Combined Online Assistance for Caregiver Health (COACH): The Efficacy of a Combined Physical Activity and Coping Skills Training Intervention for Caregivers
Abstract
Since 2002, the number of cognitively impaired Veterans has increased dramatically. This is due in part to the increased incidence of both traumatic brain injury (TBI) and Alzheimer s disease (AD) in the Veteran population. These Veterans often rely on caregivers for a wide range of help, from everyday tasks like food preparation, cleaning, and shopping to more intensive tasks like bathing, dressing, and toileting. Informal or unpaid care is the most common form of long-term care in the Department of Veterans Affairs. In-home care by informal caregivers has clear benefits for the care recipient, yet it can result in frequent unintended consequences for the caregivers, including caregiver burden and depression. Caregiver burden is associated with negative psychological and physical health outcomes for both the caregiver and the care recipient. Treatment options for caregiver burden are limited as pharmacological methods have shown limited effects, and the effects of psychological interventions (i.e., caregiver skill training) are modest. Furthermore, these interventions have been limited by accessibility to and acceptability of these methods by caregivers. Efforts to develop telephone or Internet-based psychosocial interventions have produced mixed results. Identification of methods to augment the effectiveness of caregiver skills training interventions and improve the delivery of these interventions is necessary. One promising strategy for possible augmentation is exercise training. Specifically, recent trials of the effects of exercise on caregiver burden are promising. Furthermore, tablet-based technology holds great promise to improve the delivery of caregiver interventions due to their pared down user-friendly interface. We expect exercise training to augment the effects of caregiver skills training and thus increase the benefits of an already efficacious treatment. We also expect that delivering the intervention through tablet-based technology could lead to greater acceptability with increased accessibility among caregivers. This proposal is a randomized controlled trial of a multi-modal intervention that consists of an exercise training component and a caregiver skills training (CST) component. The exercise training consists of either a combined aerobic and resistance exercise (CARE) program or a stretching exercise (SE) program. The CARE program will emphasize a mixture of strength training and aerobic exercises, while the SE program will focus on increased flexibility and range of motion. The CST component consists of weekly caregiver support video teleconferences (V-Tels) that promote caregiver self-care and teach valuable problem-solving skills that can be applied to problems that caregivers often face. This 3-year proposal will include 200 caregivers of Veterans diagnosed with TBI and/or AD age 18 to 85 with half randomized to an active intervention (CARE+CST) and half to a control condition (SE+CST). The exercise training consists of a 6-month home-based exercise program during which participants will have weekly V-tels with study staff using study-issued tablets. Caregivers will also participate in regular CST V-tels with study staff. The CST is based upon an evidence-based model that is comprised of psychoeducation, problem-solving skill building, relaxation strategies, caregiver self-care, and social support. After completion of the multi-modal intervention, participants will enter a 6-month long follow-up phase. At three predetermined time points (e.g., Study Entry; After Completion of the Multi-Modal Intervention; and After Completion of the Follow-Up Phase), participants will complete a variety of psychological well-being measures that tap into areas such as caregiver burden and depression, as well as physiological measures including cardiovascular inflammatory markers. To study possible predictors of treatment response, we will also collect biological and genetic data. We hope t
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 29, 2016
- Source ID
- W81XWH1510246
Entities
People
- Jennifer Fairchild
Organizations
- Palo Alto Veterans Institute for Research
- United States Army