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Juengst SB, Wright B, Driver S, Calhoun S, Muir A, Dart G, Goldin Y, Lengenfelder J, Bell K. Multisite randomized feasibility study of Problem-Solving Training for care partners of adults with traumatic brain injury during inpatient rehabilitation. NeuroRehabilitation 2023; 52:109-122. [PMID: 36617760 DOI: 10.3233/nre-220129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Problem-Solving Training (PST) during inpatient rehabilitation could provide care partners the skills needed to manage their life roles after discharge. OBJECTIVE Determine the feasibility of PST+ Education versus Education for care partners of adults with traumatic brain injury (TBI) during inpatient rehabilitation. METHODS We conducted a multisite randomized feasibility trial across three sites. We present recruitment rates, reasons for refusal to participate, and reasons for non-completion of interventions. We measured client satisfaction, participant engagement, and fidelity for both interventions. We compared change in depressive symptoms and caregiver burden between PST and Education groups. RESULTS Though the interventions were generally feasible, recruitment and retention rates were lower than anticipated largely due to the COVID-19 pandemic. Participants who completed >3 sessions were less likely to be employed full-time and more often spouses and co-residing. Length of inpatient rehabilitation stay was correlated with number of sessions completed. We observed potential benefits of PST over Education, specifically for reducing depression symptoms and caregiver burden. CONCLUSION High satisfaction, engagement, and fidelity, overall recruitment and retention, and positive change in outcomes suggest that PST is generally feasible and beneficial for care partners of persons with TBI. Adaptations, such as developing a 3-session version of PST, could improve feasibility.
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Affiliation(s)
| | - Brittany Wright
- Department of Physical Medicine and Rehabilitation, North Texas TBI Model System, UT Southwestern Medical Center, Dallas, TX, USA
| | - Simon Driver
- North Texas TBI Model System, Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Stephanie Calhoun
- North Texas TBI Model System, Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Aimee Muir
- North Texas TBI Model System, Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Georgianna Dart
- Hackensack Meridian JFK Johnson Rehabilitation Institute, Edison, NJ, USA
| | - Yelena Goldin
- Hackensack Meridian JFK Johnson Rehabilitation Institute, Edison, NJ, USA
| | - Jean Lengenfelder
- Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, North Texas TBI Model System, UT Southwestern Medical Center, Dallas, TX, USA
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Osborne CL, Pool CL, Juengst SB. Feasibility of Problem-Solving Training During Inpatient Rehabilitation in Patients With Stroke. Am J Occup Ther 2023; 77:24000. [PMID: 36706277 DOI: 10.5014/ajot.2023.050083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Stroke survivors report feeling unprepared to manage challenges that arise during the transition from hospital to home. Cultivating problem-solving skills before discharge may better prepare patients for the transition home. OBJECTIVE To determine the feasibility of a protocol to deliver Problem-Solving Training (PST) to stroke survivors during inpatient rehabilitation to increase goal achievement. DESIGN Single-group feasibility study. SETTING Academic and county hospital inpatient rehabilitation units. PARTICIPANTS Adult patients with stroke and planned discharge home. INTERVENTION Up to six PST sessions over 2 to 3 wk followed by 3 mo of mobile health boosters. RESULTS Of 17 eligible participants, 15 consented and 11 completed three or more PST sessions. Six participants used electronic boosters, achieving at least one goal postdischarge. Participants reported high satisfaction with PST (Client Satisfaction Questionnaire-8 M score = 29.3, SD = 4.4; range = 8-32), moderate depression at baseline (eight-item Patient Health Questionnaire [PHQ-8] score, M = 11.0, SD = 6.1; range = 0-27), mild depression at 3 mo postdischarge (PHQ-8 score, M = 8.3, SD = 5.5), moderately high self-efficacy at baseline (General Self-Efficacy Scale [GSE] score, M = 31.1, SD = 7.3; range = 10-40), and a self-efficacy increase at 3 mo postdischarge (GSE score, M = 34.1, SD = 4.2). CONCLUSIONS AND RELEVANCE PST among patients with stroke during inpatient rehabilitation was feasible, and participants demonstrated improvements in clinical outcomes and goal attainment. Barriers to participation and adherence should be addressed in future studies. What This Article Adds: Teaching patients problem-solving skills early after a stroke using a metacognitive strategy is feasible and may decrease depression and increase self-efficacy while fostering independent goal setting and problem solving.
