A Randomized Controlled Trial to Evaluate the Veterans' In‐home Program for Military Veterans With Traumatic Brain Injury and Their Families: Report on Impact for Family Members

Abstract

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.

Impact of TBI on caregivers of veterans with TBI: Burden and interventions

“…Family members received education and support and were actively involved in the intervention. After programme completion, VIP family members reported less depression and lower perceived burden [29], and Veterans had better community re-integration and less difficulty managing everyday problems related to TBI [30] compared to the standard of care controls. Perlick and colleagues [31] developed a Veterans Multi-Family Group offered in three phases: (1) joining in which clinicians met with individual families for two or three sessions to evaluate on-going problems and define treatment goals, (2) two three-hour educational workshops about TBI for Veterans with TBI and their caregivers and (3) bimonthly problem-solving multifamily group meetings attended by Veterans and their families for 6 months.…”

“…Initial evaluation of the group indicated improved satisfaction and quality of relationship. Winter, Moriarty and others [29,30] at the Veterans Affairs Medical Center in Philadelphia developed the Veterans' In-home Program (VIP) and evaluated its impact on 81 dyads consisting of a Veteran with TBI and a family member compared to standard care in a RCT. VIP involved 6 in-home visits by an occupational therapist and 2 telephone contacts over a 3-4 month period.…”

Interventions That Support or Involve Caregivers or Families of Patients with Traumatic Injury: a Systematic Review

“…These analyses included five RCTs (455 patients). 28,29,31,33,35 Interventions evaluated across the five RCTs included a home visitation program to improve caregiver coping (Veterans In-Home Program-VIP), 28,37 group psychoeducation, 33 family-based telephone counseling using motivational interviewing for problem-solving, 35 problem-solving therapy with TBI family caregivers, 29 and patient and significant other mentoring on topics such as disease education and relationship skills (i.e., building trust, problem-solving, goal-setting). 31 The number of contacts across interventions was similar.…”

“…We analyzed family caregiver psychological symptoms using data from four RCTs (296 patients) 28,29,32,33 that evaluated problemsolving therapy with family caregivers, 29,32 illness education and skills training, 33 and VIP. 37 The number of contacts across interventions ranged from 8 to 12. Meta-analysis results found no benefit of the intervention on caregiver psychological symptoms (SMD − 0.26, 95% CI − 0.57 to 0.05, I 2 = 0.0, Q = 2.1, p = 0.56) ( Fig.…”

“…Two studies found no effect of a family-involved treatment on quality of life 29,32 ; however, small sample sizes (n = 67 enrolled 32 ; n = 153 enrolled 29 ) might have precluded the ability to detect significant differences. Three studies, 30,32,37 which included a companion paper to the Winter et al 2016 study, 37 examined caregiver burden, but only two were RCTs, 32,37 and therefore we did not have enough studies to conduct a meta-analysis. All studies showed decreased caregiver burden and similar small effect sizes, 42 ranging from Cohen's d = 0.30, 32 Cohen's d = 0.31, 37 to SDM = 0.35, 30 assessed at 4 to 12 months, but this finding was statistically significant in only one of the three studies.…”