Randomized Trial to Evaluate Effects of Peer- and Clinician-Led Interventions for Caregivers of Individuals With Acquired Brain Injury

Objective

To evaluate the effectiveness of 2 interventions for caregivers of patients with acquired brain injury (ABI) transitioning home after inpatient rehabilitation, to prepare them for the role of caregiving and reduce stress and depression.

Design

Controlled trial with participants randomly assigned to (1) usual care (UC), (2) clinician-delivered Problem-Solving Training (PST), or (3) peer-led Building Better Caregivers (BBC) training; both experimental interventions initiated during the inpatient rehabilitation stay, delivered virtually, of similar intensity (six 60-minute sessions), and focused on managing stress and building skills related to caregiving.

Setting

Nonprofit rehabilitation hospital specializing in care of persons with acquired brain and spinal cord injuries.

Participants

Caregivers (n=169) of patients with ABI (54 stroke; 115 other ABI) admitted for rehabilitation whose discharge location was home with care provided by family members (caregivers: 83% women, 62% White, age [mean ± SD]: 51±11.5 y). Participants were recruited from February 2021 to November 2022, when COVID-19 restrictions were in place.

Interventions

Noted above.

Main Outcome Measures

Caregiver-reported stress, depressive symptoms, and caregiving self-efficacy; patient unplanned hospital readmissions and emergency department visits 30 days post discharge.

Results

Only 61% of participants in the 2 intervention groups completed 3 or more of 6 intervention sessions and only 53% completed all data collection surveys. Statistically significant improvements between UC and PST groups were noted for caregiver stress (p=.039). Positive differences in caregiver self-efficacy found between UC and the BBC intervention groups approached significance at 30 days after discharge (p=.054). Patient unplanned hospital readmissions and days hospitalized were also higher, albeit not statistically significant, for UC participants than both intervention groups.

Conclusions

Although positive findings were noted, results were negatively affected by study limitations including low enrollment and limited engagement (intervention completion and follow-up outcomes assessment). These limitations resulted, in part, from restrictions put into place during the COVID-19 pandemic, which limited contact with study participants and required alterations to the BBC intervention likely influencing its effectiveness. Despite limitations noted, the encouraging findings suggest the need for further research.