Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on interventions for caregivers of persons with traumatic brain injury (TBI) that facilitate participation in the caregiver role.
Full Systematic Review Question
This systematic review addressed the question: “What is the evidence for the effectiveness of interventions for caregivers of persons with TBI that facilitate participation in the caregiver role?”
Current Theme Reported
The main theme of the studies included in this systematic review brief is relationship building interventions for caregivers of adults with traumatic brain injury (TBI).
Clinical Scenario
According to the Centers for Disease Control and Prevention (CDC, 2021a), 2.9 million Americans were diagnosed with traumatic brain injury (TBI) in 2014. An individual with TBI may experience long-term changes in cognition, physical abilities, emotions, and behavior as well as many other chronic health problems (CDC, 2021b). Because of these changes and chronic health problems, approximately 33% of individuals with moderate to severe TBI require assistance with everyday activities from someone else (CDC, n.d.), typically a family member serves as the caregiver. Providing long-term care to an individual with TBI can impact the caregiver’s stress (Ikiugu et al., 2021; Suntai et al., 2021), perceived burden (Brickell et al., 2019), health and well-being (Ikiugu et al., 2021), satisfaction with life (Sabella & Suchan, 2019) and can be problematic or stressful on the relationship between the individual with TBI and their caregiver (Brickell et al., 2021). Poor preparation, increased burden, and lack of resources may impact the caregiver’s ability to provide the care needed (Everhart et al., 2020) and impact the caregivers’ overall health and well-being. Occupational therapy practitioners are uniquely qualified to assess and provide interventions that address the needs of the caregiver, including physical and mental health and well-being, and to facilitate the role of caregiving (American Occupational Therapy Association [AOTA], 2020).
Summary of Key Findings
Four articles related to relationship building and strategies for caregivers of individuals with TBI were included in the review. These four articles were further divided into 2 categories, depending on the method of delivery (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009).
Evidence Table for Relationship Building Interventions for Caregivers of Adults With Traumatic Brain Injury
Note. NRCT = nonrandomized control trial; RCT = randomized control trial; TBI = traumatic brain injury; TCI = Therapeutic Couples Intervention; VIP = veterans in home program.
Bottom Line for Occupational Therapy Practice
Occupational therapy practitioners can assess and provide interventions for caregivers of individuals with TBI that facilitate the role of caregiving (AOTA, 2020). As the individual with TBI is experiencing life-changing events, so is the caregiver, as their life has been changed potentially with roles within the marriage and increasing demands to manage everyday tasks. Being a caregiver for an individual with a TBI can be very challenging at times, creating high stress and burden and may negatively affect the relationship. Problems that may arise in the relationship include financial burden, communication barriers, negative behavior, and poor emotion regulation. Family functioning and a satisfactory relationship between an individual with TBI and their caregiver is crucial for the health management and experienced burnout by the caregiver and for improvements in recovery made by the individual with TBI (Maggio et al., 2018). The interventions addressed marital needs, empathy, emotional awareness and regulation, stress management, communication, positive behavior strategies, normalization, reframing, empathic reflection, validation, problem solving, and communication. This review provides moderate strength of evidence to support the use of face-to-face interventions with the couple combined, either as an individual couple or combined with other couples in a group, to improve martial adjustment and satisfaction, reduce destructive patterns (Backhaus et al., 2019), improve relationship quality (Kreutzer et al., 2020), and improve conversational performance and positive change (Togher et al., 2016). Telephone calls with in-home visits that varied with the couples participating together and separately were not significant for improving caregiver relationship satisfaction (Moriarty et al., 2016). Practitioners should include both the caregiver and individual with TBI together in face-to-face interventions, as this was more effective at improving relationship satisfaction than varying individual and combined couple sessions that were delivered on the phone and with home visits.
Footnotes
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Indicates articles included in the systematic review brief.