Wray 2010.
| Methods | A prospective 2 × 3 randomised control group design (September 2005‐April 2007) | |
| Participants | Spouse or partner caregivers of veterans with moderate‐to‐severe dementia identified via (a) the Veterans Information System Technology Architecture Patient Care database activity indicating an encounter coded for a dementia diagnosis, (b) clinician referral, (c) self or family referral in response to information and publicity about the study. The study was conducted in New York, United States of America. Caregivers were primary caregivers who lived with the person for at least one year, and exhibited at least a moderate level of caregiving strain as defined by a score of 7 or more. Caregivers mean age was 73.94 years (SD not reported). Mean years of caregivers education in the intervention group was 12.69 (SD 3.04) and in the control group 12.34 (SD 2.40). Mean monthly income (US dollars) was similar across the two groups; intervention group (2784.22, SD 1351.47) and control group (2420.75, SD 1376.32). | |
| Interventions | Intervention: The Telehealth Education Program (TEP) (group‐delivered, up to 8/group) (n = 83) Aim: To address major areas that can be problematic for caregivers who want to continue to take care of the veteran with dementia at home: (a) verbal and nonverbal communication, (b) effective structuring of caregiver–patient interactions, (c) management of challenging behavioural problems, and (d) accessing resources and planning for the future. Interventionist(s): Four trained group leaders (three masters‐prepared social workers and one nurse dementia care manager) with expertise in geriatrics led the support groups. Mode of delivery: Telephone Duration: 10 weeks (group format in groups of up to 8, 1 hour telephone meetings) Content: A TEP participant workbook and leader manual were developed for the project. Caregiver participants followed a TEP participant workbook at each of the sessions and weekly homework assignments were included. The TEP group intervention protocol included three primary components: (a) education about dementia and its symptoms and about caregiving skills and resources to address these symptoms, (b) emotion‐focused (such as relaxation and self‐care strategies) and problem‐focused coping strategies (such as problem‐solving and caregiving skills), and (c) group support. TEP content was designed to address major areas that can be problematic for caregivers who want to continue to take care of the veteran with dementia at home: (a) verbal and nonverbal communication, (b) effective structuring of caregiver–patient interactions, (c) management of challenging behavioural problems, and (d) accessing resources and planning for the future. Standardisation: No detail provided Comparison group: Usual care (n = 75) |
|
| Outcomes | Cost: No specific instruments. Veteran health care cost and utilisation data were collected from national abstracts of the VA’s Decision Support System (DSS) and the fee basis files hosted at the VA Austin Automation Center (AAC). For each participant, all cost and utilisation data were summed over 6‐month time intervals, resulting in a total value for each of three data collection periods: baseline (0–6 months before the intervention), short‐term follow‐up time point (from intervention start to 6 months following the start of the intervention), and medium‐term follow‐up time point (from 6 to 12 months after the start of the intervention). |
|
| Notes | The information reported was from a paper linked to the registered trial. VA and VMCA were not explained but they appear to be the names or linked to the name of the health care centres/organisations. Additional unpublished results requested via email in October 2017; results not received at the time of submission of this review Funding source: Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (IIR 03‐076‐01) (p.631) |
|
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Insufficient information to assess |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information to assess |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Unable to blind due to nature of the intervention |
| Blinding of outcome assessment (detection bias) All outcomes | Low risk | Stated that “…data were extracted by one of the investigators (Jian Gao) who was blind to the participants’ group membership” (p.626) |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Insufficient information to assess |
| Selective reporting (reporting bias) | Low risk | All stated outcomes reported |
| Other bias | Unclear risk | Insufficient information to assess. Stated “no statistically significant differences between participants in the two conditions at baseline” (p.627). This referred to caregivers only but results were based on patient hospitalisation and this may have impacted on outcomes. |
AA: Alzheimer's association AAC: Austin Automation Center ADL: Activities of daily living ADRD: Alzheimer's disease or related disorders AHA: American Heart Association BAC: Behavioural activation intervention through group conference call BCOS: Bakas caregiver outcomes scale BPSD: Behavioural and psychological dimensions of depression BSI‐18: Brief symptom inventory ‐ 18 CAI: Caregiver appraisal instrument CBC: Cognitive behavioural intervention via group conference call CBS: Conditional bother scale CBT: Cognitive behavioural therapy CED‐D: Definition unable to be found CES‐D: Center for epidemiological depression scale CGs: Caregivers CHHB: Caregiver health and behaviour inventory CONNECT: Definition unable to be found, may not be an acronym CR: Care recipient CRA: Caregiver reaction assessment CSQ‐8: Client satisfaction questionnaire ‐ 8 DASS‐21: Depression, anxiety and stress scale ‐ 21 DSM‐IV: Diagnostic and statistical of mental disorders ‐ IV DSS: Decision support system DVD: Digital video disc FAD: Family assessment devise FAI: Frenchley activities index FamHFcare: Family heart failure care FECH: Further enabling care at home FITT: Family intervention telephone tracking FITT‐D: Family intervention telephone tracking ‐ dementia FITT‐NH: Family intervention telephone tracking ‐ nursing home GDS: Geriatric depression scale GI: Gastrointestinal HF: Heart failure hr: hour IADL: Instrumental activities of living IHBMP: In‐home behavioural management program MA: Masters of Arts MADRC: Michigan Alzheimer’s Disease Research Center MCA: Modified caregiver appraisal M‐CSI: Modified caregiver strain index MMSE: Mini‐mental state examination MS: Multiple sclerosis MSc: Master of Science NHMRC: National health medical research NIMH: National institute for mental health NSMS: Nurse specialist in multiple sclerosis PART‐O:Participation assessment with recombined tools–objective PCS: Perceived criticism scale PMR: Progressive muscle relaxation PPI: Pressing problems index PPO:Positive problem orientation PSI: Problem solving intervention PWD: People with dementia PwMS: People with multiple sclerosis REACH:Resources for enhancing alzheimer's caregiver health RMBPC: Revised memory and behavior problem checklist RPS: Rational problem‐solving SCIDCV: Structured clinical Interview for disease and statistics manual ‐IV Axis I disorders clinician version SCQ: Sense of competence questionnaire SE: Self‐efficacy SE‐CUT: Self‐efficacy: controlling upsetting thought SE‐OR: Self‐eficacy: obtaining respite SE‐RDB: Self‐efficacy: responding to disturbing behaviours SF‐12: Short Form ‐ 12 SF‐36: Short Form ‐36 SP: Support person SPSI‐R: Social problem‐solving inventory–revised SPSI‐S: Short version of the social problem solving inventory – revised SRAHP: Self‐rated abilities for health practices scale STAI: State–trait anxiety inventory TALK: Defintion not able to be found, may not be an acronym TBI: Traumatic brain injury TEP:Telehealth education program TO: baseline TSC: Telephone support condition TSG: Telephone support group WHOQoLBREF: World Health Organisation Quality of Life Abbreviated Version ZBI: Zarit Burden Interview