Problem-solving training via videoconferencing for family caregivers of persons with spinal cord injuries: A randomized clinical trial. Behaviour Research and Therapy, 46, 1220-1229

Department of Educational Psychology, 4225 TAMU, Texas A&M University, College Station, TX 77845, USA.
Behaviour Research and Therapy (Impact Factor: 3.85). 09/2008; 46(11):1220-9. DOI: 10.1016/j.brat.2008.08.004
Source: PubMed


To examine the effectiveness of an individualized problem-solving intervention delivered in videoconferencing sessions with family caregivers of persons living with a spinal cord injury (SCI) and possible contagion effects on care recipients.
Family caregivers were randomly assigned to an education-only control group or an intervention group in which participants received problem-solving training (PST) in monthly videoconference session for a year.
Sixty-one caregivers (54 women, 7 men) and their care recipients (40 men, 21 women) consented to participate.
The Social Problem-Solving Inventory-Revised was administered to caregivers. Caregivers and care recipients completed the Inventory to Diagnose Depression, the SF-36 and the Satisfaction with Life scale at pre-treatment, 6 months and 12 months.
Twenty-eight caregivers discontinued the study and their follow-up data were unavailable at the final assessment. Older caregivers were more likely than younger caregivers to remain in the study. Intent-to-treat analyses projected a significant decrease in depression among caregivers receiving PST; efficacy analyses indicated this effect was pronounced at the 6th month assessment. ITT analyses and efficacy analyses revealed that care recipients of caregivers receiving PST reported gains in social functioning over time.
Community-based, telehealth interventions may benefit family caregivers and their care recipients, but the mechanisms of these effects are unclear. Attrition and sample issues should be considered in future studies with these populations.

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    • "También hubo un cambio significativo en todas las subescalas. En comparación con los pocos estudios previos que aplicaron intervenciones de solución de problemas en cuidadores y evaluaron esta variable, los presentes hallazgos son más positivos; los anteriores encontraron cambios sólo en las habilidades disfuncionales (Rivera et al., 2008), sólo en las funcionales (Elliot et al., 2009) o no encontraron cambios significativos (Elliot et al., 2008). Los hallazgos de Grant et al. (2002) fueron más afines a los nuestros, pues hallaron mejoría en todas las dimensiones excepto en la orientación positiva. "
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    ABSTRACT: The goal of the present study was to assess depressive symptoms, problem-solving skills, and their role in therapeutic change in an indicated prevention of depression intervention aimed at non-professional female caregivers. We performed a randomized controlled trial in which participants were randomized to a problem-solving intervention (n = 89) or a usual care control group (n = 84). There was a significant pre- to post-treatment improvement in problem-solving skills in the intervention group, t(88) = -10.44, p < .001. We also observed significant associations between depressive symptomatology and positive (r = -.22, p = .043) and negative (r = .21, p = .045) problem orientation, as well as the generation of alternative solutions (r = -.22, p = .040). The changes in global and functional problem-solving skills were moderators of the post-treatment decrease in depressive symptomatology.
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    • "In general , the present study supports the potential usefulness of tailored cognitive behavioral therapy delivered in telephone ses - sions to individual caregivers of persons with a variety of chronic disabilities ( Berry et al . , 2012 ; Elliott et al . , 2008 ; Grant et al . , 2002 ; Rivera et al . , 2008 ) . However , the lack of effects on care - giver problem - solving abilities raises issues about the precise mechanisms through which benefits may occur . Although lacking in specificity , our findings illustrate the benefits caregivers may experience from frequent , therapeutic , and guid"
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    ABSTRACT: Objective: Intervention trials for stroke caregivers after the early poststroke period are lacking. To address this gap, we examined the effectiveness of a problem-solving intervention (PSI) for stroke caregivers who provided care for at least 6 months and who experienced significant strain in their role. Method: One hundred twenty-two family caregivers (age = 66.2 years, 77.9% female) were randomly allocated to a PSI or control group. The PSI was composed of 2 home visits and 18 telephone calls delivered over a 3-month intensive intervention and a 9-month maintenance period. PSI and control groups received monthly information letters in addition to usual care. Primary caregiver outcomes were depressive symptoms (measure: Center for Epidemiologic Studies-Depression Scale) and sense of competence (measure: Sense of Competence Questionnaire). Results: In covariance analyses, caregivers of the PSI group showed significantly lower levels of depressive symptoms after 3 months (p < .01, d = -.48) and after 12 months (p < .05, d = -.37), but no better sense of competence compared with the control group. Latent growth curve analyses revealed positive significant (p < .05) linear and quadratic effects of PSI on both primary outcomes. No effects, however, were found on caregiver social-problem-solving abilities. Conclusions: Although beneficial effects were observed among caregivers in the PSI group, the lack of effects on problem-solving abilities implies other characteristics of the intervention might account for these benefits. The relative intensity and therapeutic contact during the first 3 months of the intervention may be particularly helpful to caregivers of stroke survivors.
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    • "Even though care recipients did not directly participate in PST, their levels of depressive symptoms declined over time, whereas care recipients whose caregivers were in the control condition showed a stable trajectory of depressive symptoms. This finding adds to the few clinical trials that have examined such indirect effects of caregiver interventions on the well-being of care recipients (e.g., Elliott et al., 2008; Wade et al., 2006b). Although demonstrating beneficial effects of family interventions on care recipients is important, it is essential that interventions " . . . "
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    ABSTRACT: To examine whether an individualized problem-solving intervention provided to family caregivers of persons with severe disabilities provides benefits to both caregivers and their care recipients. Family caregivers were randomly assigned to an education-only control group or a problem-solving training (PST) intervention group. Participants received monthly contacts for 1 year. Family caregivers (129 women, 18 men) and their care recipients (81 women, 66 men) consented to participate. Caregivers completed the Social Problem-Solving Inventory-Revised, the Center for Epidemiological Studies-Depression scale, the Satisfaction with Life scale, and a measure of health complaints at baseline and in 3 additional assessments throughout the year. Care recipient depression was assessed with a short form of the Hamilton Depression Scale. Latent growth modeling was used to analyze data from the dyads. Caregivers who received PST reported a significant decrease in depression over time, and they also displayed gains in constructive problem-solving abilities and decreases in dysfunctional problem-solving abilities. Care recipients displayed significant decreases in depression over time, and these decreases were significantly associated with decreases in caregiver depression in response to training. PST significantly improved the problem-solving skills of community-residing caregivers and also lessened their depressive symptoms. Care recipients in the PST group also had reductions in depression over time, and it appears that decreases in caregiver depression may account for this effect.
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