1008 — Pilot Test of a Low-Cost, Telephone and Online Intervention for Caregivers of Veterans Post Stroke

Uphold CR, COIN - North Florida/South Georgia and Tampa, University of Florida; Dang S, Miami VA Medical Center, University of Miami; Jordan M, COIN - North Florida/South Georgia and Tampa; Freytes IM, COIN - North Florida/South Georgia and Tampa; Rutter T, COIN - North Florida/South Georgia and Tampa; Ruiz D, Miami VA Medical Center; Schembler T, COIN - North Florida/South Georgia and Tampa; Rogers J, COIN - North Florida/South Georgia and Tampa, University of Florida;

Objectives:
Caregiver depression often follows a stroke and is a major contributor of survivors' hospital readmission and institutionalization. Previous caregiver interventions have been labor intensive and burdensome for caregivers. Thus, we pilot-tested a brief, low-cost intervention that used telephone support plus the Internet (i.e., our team's previously developed and nationally available RESCUE stroke caregiver website). The objectives of the intervention was to: 1) reduce caregiver burden and depressive symptoms, 2) improve caregiver problem-solving abilities and quality of life, and 3) improve Veteran functional abilities.

Methods:
The intervention consisted of four, nurse-led telephone and online sessions. The COPE model, which emphasizes that improved caregiving involves Creative thinking, maintaining an Optimistic attitude, and using Problem solving skills and Expert information, guided the intervention. The intervention was conducted at VA medical centers in Gainesville and Miami, Florida. We used a one-group, pre-/post-test design and mixed methods. The sample consisted of 72 stroke caregivers. The following tools measured the outcomes: Zarit Burden Interview (burden), Center for Epidemiologic Studies Depression (depressive symptoms), VR-12 Health Survey (quality of life), Social Problem-Solving Inventory (problem solving skills) ,and Barthel Index (Veteran's functional abilities. We determined the caregivers' acceptability of the intervention with the Treatment Enactment Survey. To obtain Caregivers' perceptions of the barriers/facilitators of the intervention we conducted qualitative interviews with 15 randomly selected caregivers.

Results:
The majority of caregivers were female (96%), Caucasian (68%), and caring for their spouses (78%). The adherence rate for completing the intervention was 90%. Using two-tailed, paired t-tests, we found a significant decrease in depression (t = 3.06, p = 0.006) and burden (t = -2.92, p = 0.003). Although not statistically significant, there were improvements in caregivers' problem solving and quality of life and Veterans' functional abilities. Most caregivers (85%) rated all items on the Enactment survey as high/highly acceptable. In qualitative interviews, caregivers stated that the intervention was beneficial without causing additional burden because it was delivered over the phone and Internet.

Implications:
The intervention was feasible, improved outcomes, and had high caregiver adherence and acceptability. Lessons learned led to recent funding of a randomized clinical trial to further test the intervention.

Impacts:
The intervention has potential to improve transtional and in-home care of Veterans post-stroke through low-cost, telephone and online caregiver support and education.