Bakas Tamilyn, Austin Joan K, Habermann Barbara, Jessup Nenette M, McLennon Susan M, Mitchell Pamela H, Morrison Gwendolyn, Yang Ziyi, Stump Timothy E, Weaver Michael T
From the Indiana University School of Nursing, Indianapolis (T.B., J.K.A., S.M.M.); University of Cincinnati College of Nursing, OH (T.B.); College of Health Sciences, University of Delaware, Newark (B.H.); Indiana University Melvin and Bren Simon Cancer Center, Indianapolis (N.M.J.); School of Nursing, University of Washington, Seattle (P.H.M.); Indianapolis Economics Department, Indiana University Purdue University (G.M.); Richard M. Fairbanks School of Public Health, Indianapolis, IN (Z.Y., T.E.S.); and College of Nursing, University of Florida, Gainesville (M.T.W.).
Stroke. 2015 Dec;46(12):3478-87. doi: 10.1161/STROKEAHA.115.011099. Epub 2015 Nov 8.
There are few evidence-based programs for stroke family caregivers postdischarge. The purpose of this study was to evaluate efficacy of the Telephone Assessment and Skill-Building Kit (TASK II), a nurse-led intervention enabling caregivers to build skills based on assessment of their own needs.
A total of 254 stroke caregivers (primarily female TASK II/information, support, and referral 78.0%/78.6%; white 70.7%/72.1%; about half spouses 48.4%/46.6%) were randomized to the TASK II intervention (n=123) or to an information, support, and referral group (n=131). Both groups received 8 weekly telephone sessions, with a booster at 12 weeks. General linear models with repeated measures tested efficacy, controlling for patient hospital days and call minutes. Prespecified 8-week primary outcomes were depressive symptoms (with Patient Health Questionnaire Depressive Symptom Scale PHQ-9 ≥5), life changes, and unhealthy days.
Among caregivers with baseline PHQ-9 ≥5, those randomized to the TASK II intervention had a greater reduction in depressive symptoms from baseline to 8, 24, and 52 weeks and greater improvement in life changes from baseline to 12 weeks compared with the information, support, and referral group (P<0.05); but not found for the total sample. Although not sustained at 12, 24, or 52 weeks, caregivers randomized to the TASK II intervention had a relatively greater reduction in unhealthy days from baseline to 8 weeks (P<0.05).
The TASK II intervention reduced depressive symptoms and improved life changes for caregivers with mild to severe depressive symptoms. The TASK II intervention reduced unhealthy days for the total sample, although not sustained over the long term.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01275495.
针对出院后的中风患者家庭照护者,基于循证的项目很少。本研究的目的是评估由护士主导的电话评估与技能提升工具包(TASK II)的效果,该工具包能让照护者根据自身需求评估来提升技能。
共有254名中风患者照护者(主要为女性,TASK II组/信息、支持与转介组分别为78.0%/78.6%;白人分别为70.7%/72.1%;约一半为配偶,分别为48.4%/46.6%)被随机分为TASK II干预组(n = 123)或信息、支持与转介组(n = 131)。两组均接受为期8周的每周一次电话咨询,并在第12周进行强化咨询。采用重复测量的一般线性模型来测试效果,并对患者住院天数和通话时长进行控制。预先设定的8周主要结局指标为抑郁症状(患者健康问卷抑郁症状量表PHQ - 9≥5)、生活变化和不健康天数。
在基线PHQ - 9≥5的照护者中,与信息、支持与转介组相比,被随机分配到TASK II干预组的照护者从基线到第8周、24周和52周时抑郁症状的减轻幅度更大,从基线到第12周时生活变化的改善程度更大(P < 0.05);但在总样本中未发现此差异。尽管在第12周、24周或52周时未持续存在,但被随机分配到TASK II干预组的照护者从基线到第8周时不健康天数的减少幅度相对更大(P < 0.05)。
TASK II干预可减轻轻度至重度抑郁症状照护者的抑郁症状并改善生活变化。TASK II干预可减少总样本的不健康天数,尽管长期来看未持续存在。