, Severity: Mean GCS=9.6. Caregivers: Mean Age= 50.9±13.43yr; Gender: Male=23, Female=53; Relationship to Patient: Spouse=51%, Parent=34%, Other=15%
Intervention: Participants received the Brain Injury Family Intervention (BIFI), a structured family intervention program which includes educational, skill building, and psychological support components. The BIFI consisted of five 2h sessions over 10wk. Outcome measures were assessed following each session and following completion of the entire program
Outcome Measures: The Learning Survey (assesses perceptions of goal attainment and helpfulness of each session), Session Report Form, Program Satisfaction Survey, Overall Program Helpfulness rated on a 4-point scale, ranging from 1 (not at all helpful) to 4 (very helpful) |
1. Ratings of Overall Program Helpfulness were high for both patients and caregivers, with 71% of patients and 89% of caregivers rating the program as “very helpful” (Program Satisfaction Survey).
2. Across program sessions, 85% of patients and 92% of caregivers agreed that their program goals were met (The Learning Survey).
3. No significant differences were observed for individual session helpfulness or goal attainment ratings between patients and caregivers (p>.05). |
