Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
BMC Health Serv Res. 2019 Jan 9;19(1):20. doi: 10.1186/s12913-018-3853-8.
To date, there has been a dearth of scientifically tested, established intervention concepts focussed on supporting informal caregivers and embedded in routine health care structures. The aim of this study was to assess effects of a brief telephone intervention for caregivers of persons with cognitive impairment (PCIs) on caregivers' depressiveness and subjective burden.
A two-arm cluster-randomised controlled intervention study was carried out at 32 German day-care centres. During the six-month intervention period, informal caregivers in the intervention group (n = 205) received counselling in three phone calls focussed on stress reduction, development of self-management strategies, and how to deal with challenging behaviours. Both the control group (n = 154) and the intervention group were free to take part in any support programmes offered by the German Health Care System (TAU). Caregivers' subjective burden and depressiveness were measured with the Burden Scale for Family Caregivers - short version (BSFC-s) and the WHO-5 Well-Being Index (WHO-5). Outcomes were assessed by means of computer-assisted telephone interviews (CATIs) at baseline and at the end of the six-month intervention phase. Multiple regression analyses were used to show the influence of group allocation.
After the intervention phase, group allocation was not found to significantly predict caregivers' subjective burden or depressiveness. The baseline scores (p < 0.001) were the only significant predictors of change in both outcomes. However, sensitivity analyses for caregivers who did not experience any events that they felt were major (in a negative or positive sense) during the six months (n = 271) showed that group allocation (p < 0.05) was a significant predictor of positive change in both outcomes (BSFC-s: Δ-1.3, [- 2.4, - 0.3], Cohen's d = 0.27; WHO-5: Δ1.5, [0.4, 2.7], Cohen's d = 0.26). Effect sizes were highest in the subgroup of caregivers of people with mild dementia (BSFC-s: Cohen's d = 0.43; WHO-5: Cohen's d = 0.42).
A "low-dose" psychoeducative telephone intervention designed to empower caregivers is effective, especially in an early stage, if the overlap between the effect of the intervention and the effect of events that are experienced as major events in the caregiver's life is considered.
Identifier: ISRCTN16412551 (Registration date: 30 July 2014, registered retrospectively).
迄今为止,科学界尚未提出任何经过验证的、以支持非专业照护者为重点并嵌入常规医疗保健结构的干预概念。本研究旨在评估针对认知障碍患者(PCIs)的非专业照护者的简短电话干预对其抑郁和主观负担的影响。
这是一项在德国 32 个日间护理中心开展的双臂、聚类随机对照干预研究。在六个月的干预期间,干预组(n=205)的非专业照护者通过三次电话咨询接受压力减轻、自我管理策略制定和应对挑战性行为方面的辅导。对照组(n=154)和干预组均可自由参加德国卫生保健系统(TAU)提供的任何支持计划。使用家庭照护者负担量表-简短版(BSFC-s)和世界卫生组织-5 幸福感指数(WHO-5)来衡量照护者的主观负担和抑郁程度。通过计算机辅助电话访谈(CATIs)在基线和六个月的干预阶段结束时评估结果。多元回归分析用于显示组分配的影响。
干预阶段后,组分配未显著预测照护者的主观负担或抑郁程度。基线分数(p<0.001)是两个结局变化的唯一显著预测因素。然而,对六个月期间未经历任何他们认为是重大事件(无论是负面还是正面)的照护者(n=271)进行敏感性分析显示,组分配(p<0.05)是两个结局(BSFC-s:-1.3,[-2.4,-0.3],Cohen's d=0.27;WHO-5:1.5,[0.4,2.7],Cohen's d=0.26)的阳性变化的显著预测因素。在轻度痴呆患者的照护者亚组中,效应大小最高(BSFC-s:Cohen's d=0.43;WHO-5:Cohen's d=0.42)。
如果考虑到干预的效果与照护者生活中经历的重大事件的效果之间的重叠,那么专门设计用于增强照护者能力的“低剂量”心理教育电话干预是有效的,尤其是在早期阶段。
标识符:ISRCTN8716222(注册日期:2014 年 7 月 30 日,回溯性注册)。