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Affiliation(s)
- Candice L Osborne
- Candice L. Osborne, PhD, MPH, OTR, is Research Scientist, Department of Research, Craig Hospital, Englewood, CO. At the time of the research, Osborne was Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas;
| | - Courtney L Pool
- Courtney L. Pool, MOT, OTR, is Occupational Therapist, Department of Occupational Therapy, NeuroRestorative, Houston, TX
| | - Shannon B Juengst
- Shannon B. Juengst, PhD, CRC, is Clinical Investigator, Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX
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Juengst SB, Perrin PB, Klyce DW, O’Neil-Pirozzi TM, Herrera S, Wright B, Lengenfelder J, Lercher K, Callender L, Arango-Lasprilla JC. Caregiver Characteristics of Adults with Acute Traumatic Brain Injury in the United States and Latin America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5717. [PMID: 35565112 PMCID: PMC9102876 DOI: 10.3390/ijerph19095717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022]
Abstract
Objectives: To compare characteristics of caregivers of adults with acute traumatic brain injury (TBI) in the U.S. and Latin America (Mexico and Colombia). Design: Secondary data analysis of two cohorts. Cohort 1: English-speaking caregivers of adults with TBI in the U.S. (n = 80). Cohort 2: Spanish-speaking caregivers of adults with TBI in Mexico or Colombia (n = 109). Results: Similarities between the U.S. and Latin American caregiver groups, respectively, were: predominantly women (81.3%, 81.7%, respectively); spouses/domestic partners (45%, 31.2%); and motor vehicle accident (41.5%, 48.6%) followed by fall etiologies (40%, 21.1%). Differences between U.S. and Latin American caregivers were: age (49.5 years, 41.5 years, p < 0.001); employment status ((Χ52 = 59.63, p < 0.001), full-time employment (63.7%, 25.7%), homemaker (2.5%, 31.2%), and retired (17.5%, 1.8%)); violence-related etiology (2.5%, 15.6%); and severity of depressive symptoms (M = 7.9, SD = 5.8; M = 5.8, SD = 5.7; p = 0.014). Conclusions: TBI caregivers in the U.S. were older and employed full-time or retired more often than those in Latin America. Violence-related etiology was nearly five times more common in Latin America, raising concerns for potential implications of post-traumatic stress and family adjustment after injury. Although both groups likely could use mental health support, this was particularly true of the U.S. cohort, maybe due to differential demographics, mechanisms of injury, or family and community support.
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Affiliation(s)
- Shannon B. Juengst
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.H.); (B.W.)
- TIRR Memorial Hermann Brain Injury Research Center, Houston, TX 77030, USA
- Department of Physical Medicine & Rehabilitation, UT Health Sciences Center at Houston, Houston, TX 77030, USA
| | - Paul B. Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, USA;
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23284, USA
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA;
| | - Daniel W. Klyce
- Central Virginia Veterans Affairs Health Care System, Richmond, VA 23249, USA;
- Virginia Commonwealth University Health System, Richmond, VA 23284, USA
- Sheltering Arms Institute, Richmond, VA 23233, USA
| | - Therese M. O’Neil-Pirozzi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA 02129, USA;
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA 02115, USA
| | - Susan Herrera
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.H.); (B.W.)
| | - Brittany Wright
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.H.); (B.W.)
