Publication year
2016
Citation Title
A randomized controlled trial to evaluate the veterans’ in-home program for military veterans with traumatic brain injury and their families: Report on impact for family members
Journal Name
PM&R
Journal Volume
8
Issue Number
6
Page Numbers
495-509
DOI
10.1016/j.pmrj.2015.10.008
Summary
Traumatic brain injury (TBI) creates challenges for both patients and their family members, yet few intervention programs have taken the needs of the whole family into consideration. This study examined the effectiveness of the Veterans' In-home Program on family member's well-being. Findings suggested that compared to traditional care programs, Veterans' In-home Program was better at increasing family members' well-being.
Key Findings
Compared to controls at follow-up, family members in the Veterans’ In-home Program group had fewer depressive symptoms and lower caregiver burden.
The family member satisfaction scores did not differ between the experimental and control groups.
Family members had high acceptance of the Veterans’ In-home Program intervention.
Implications for Program Leaders
Provide additional support to Service members with TBI and their family members
Develop classes for Service members to help them understand TBI and how to work together with family members to overcome challenges caused by TBI
Offer support groups for non-Service members that promote healthy coping and family well-being
Implications for Policy Makers
Continue to offer support to Service members who were diagnosed with TBI
Encourage awareness campaigns regarding the importance of both patients’ and family members’ psychological well-being
Recommend professional development courses for providers to educate them about the unique challenges faced by civilian family members
Methods
Participants were recruited from a Veteran Affairs (VA) outpatient polytrauma program, and they were randomly assigned to the Veterans’ In-home Program experimental condition or the traditional care control condition.
The study included a baseline interview, intervention, and a follow-up interview; of the 81 family members, 63 completed the follow-up interview.
Family members’ well-being was assessed in three domains: depressive symptoms, burden, and satisfaction.
Participants
The sample included 81 Veterans with TBI and a family member for each of them.
The average age for family members was 42 years (SD = 12.51), and 94% were women.
The family members were predominantly White (59%), followed by Black (33%) and Hispanic (8%).
Limitations
The results of the study could not be generalized to civilians with TBI or Veterans who do not use the Veterans Health Administration (VHA) services.
The intervention effect observed in the study might simply be due to the intervention group having more interactions with the facilitators than the control group.
The sample is small and the retention rate of the sample is low, therefore generalizability of the study is limited.
Avenues for Future Research
Recruit a larger sample of families that include civilians with TBI and Service members with TBI from non-VHA settings
Collect longitudinal data to examine the impact of the Veterans’ In-home Program over a longer period of time
Implement retention strategies (e.g., more flexible scheduling) to decrease family attrition
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Abstract
Background: Traumatic brain injury (TBI) creates many challenges for families as well as for patients. Few intervention studies have considered both the needs of the person with TBI and his or her family and included both in the intervention process. To address this gap, we designed an innovative intervention for veterans with TBI and familiesdthe Veterans’ In-home Program (VIP)dtargeting veterans’ environment, delivered in veterans’ homes, and involving their families. Objectives: To determine whether the VIP is more effective than standard outpatient clinic care in improving family members’ well-being in 3 domains (depressive symptoms, burden, and satisfaction) andto assess its acceptability to family members. Design: In this randomized controlled trial, 81 dyads (veteran/family member) were randomly assigned to VIP or an enhanced usual care control condition. Randomization occurred after the baseline interview. Follow-up interviews occurred 3-4 months after baseline, and the interviewer was blinded to group assignment. Setting: Interviews and intervention sessions were conducted in veterans’ homes or by telephone. Participants: A total of 81 veterans with TBI recruited from a Veterans Affairs (VA) polytrauma program and a key family member for each participated. Of the 81 family members, 63 completed the follow-up interview. Intervention: The VIP, guided by the personeenvironment fit model, consisted of 6 home visits and 2 telephone calls delivered by occupational therapists over a 3- to 4-month period. Family members were invited to participate in the 6 home sessions. Main Outcome Measures: Family member well-being was operationally defined as depressive symptomatology, caregiver burden, and caregiver satisfaction 3-4 months after baseline. Acceptability was operationally defined through 3 indicators. Results: Family members in the VIP showed significantly lower depressive symptom scores and lower burden scores when compared to controls at follow-up. Satisfaction with caregiving did not differ between groups. Family members’ acceptance of the intervention was high. Conclusions: VIP represents the first evidence-based intervention that considers both the veteran with TBI and the family. VIP had a significant impact on family member well-being and thus addresses a large gap in previous research and services for families of veterans with TBI.
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