In-Home Adjustment of New Spinal Cord Injury Caregivers

Study Overview
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Brief Summary
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To improve spinal cord injury (SCI) rehabilitation through stronger informal caregiving, the proposed study will modify and evaluate a telehealth Transition Assistance Program (TAP) for informal caregivers of individuals with SCI during the transition from hospital to home. The TAP was previously developed for stroke caregivers and has been found to decrease caregiver strain and depression. In the proposed study, the TAP will be modified for SCI and implemented at a state-of-the-art SCI rehabilitation facility with a very high volume of SCI treatment and with telehealth technology already in place through which to test the intervention.

Detailed Description
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SCI Caregivers will be randomly assigned to either the TAP group or to a control receiving the standard care provided by the rehabilitation facility. The TAP begins before discharge and extends across six weeks. It includes three components to improve caregiver mental health and informal care: (1) skill development, (2) education, and (3) supportive problem solving. TAP caregivers will receive an SCI caregiving guidebook, a 1-hour intervention session by an SCI clinician before hospital discharge, and four 1-hour telehealth clinic-to-home visits at 1, 2, 4, and 6 weeks after discharge by the same clinician. Data will be collected from caregivers and individuals with SCI at baseline immediately before discharge and at 2 and 4 months after discharge.

Official Title
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In-Home Adjustment of New Spinal Cord Injury Caregivers

Conditions
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Spinal Cord Injuries

Intervention / Treatment
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* Behavioral: Transition Assistance Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: SCI Patient Inclusion Criteria: have a telephone in the home or cellular phone and are able to talk on the phone in English are able to provide informed consent demonstrate a clinician-rated loss in motor/sensory function on the ASIA scale (i.e., have a spinal cord injury) Caregiver Inclusion Criteria: have a telephone in the home or cellular phone and are able to talk on the phone in English are able to provide informed consent are a primary caregiver of the individual with SCI Caregivers with scores below 10 on the literacy screen will identify a family member or friend to review the guidebook with the caregiver. If no one is identified, the TAP clinician will review the materials with the caregiver and function in that additional capacity Exclusion Criteria: individual with SCI receives his/her primary care from a professional caregiver or other individual outside of the household besides the primary caregiver individuals with SCI or caregivers with known current uncontrolled substance dependence, aphasia, anosognosia (deficit in self-awareness), or treatment due to known self-inflicted injury individuals living alone prisoners SCI patient without decision making capacity to consent