| | - Jean Lengenfelder
- Department of Physical Medicine & Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ 07101, USA;
- Kessler Foundation, East Hanover, NJ 07936, USA
| | - Kirk Lercher
- Department of Physical Medicine & Rehabilitation, JFK Johnson Rehabilitation Institute, Hackensack Meridian Health, Edison, NJ 08820, USA;
| | - Librada Callender
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX 75246, USA;
| | - Juan Carlos Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain;
- IKERBASQUE, Basque Foundation for Science, 48009 Bilbao, Spain
- Department of Cell Biology and Histology, University of the Basque Country, 48940 Leioa, Spain
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Kew CL, Juengst SB, Kelley B, Osborne CL. Linking Problems Reported by Care Partners of Individuals With Alzheimer’s Disease and Lewy Body Dementia to the International Classification of Functioning Disability and Health. Gerontol Geriatr Med 2022; 8:23337214221086810. [PMID: 35368457 PMCID: PMC8973046 DOI: 10.1177/23337214221086810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/02/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
Aim This study aims to classify, describe, and compare the problems reported by care partners of adults with Alzheimer’s disease (AD) and Lewy body dementia (LBD) using the International Classification of Functioning Disability and Health (ICF) Methods Problems that care partners experience were collected during a problem-solving training intervention. The meaningful concepts were then extracted and linked to the ICF using a standardized linking technique. Results 402 meaningful concepts were extracted from 128 problems reported by care partners. 79.4% of the concepts were linkable to the ICF. “Body functions” was most frequently addressed followed by “Activities and participation.” LBD care partners reported more problems (M = 23.6 ± 13.4) on average than AD care partners (M = 19.4 ± 12.1). LBD care partners reported greater relative proportions of problems in mental function (emotional and sleep functions) than AD care partners. Conclusion This study suggests that the experience of LBD care partners may include significantly more challenges and may be more emotionally demanding than the care experience of AD care partners. Interventions designed to support care partners of adults with dementia may need to be tailored to meet the needs of care partners based on the care receiver’s type of dementia.
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Affiliation(s)
- Chung Lin Kew
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical School, Dallas, TX, USA
- Department of Applied Clinical Research, UT Southwestern Medical School, Dallas, Dallas, TX, USA
- School of Public Health, Texas A&M University College Station, College Station, TX, USA
| | - Shannon B. Juengst
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical School, Dallas, TX, USA
- Department of Applied Clinical Research, UT Southwestern Medical School, Dallas, Dallas, TX, USA
- Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA
| | - Brendan Kelley
- Department of Neurology, UT Southwestern Medical School, Dallas, TX, USA
| | - Candice L. Osborne
- Department of Physical Medicine & Rehabilitation, UT Southwestern Medical School, Dallas, TX, USA
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Juengst S, Supnet C, Kew CLN, Silva V, Vega M, Han G, Kelley B, Smith ML, Maestre G. Bilingual problem-solving training for caregivers of adults with dementia: A randomized, factorial-design protocol for the CaDeS trial. Contemp Clin Trials 2021; 108:106506. [PMID: 34273551 PMCID: PMC8453060 DOI: 10.1016/j.cct.2021.106506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Caregivers of individuals with Alzheimer's disease and related dementias (ADRD) often experience debilitating caregiver burden and emotional distress. To address these negative emotional consequences of caregiving, we will test and refine a strategy training intervention - Problem-Solving Training (PST) - that promotes self-efficacy and reduces caregiver burden and depressive symptoms. Previous research supports efficacy of PST; however, we do not know exactly how many PST sessions are needed or if post-training "boosters" are required to maintain PST benefits. Additionally, we translated and culturally-adapted PST into "Descubriendo Soluciones Juntos" (DSJ), our novel intervention for Spanish-speaking caregivers. METHOD In this 2 × 2 factorial design randomized controlled trial, we will test remotely-delivered PST/DSJ sessions for both English- and Spanish-speaking caregivers of persons with ADRD to determine the optimal number of PST/DSJ sessions and ongoing "booster" sessions needed to best help caregivers navigate their current and future needs. AIMS 1) Compare the efficacy of three vs. six PST/DSJ sessions each with and without booster sessions for decreasing caregiver burden and depression and enhancing caregiver problem-solving; 2) Identify key factors associated with efficacy of PST/DSJ, including age, gender, primary language, relationship to care recipient, and uptake of the PST/DSJ strategy. RESULTS These results will establish guidelines needed for an evidence-based, culturally-adapted, and implementable problem-solving intervention to reduce caregiver stress and burden and improve caregiver health and well-being. CONCLUSION This work promotes inclusion of diverse and underserved populations and advances therapeutic behavioral interventions that improve the lives of caregivers of individuals with chronic conditions.
