Recovering together: building resiliency in dyads of stroke patients and their caregivers at risk for chronic emotional distress; a feasibility study

Abstract

Background: A stroke is a sudden, life-altering event with potentially devastating consequences for survivors and their loved ones. Despite advances in endovascular and neurocritical care approaches to stroke treatment and recovery, there remains a considerable unmet need for interventions targeting the emotional impact of stroke for both patients and their informal caregivers. This is important because untreated emotional distress becomes chronic and negatively impacts quality of life in both patients and caregivers. Our team previously used mixed methods to iteratively develop a six-session modular dyadic intervention to prevent chronic emotional distress in patients with stroke and their informal caregivers called "Recovering Together" (RT) using feedback from dyads and the medical team. The aim of the current study is to test the feasibility of recruitment, acceptability of screening and randomization methods, acceptability of RT, satisfaction with RT, feasibility of the assessment process at all time points, and acceptability of outcome measures. Secondarily, we aimed to explore within-treatment effect sizes and change in clinically significant symptoms of depression, anxiety, and post-traumatic stress (PTS). The larger goal was to strengthen methodological rigor before a subsequent efficacy trial. Methods: We conducted a feasibility randomized controlled trial to evaluate the RT intervention relative to minimally enhanced usual care (MEUC) in stroke patients admitted to a Neurosciences Intensive Care Unit (Neuro-ICU). Dyads were enrolled within 1 week of hospitalization if they met specific eligibility criteria. Assessments were done via paper and pencil at baseline, and electronically via REDCap or over the phone at post-intervention (approximately 6 weeks after baseline), and 3 months later. Assessments included demographics, resiliency intervention targets (mindfulness, coping, self-efficacy, and interpersonal bond), and emotional distress (depression, anxiety, and PTS). Primary outcomes were feasibility and acceptability markers. Secondary outcomes were depression, anxiety, PTS, mindfulness, coping, self-efficacy, and interpersonal bond.

Videoconferencing psychotherapy for couples and families: A systematic review

“…Further interventions included TBI‐focused couples therapy (TBIconneCT; Rietdijk et al, 2020), and Supporting Teens’ Autonomy Daily (Sibley et al, 2017). Other interventions were described as family‐based cognitive‐behavior therapy (CBT) ( n = 4), for example, those delivered by Bannon et al (2020), Carpenter et al (2018), Comer, Furr, Kerns, et al (2017) and Nelson et al (2003), or more generally as family based therapy ( n = 2) (Anderson et al, 2017; Cluxton‐Keller et al, 2018). Some papers described delivering counseling without further elaboration on a particular framework ( n = 2) (Coelho et al, 2005; Glueckauf et al, 2002).…”

Feasibility and Efficacy of a Resiliency Intervention for the Prevention of Chronic Emotional Distress Among Survivor-Caregiver Dyads Admitted to the Neuroscience Intensive Care Unit

“…When possible, the bedside nurse helped introduce the study. An institutional review board-approved recruitment video, which included 2 dyads who successfully completed a prior feasibility study, 18 was used as needed. Inclusion criteria for patients were as follows: (1) Randomization, Allocation Concealment, and Follow-up…”

“…Third, we instructed participants to practice skills through the web-based application, but this was not formally collected. Downloaded From: https://jamanetwork.com/ on 10/31/2020 score 4,6,7,18,35,[49][50][51] and others a higher cut-off score. 3,52 Given the acute nature of neurological illness and the detrimental consequences of depression and anxiety symptoms that go unaddressed, we chose to use a lower score that allows for higher sensitivity so that we would not miss any dyads that might benefit from our program.…”

Grief and Loss Associated With Stroke Recovery: A Qualitative Study of Stroke Survivors and Their Spousal Caregivers

“…It is essential that patients and caregivers alike are educated about the emotional and social aspects of stroke recovery and that loss beyond the physical is acknowledged. Recent findings from the development and pilot study of the program “Recovering Together,” a dyadic cognitive behavioral approach, indicate that programs targeting both the stroke survivor and caregiver after discharge and during recovery may have positive effects on resilience, coping, and emotional well-being ( 37 , 38 ).…”