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 89 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Transition Assistance Program (TAP)<br> | Behavioral: Transition Assistance Program<br>* TAP caregivers will receive an SCI caregiving guidebook, a 1-hour intervention session by an SCI clinician before hospital discharge, and four 1-hour telehealth clinic-to-home visits at 1, 2, 4, and 6 weeks after discharge by the same clinician<br>|
| No Intervention: Standard of Care<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Zarit Burden Interview - Change from Baseline, at 2 and 4 Months after Discharge | 22 item self-report measuring perceived burden on a 4 point scale [(1) Never, (2) Sometimes, (3) Quite Frequently, (4) Nearly Always] Given to the caregiver only in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| The Self-Perceived Burden Scale - Patient - Change from Baseline, at 2 and 4 Months after Discharge | 25 item self-report measuring perceived self-burden on a 5 point scale [(1) None of the time, (2) A little of the time, (3) Some of the time, (4) Most of the time, (5) All of the time] Given to the patient only in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Short Form - VR 12 Health Survey - Change from Baseline, at 2 and 4 Months after Discharge | 12 item self-report measuring participant views on his/her own health. Various scales included: 6 point scale [(1) All of the time, (2) Most of the time, (3) A good bit of the time, (4) Some of the time, (5) A little bit of the time, (6) None of the time] 5 point scale [(1) Excellent, (2) Very good, (3) Good, (4) Fair, (5) Poor] 5 point scale [(1) Much Better, (2) Slightly Better, (3) About the Same, (4) Slightly Worse, (5) Much Worse] 5 point scale [(5) All of the time, (4) Most of the time, (3) Some of the time, (2) A little bit of the time, (1) None of the time] 3 point scale [(1) Yes, limited a lot, (2) Yes, limited a little, (3) No, Not limited at all] Given to both the patient and caregiver in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| SCI-QOL Positive Affect & Well-Being - Change from Baseline, at 2 and 4 Months after Discharge | 10 item self-report measuring perceived well-being on a 5 point scale [(1) Never, (2) Rarely, (3) Sometimes, (4) Often, (5) Always] Given to both the patient and caregiver in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Spinal Cord Independence Measure - Change from Baseline, at 2 and 4 Months after Discharge | 19 item self-report measuring spinal cord injury patient's independence. Each item is scored using the following scales [totals range from 0-100]: 0, 1 0, 1, 2 0, 1, 2, 3 0, 2, 4, 6 0, 5, 8, 10 0, 1, 2, 3, 4 0, 1, 2, 4, 5 0, 2, 4, 6, 8, 10 0, 3, 6, 9, 11, 13, 15 0, 1, 2, 3, 4, 5, 6, 7, 8 Each item's scale includes descriptive explanations of levels of independence. Example: 0. Requires total assistance Requires partial assistance; does not clean self Requires partial assistance; cleans self independently 4. Uses toilet independently in all tasks but needs adaptive devices or special setting (e.g., bars) 5. Uses toilet independently; does not require adaptive devices or special setting) Given to the patient only in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Revised Scale for Caregiving Self-Efficacy - Change from Baseline, at 2 and 4 Months after Discharge | 15 item (+4 practice items) self-report measuring perceived self-efficacy on an 11 point scale [from 0 to 100 in increments of 10; ranging from cannot do at all (0) to moderately certain can do (50) to, certain can do (100)] Given to the caregiver only in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Relationship Assessment Scale - Change from Baseline, at 2 and 4 Months after Discharge | 7 item self-report measuring perceived relationship between the caregiver and patient on a 5 point scale [ranging from (1) Not at all to (5) Very much] Given to both the caregiver and patient in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Exemplary Care Scale - Change from Baseline, at 2 and 4 Months after Discharge | 11 item self-report measuring perceived quality of care by/from the caregiver on a 4 point scale [(1) Never, (2) Sometimes, (3) Often, (4) Always] Given to both the caregiver and patient in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Center for Epidemiologic Studies Depression Scale - Change from Baseline, at 2 and 4 Months after Discharge | 20 item self-report measuring days of depressive symptoms within the last week on a 5 point scale [(0) Not at all or less than 1 day, (1) 1-2 days, (2) 2-4 days, (3) 5-7 days, (4) Nearly every day for 2 weeks] Given to both the caregiver and patient in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Dissemination & Implementation Questions | 33 item self-report measuring satisfaction with the TAP intervention on a 7 point scale [(1) Never, (2) Rarely, (3) Occasionally, (4) Sometimes, (5) Often, (6) Very Often, (7) Always] as well as three open ended questions. Given to the caregiver only in TAP group. | One day | 
| ADAPSS - Change from Baseline, at 2 and 4 Months after Discharge | 6 item self-report measuring perception of SCI on a 6 point scale [(1) Strongly Disagree, (2) Moderately Disagree, (3) Mildly Disagree, (4) Mildly Agree, (5) Moderately Agree, (6) Strongly Agree] Given to only the patient in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Brief COPE - Change from Baseline, at 2 and 4 Months after Discharge | 10 item self-report measuring methods of coping on a 4 point scale [(1) I usually don't do this at all, (2) I usually do this a little bit, (3) I usually do this a medium amount, (4) I usually do this a lot] Given to both the patient and caregiver in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Craig Handicap Assessment and Reporting Technique (CHART) Short Form - Change from Baseline, at 2 and 4 Months after Discharge | 17 item self-report measuring the level of handicap in a community setting including free response of whole numbers (ex: number of times per week left alone), as well as Yes/No/Not Applicable) Given to only the patient in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Cognitive Flexibility Scale - Change from Baseline, at 2 and 4 Months after Discharge | 12 item self-report measuring cognitive flexibility regarding problem solving on a 6 point scale [(1) Strongly Agree, (2) Agree, (3) Slightly Agree, (4) Slightly Disagree, (5) Disagree, (6) Strongly Disagree] Given to both the patient and caregiver in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Disability Identity and Opportunity Scale - Change from Baseline, at 2 and 4 Months after Discharge | 23 item self-report measuring attitudes towards being disabled on a 5 point scale [(1) Strongly Disagree, (5) Strongly Disagree] Given to only the patient in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Family Dynamics Scale - Change from Baseline, at 2 and 4 Months after Discharge | 15 item self-report scale measuring perceived family dynamics (including communication, adaptability, etc.) on a 6 point scale [(1) Extremely Well, (2) Very Well, (3) Well, (4) A Bit, (5) Not Well, (6) Not at All] Given only to the caregiver in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Generalized Anxiety Disorder 7 (GAD 7) - Change from Baseline, at 2 and 4 Months after Discharge | 7 item self-report scale measuring level of anxiety over the last 2 weeks on a 4 point scale [(0) Always, (1) Often, (2) Sometimes, (3) Occasionally] Given to both the patient and caregiver in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Spinal Cord Injury Coping Questionnaire - Change from Baseline, at 2 and 4 Months after | 12 item self-report scale measuring the acceptance, fighting spirit, and social reliance of an SCI patient on a 4 point scale [(1) Strongly Agree, (2) Agree, (3) Disagree, (4) Strongly Disagree] Given to only the patient in all treatment groups | Baseline, 2 months after discharge, 4 months after discharge | 
| Ten-Item Personality Inventory - Change from Baseline, at 2 and 4 Months after | 10 item self-report scale measuring personality (based on the Big 5) on a 7 point scale [(1) Disagree Strongly, (2) Disagree Moderately, (3) Disagree a Little, (4) Neither Agree nor Disagree, (5) Agree a Little, (6) Agree Moderately, (7) Agree Strongly] Given to both the patient and caregiver in all treatment groups | Baseline, 2 months after discharge, 4 months after discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Demographics - Patient | 34 item self-report demographics survey, including specific information regarding the SCI and relationship between the patient and caregiver. 16 items on baseline and 18 items for the two follow up sessions. Given to the patient only in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Demographics - Caregiver | 31 item self-report demographics survey, including specific information regarding the relationship between the caregiver and patient. 20 items on baseline and 11 items for the two follow up sessions. Given to the caregiver only in all treatment groups. | Baseline, 2 months after discharge, 4 months after discharge | 
| Brief Health Literacy Screening Tool | 4 item self-report measuring caregiver literacy on a 5 point scale [(1) Always, (2) Often, (3) Sometimes, (4) Occasionally, (5) Never] Given to the caregiver only in all treatment groups. | One day |