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Affiliation(s)
- ShannonB Juengst
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America; Department of Applied Clinical Research, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America.
| | - Charlene Supnet
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Chung Lin Novelle Kew
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America; Department of Applied Clinical Research, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Valeria Silva
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Marlene Vega
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America; Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Gang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, United States of America; Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, United States of America
| | - Brendan Kelley
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States of America
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, United States of America; Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Road, College Station, TX 77843, United States of America
| | - Gladys Maestre
- School of Medicine, University of Texas Rio Grande Valley, One West University Boulevard, Brownsville, TX 78520, United States of America
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Juengst SB, Osborne CL, Holavanahalli R, Silva V, Kew CL, Nabasny A, Bell KR. Feasibility Study of Problem-Solving Training for Care Partners of Adults With Traumatic Brain Injury, Spinal Cord Injury, Burn Injury, or Stroke During the Inpatient Hospital Stay. Arch Rehabil Res Clin Transl 2019; 1:100009. [PMID: 33543049 PMCID: PMC7853336 DOI: 10.1016/j.arrct.2019.100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the feasibility of delivering an evidence-based self-management intervention, problem-solving training (PST), to care partners of individuals with traumatic brain injury (TBI), spinal cord injury (SCI), burn injury, or stroke during the inpatient hospital stay. DESIGN In this single group pre-post intervention pilot feasibility study. SETTING Inpatient rehabilitation or acute care and community. PARTICIPANTS Care partners (spouse or partner, family member, friend who is in any way responsible for the health or well-being of the care recipient) of individuals with TBI, SCI, burn injury, or stroke (N=39). INTERVENTION PST is a metacognitive self-management intervention that teaches individuals a global strategy for addressing self-selected problems. Participants received up to 6 sessions of PST in person or via telephone during their care recipient's inpatient stay. MAIN OUTCOME MEASURES We measured feasibility of recruitment, intervention delivery, and postintervention use of a smartphone app (Care Partner Problem Solving [CaPPS]) and participant satisfaction (Client Satisfaction Questionnaire [CSQ]) and engagement (Pittsburgh Rehabilitation Participation Scale [PRPS]) with the intervention. RESULTS Of 39 care partners approached, n=10 (25.6%) were ineligible. Of n=29 (74.4%) who were eligible, n=17 (58.6%) refused, and n=12 (41.4%) consented, of whom n=8 (66.7%) completed ≥3 PST sessions. Not perceiving any benefit was the most common reason for refusal, followed by no interest in research. Participants were very satisfied with PST (CSQ mean=3.35, SD=0.60), reported strong working alliance (Working Alliance Inventory mean=6.8, SD=3.1), and demonstrated very good engagement (PRPS mean=4.75, SD=1.41). CaPPS was downloaded and used by only n=3 participants. CONCLUSIONS Delivering a self-management intervention to care partners during the care recipient's acute hospital stay is feasible for a subset of potential participants. Short lengths of stay, language fluency, and perceiving no potential benefit were noted barriers. Boosters via smartphone app have potential, but several barriers must first be overcome.
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Affiliation(s)
- Shannon B. Juengst
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Candice L. Osborne
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Radha Holavanahalli
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Valeria Silva
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chung Lin Kew
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Andrew Nabasny
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Rehabilitation Counseling, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathleen R. Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
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