Improving outcomes for care partners of individuals with traumatic brain injury: Results for a mHealth randomized control trial of the CareQOL app

Noelle E Carlozzi; Jonathan P Troost; Srijan Sen; Sung Won Choi; Zhenke Wu; Jennifer A Miner; Wendy L Lombard; Christopher Graves; Angelle M Sander

doi:10.1016/j.apmr.2024.12.022

Improving outcomes for care partners of individuals with traumatic brain injury: Results for a mHealth randomized control trial of the CareQOL app

Arch Phys Med Rehabil. 2025 Jan 9:S0003-9993(25)00025-5. doi: 10.1016/j.apmr.2024.12.022. Online ahead of print.

Authors

Noelle E Carlozzi¹, Jonathan P Troost², Srijan Sen³, Sung Won Choi⁴, Zhenke Wu⁵, Jennifer A Miner⁶, Wendy L Lombard⁶, Christopher Graves⁶, Angelle M Sander⁷

Affiliations

¹ Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA. Electronic address: [email protected].
² Michigan Institute for Clinical and Health Research, University of Michigan; Ann Arbor, MI, USA.
³ Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
⁴ Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
⁵ Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Michigan Institute for Data and Artificial Intelligence, University of Michigan, Ann Arbor, MI, USA.
⁶ Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
⁷ H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA; Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA.

PMID: 39798892
DOI: 10.1016/j.apmr.2024.12.022

Abstract

Objective: To test the efficacy of a randomized control trial low-touch mobile health intervention designed to promote care partner self-awareness and self-care.

Design: This randomized controlled trial (RCT) 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 TBI, as well as a 6-month home monitoring period that included three 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.

Setting: Two academic medical centers PARTICIPANTS: 254 TBI care partners INTERVENTIONS: 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) RESULTS: Care partners were randomized to self-monitoring alone (n=128) or self-monitoring plus self-care push notifications (n=126). Although we did not see improvements in HRQOL outcomes, nor in physical activity or sleep, we found that across all the different measures, approximately1/3 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 such as 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.

Conclusions: Findings suggest that engagement with the app, even when it is confined to self-monitoring alone, is associated with small improvements in HRQOL.

Trial registration: ClinicalTrial.gov NCT04570930; https://clinicaltrials.gov/ct2/show/NCT04570930.

Keywords: brain injuries, traumatic; caregivers; mobile applications; outcome assessment, health care; quality of life; self-monitoring.

Associated data

ClinicalTrials.gov/NCT04570930