Article

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 families-the Veterans' In-home Program (VIP)-targeting 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) and to 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 person-environment 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.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS