Effect of the WeCareAdvisor™ on family caregiver outcomes in dementia: a pilot randomized controlled trial

Abstract

BackgroundBehavioral and psychological symptoms of dementia (BPSD) are universal and associated with multiple negative outcomes. This pilot randomized controlled trial (RCT) evaluated the effect of using the WeCareAdvisor, an innovative web-based tool developed to enable family caregivers to assess, manage, and track BPSD.MethodsThis RCT enrolled 57 dementia family caregivers from community and clinical settings in Ann Arbor, Michigan and Baltimore, Maryland. Participants were randomly assigned to immediate use of the WeCareAdvisor tool (WCA, n = 27) or a Waitlist control group (n = 30) that received the tool after a one-month waiting period. Outcomes for the caregiver and the person they were caring for were assessed at baseline (T0) and one-month followup for both the WCA (T1) and Waitlist control (T2) groups.ResultsCaregiver mean age was 65.9 ± 14.0 years old. About half (49%) were spouses. Baseline characteristics were comparable between groups except for mean caregiver confidence which was higher in the control group (WCA 35.0 ± 10.0 vs. Waitlist control 39.7 ± 6.9, p = 0.04). There were no significant differences between the WCA and control groups in characteristics of the person with dementia. After their one-month of tool use (T1), WCA caregivers showed significant within group improvement in caregiver distress (− 6.08 ± 6.31 points, t = − 4.82, p < 0.0001) and behavioral frequency (− 3.60 ± 5.05, t = − 3.56, p = 0.002), severity (− 3.24 ± 3.87, t = − 4.19, p = 0.0003) and total behavioral score (− 6.80 ± 10.73, t = − 3.17, p = 004). In the same timeframe, Waitlist control caregivers showed a significant decrease in confidence (− 6.40 ± 10.30, t = − 3.40, p = 0.002). The WCA group showed greater improvement in distress compared to the Waitlist group (T0-T1; t = − 2.49, p = 0.02), which remained significant after adjusting for site and baseline distress. There were no significant between-group differences in caregiver confidence or other secondary outcomes. After their one month of tool use (T2), the Waitlist group also showed significant improvement in caregiver distress (− 3.72 ± 7.53, t = − 2.66, p = 0.013), stress (− 0.41 ± 1.02, t = − 2.19, p = 0.037), confidence (4.38 ± 5.17, t = 4.56, p < 0.0001), burden (− 2.76 ± 7.26, t = − 2.05, p = 0.05), negative communication (− 1.48 ± 2.96, t = − 2.70, p = 0.012) and behavioral frequency (− 1.86 ± 4.58, t = − 2.19, p = 0.037); distress remained significant after adjustment.ConclusionsIn this pilot RCT, WCA use resulted in a significant decrease in caregiver distress. Future research will identify whether longer use of WCA can impact other caregiver and behavioral outcomes.Trial registrationClinicaltrials.gov identifier NCT02420535 (Date of registry: 4/20/2015, prior to the start of the clinical trial).

Internet-Based Supportive Interventions for Family Caregivers of People With Dementia: Systematic Review and Meta-Analysis

“…The intervention duration ranged from 4 weeks to 12 months. Eight studies were performed in the United States [ 25 , 26 , 31 , 38 , 41 , 42 , 44 , 46 ], 3 studies were performed in Netherlands [ 28 , 37 , 40 ], 2 studies were performed in France [ 29 , 43 ], and 1 study each was conducted in Canada [ 39 ], Germany [ 30 ], Spain [ 27 ], and the UK [ 45 ]. All of the included studies reported clear inclusion and exclusion criteria for their participants.…”

“…All of the included studies reported clear inclusion and exclusion criteria for their participants. In 9 studies, the forms of internet-based support interventions were personalized [ 25 , 27 , 28 , 40 - 42 , 44 - 46 ] whereas in the other 8 studies [ 26 , 29 - 31 , 37 - 39 , 43 ], they were nonpersonalized. The nature of the treatment of control group participants differed from one study to another.…”

“…The nature of the treatment of control group participants differed from one study to another. The control groups in 10 studies [ 25 , 27 - 30 , 40 , 42 - 45 ] were exposed to the same conditions as the corresponding intervention groups, except for the implementation of internet-based support intervention in the latter. However, in some studies, the control group received e-bulletins [ 37 ], booklet [ 39 ], or book [ 26 ] while the intervention group received internet-based support intervention.…”

“…Kajiyama et al [ 31 ] provided a website containing the similar navigational features to caregivers in the control condition, but they did not provide any of the information or skills training content presented in the intervention group. All 17 included studies evaluated the effect of internet-based supportive interventions in ameliorating health outcomes for family caregivers of people with dementia, and 6 studies [ 28 , 29 , 42 - 45 ] also reported potential effects of internet-based supportive intervention access by caregivers on their care recipients. The main characteristics of the included studies are presented in Multimedia Appendix 2 .…”

“…A total of 11 studies assessed the effects of internet-based supportive interventions on depressive symptoms using the Centre for Epidemiologic Studies Depression Scale [ 25 , 27 , 30 , 31 , 37 , 38 , 42 , 46 ], Patient Health Questionnaire [ 26 , 44 ], and Beck Depression Inventory-II Scale [ 29 ]. Because of the different assessment tools, we used the SMD to represent the pooled effect size.…”