Improving Outcomes for Care Partners of Individuals With Traumatic Brain Injury: Results for a mHealth Randomized Control Trial of the CareQOL App.

Abstract

To test the efficacy of a randomized control trial low-touch mobile health intervention designed to promote care partner self-awareness and self-care. This randomized controlled trial included a baseline assessment of self-report surveys of health-related quality of life (HRQOL), care partner-specific outcomes, and the functional/mental status of the person with traumatic brain injury (TBI), as well as a 6-month home monitoring period that included 3 daily questions about HRQOL, monthly assessments of 12 HRQOL domains, and the use of a Fitbit to continuously monitor physical activity and sleep. HRQOL surveys were repeated at 3 and 6 months post-home monitoring. Two academic medical centers. A total of 254 TBI care partners. The CareQOL app, a mobile health app designed to promote care partner self-awareness (through self-monitoring) and self-care (through personalized self-care push notifications). Care partners were randomly assigned to self-monitoring alone (n=128) or self-monitoring plus self-care push notifications (n=126). Although we neither saw improvements in HRQOL outcomes, nor in physical activity or sleep, we found that across all the different measures, approximately 1/3 of the participants showed clinically meaningful improvements, 1/3 stayed the same, and 1/3 got worse; care partners who reported engagement in the intervention were more likely to show improvements than those who were not engaged. There was preliminary support for factors that being male, caring for a person with posttraumatic stress symptoms, living in the same household as the person with TBI, being a spousal care partner, working, and being diagnosed with COVID-19 during the study were associated with increased risk for negative outcomes. Findings suggest that engagement with the app, even when it is confined to self-monitoring alone, is associated with small improvements in HRQOL.