Caregiver Outcomes from the BRITE Study: Secondary Outcomes of a Multisite Pragmatic Randomized Controlled Trial of Post-Rehabilitation Discharge Transitional Support after Traumatic Brain Injury

Caregivers of individuals admitted to inpatient rehabilitation following traumatic brain injury (TBI) often experience high burden and unmet needs after hospital discharge. Transitional periods are challenging, and standard discharge planning with referrals to outpatient care is typically not enough support for this critical phase. We sought to evaluate the impact of a post-inpatient rehabilitation patient/caregiver intervention (rehabilitation transition planning; RTP) on caregiver burden and quality of life, compared to standard rehabilitation discharge planning (RDP). Of 925 randomized patient participants at six inpatient rehabilitation centers, 591 had caregivers who enrolled in the study. Patients and caregivers in the RTP group (N = 295) received up to 12 remote follow-up support contacts for 6 months post-discharge. The RDP control group (n = 296) received standard discharge planning. Caregiver outcomes (Bakas, Zarit, PROMIS, SF-12 Physical/Mental) were assessed at 6 and 12 months. Data analysis used intention-to-treat principles. No significant differences were observed in any caregiver outcome measures at 6 or 12 months between RTP and RDP groups. In exploratory analyses, greater functional impairment, need for assistance, and a history of prior mental health problems on the part of the patient were associated with greater burden and reduced quality of life for caregivers irrespective of treatment assignment. Female caregivers, White caregivers, and those with greater education tended to show greater burden on some measures. No patient or caregiver attributes were consistently associated with a differential response to the intervention. Future research should explore alternative or more targeted interventions for this vulnerable population using both intervention-sensitive and global measures of outcome.