1124 — The RESCUE CREST Stroke Caregiver Program: Results of a Randomized Controlled Trial

Lead/Presenter: Constance Uphold,  GRECC, North Florida/South Georgia Veterans Affairs Healthcare System
All Authors: Uphold CR (GRECC, NF/SG Veterans Affairs Health System), Eliazar-Macke N (North Florida/South Georgia Veterans Affairs Health System, Research Service LeLaurin J (University of Florida, College of Medicine) Freytes IM (North Florida/South Georgia Veterans Affairs Health System, Research Service) Orozco T (North Florida/South Georgia Veterans Affairs Health System, Research Service) Montague M (University of Florida, Jacksonville, College of Medicine) Dang S (Miami Veterans Affairs Healthcare System, GRECC, University of Miami, College of Medicine)

Objectives:
Veterans with stroke often require extensive care from family members for successful rehabilitation. There are few online programs for these often-burdened, family caregivers. Our objective was to evaluate the efficacy of the RESCUE CREST program, a nurse-led intervention that combined web-based education and problem-solving over an interactive, online messaging center.

Methods:
We conducted a two-group, randomized controlled trial with repeated measures that used mixed methods. We randomized 174 caregivers from eight, geographically dispersed Veterans Affairs (VA) medical centers to an intervention (n = 88) or usual group (n = 86). The COPE model, which emphasizes creativity, optimism, planning, and expert information, guided the intervention. The intervention was led by a registered nurse at one VA medical center and included an orientation, telephone session followed by 8 asynchronous online, sessions delivered via a messaging center. The intervention was unique as each session included: 1) standardized and tailored education on the national, investigator-created RESCUE stroke caregiver website, 2) interactive, web-based discussion questions, 3) follow-up discharge planning and care coordination, 4) health assessments of caregivers and Veterans, and 5) individualized problem-solving. Data were collected at baseline and two follow-up timepoints with established survey instruments. To supplement the quantitative data, we conducted semi-structured interviews with a subsample of 16 caregivers. A general linear mixed model for repeated measures and a template analysis approach were used to analyze the data. To enhance rigor and relevance, we engaged Veterans and providers in website development and included a detailed fidelity assessment, blinding of data collectors, an advisory panel of stakeholders, a plan for sustainability, and two types of sensitivity analyses to address the group difference in timing of assessments and the effect of missing data associated with attrition.

Results:
Caregivers mean age was 58 years, 64% were Caucasian, and the majority were female and spouses of the Veteran. Significant time by group interaction effects were found for several outcomes. Compared to usual care, caregivers randomized to the intervention group had significantly greater improvement in self-efficacy (controlling upsetting thoughts), positive aspects in caregiving (enriching life) and physical health-related quality of life after the intervention. Veterans of caregivers in the intervention group had improved functional abilities post-intervention, but this change was not sustained at the longer follow-up timepoint. In qualitative interviews, facilitators identified were the flexibility of the messaging center, the comprehensiveness of the website, the nursing support, and the effectiveness of the individualized, problem-solving activities. The major barrier was difficulty in caregivers completing the study activities on a weekly basis.

Implications:
This is the first known transitional care and problem-solving intervention combined with technology that improved Veteran functional abilities and several caregiver outcomes. Weekly study activities were a barrier, whereas flexibility, support, and effectiveness of the problem-solving coaching were facilitators.

Impacts:
The intervention was successfully implemented at one site to caregivers at 8 VA medical centers. Thus, the RESCUE CREST program holds promise as an evidenced-based, telehealth model that can be transported to medical centers across the county to improve caregivers’ knowledge and skills and stroke survivors’ recovery