Integrating Caregiver Support Into MS Care

With loss of mobility in multiple sclerosis (MS) comes an increase in amount and types of
caregiver assistance, with a concomitant increase in burden for the caregiver. In fact,
effect on caregiver burden can be seen as a potential indicator of the efficacy of MS
management, suggesting that the caregiver is an appropriate and independent target for MS
therapeutic strategies.

MS patients report difficulty implementing and continuing with home exercise, mobility, and
walking programs. This feasibility study will test integration of a successful behavioral
caregiving intervention into clinical practice to improve functioning of Veterans with
multiple sclerosis (MS) and their Caregivers. Caregivers of Veterans with MS will receive a
behavioral caregiver intervention designed to address caregiver coping and management of
patient concerns, with special focus on patient mobility and walking. A pre-post intervention
design will compare outcomes for Veterans and Caregivers.

For Veterans, the intervention will target Caregiver participation in home-based Veteran
mobility activities. MS Caregivers report high burden, stress, and depression involved in
caring for their loved ones, especially as mobility declines and these outcomes are related
to physical and emotional health status of the patient. For Caregivers, the intervention will
focus on improving Caregiver coping and on managing MS-related problems. Outcomes for both
will be measured at baseline, 3 months, and 6 months.

Study Objectives include:

- Test whether a caregiver intervention can be integrated into an MS clinical setting.

- Determine whether Caregiver outcomes are improved (depression, burden, anxiety, and
number of Veteran MS problems and safety alerts reported).

- Determine whether Veteran outcomes are improved (EDSS walk, timed up and go test,
self-efficacy, and depression).

- Determine which types of Caregivers will benefit most.

- Determine which types of Veterans will benefit most.

- Refine materials for future clinical research, translation and implementation.