Life Reentry: Web-based Intervention for Partner Caregivers of People with Spinal Cord Injury

Research Objectives: (1) To demonstrate the feasibility and acceptability of the Life Reentry® (LR) intervention use among partner caregivers of people with spinal cord injury (SCI). (2) To estimate the size of treatment effects on behavioral inhibition and activation to inform power analyses for future trials.

Design: Pilot randomized, controlled trial comparing LR to an SCI education control. Assessments reported herein were conducted at baseline and immediately after the 6-week program. Data were collected through self-administered online questionnaires and semi-structured exit interviews.

Setting: Web-based group intervention.

Participants: 35 adults (17 LR, 18 controls) fluent in English, who were in an intimate relationship with their partner with SCI for at least one year prior to injury, had a partner who was at least 6-months post-SCI and at least 3 months post-discharge from rehabilitation, who provided daily assistance, lived in a private residence with their partner, and had internet access.

Interventions: Six weekly 75-minute web-based facilitated group classes and social-media-based assignments. LR included self-reflection and group discussion of experienced losses, potential barriers to life engagement and well-being, and specific strategies to overcome grief-related fear, coupled with writing-based assignments. Education group topics included presentations about secondary complications, emergency preparedness, personal assistance, mobility and travel, coupled with resource exploration assignments. Assignments were shared and discussed in private social media-based groups.

Main Outcome Measures: Primary outcome of greater behavioral activation, less inhibition as quantified by an effect size of ≥ 0.2 (Cohen’s d) for between group change in four subscales of the Behavioral Inhibition / Behavioral Activation (BIS/BAS) Scale (Drive, Fun Seeking, Reward Responsiveness, Punishment Sensitivity) at class series end. Feasibility measures included retention and homework completion rates, qualitative feedback.

Results: All attrition among randomized participants occurred pre-intervention (0% LR, 10% control). Most participants attended all six classes (88% for LR, 67% for control) and completed all assignments (94% for LR, 71% for control). Greater activation and less inhibition were observed, with between-group effect sizes for Drive and Fun-Seeking of d=0.37 and 0.26, respectively. In exit interviews, LR participants reported improved ability to conceptualize thoughts and feelings around loss and reduced feelings of guilt about participation in self-care and recreational activities.

Conclusions: The LR intervention is acceptable and feasible to implement among partner caregivers of people with SCI and is associated with attitudinal changes that may foster greater self-care and well-being among partner caregivers. Further study in larger samples is warranted.

Author(s) Disclosures: Not applicable