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Depression, UnipolarTBFNCT05011864

Integrated Tele-Behavioral Activation and Fall Prevention for Low-income Homebound Seniors With Depression

A study testing Behavioral Activation, Fall Prevention and Telephone support in people with Depression, Unipolar and Fall, run by University of Texas at Austin at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This study will test clinical and cost effectiveness of an integrated tele- and bachelor's-level counselor/coach delivered behavioral activation (BA) and fall prevention (FP) for low-income homebound older adults. Read more about this study

Who is it for?
Ages 50 to 100 years
Conditions the study is for
Depression, Unipolar, Fall
What is being tested?
Behavioral Activation, Fall Prevention and Telephone support
Could I receive a placebo?
No, everyone receives an active treatment
How many people
320 participants
Where
1 siteUnited States
Study dates
1 Nov 2021to 31 Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 to 100 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 50+
  • English or Spanish proficiency
  • 24-item Hamilton Rating Scale for Depression score > 15
  • 12-item Fall Risk Questionnaire score >4

Who cannot join

  • Recently (< 4 weeks) initiated or modified antidepressant pharmacotherapy
  • High suicide risk
  • Probable dementia
  • Bipolar disorder
  • Substance use/misuse
  • Current participation in any psychotherapy or FP program
  • Bedbound status

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Namkee G Choi, PhD contact

5122329590

nchoi@austin.utexas.edu

Kelly Vences, BSW contact

5122320604

kelly.vences@utexas.edu

United States1 site, 1 recruiting
  • University of Texas at Austin

    Austin, Texas, 78712-0358

    Namkee G. Choi, PhD, 512-232-9590, nchoi@mail.utexas.edu

    Namkee G. Choi, PhD

    Recruiting

Other trials in United States

About this study

Official title: Integrated Tele-Behavioral Activation and Fall Prevention for Low-income Homebound Older Adults With Depression

This study will test clinical and cost effectiveness of an integrated tele- and bachelor's-level counselor/coach delivered behavioral activation (BA) and fall prevention (FP) for low-income homebound older adults. The long-term objective of the proposed study is to improve access to depression treatment and fall prevention for growing numbers of low-income homebound seniors. We plan to recruit 320 low-income, racially diverse homebound seniors who are served by a home-delivered meal (HDM) program and other aging-service agencies in Central Texas. In a 4-arm, pragmatic clinical trial with randomization prior to consent, the participants in the integrated Tele-BA and FP (TBF hereafter) arm will receive 5 Tele-BA sessions and 4 in-home FP sessions. Those in the Tele-BA or FP alone arms will receive the respective intervention and 4 bimonthly telephone check-in (booster) calls, and those in the Attention Control (AC) arm will receive 5 weekly telephone check-in calls followed by 4 bimonthly follow-up calls. Follow-up assessments will be at 12, 24, and 36 weeks after baseline.

Read the detailed description

Depression and falls are significantly higher in low-income, racially diverse homebound seniors than in the general older-adult population; however, the existing systems of care are not equipped to address disparities in mental health and fall prevention services for these vulnerable older adults. The long-term objective of the proposed study is to improve access to depression treatment and fall prevention for growing numbers of low-income homebound seniors. Specific aims are to compare clinical and cost effectiveness of integrated tele-delivered behavioral activation (Tele-BA) and fall prevention (FP) by bachelor's-level lay counselors/coaches to Tele-BA or FP alone and attention control (AC). The current and projected shortages of licensed clinicians and the costs of deploying highly trained professionals pose barriers to providing services to older adults in general and low-income homebound seniors in particular. A more scalable option is to utilize lay counselors/coaches, and our recent clinical trial (1R01MD009675) and a FP pilot study show that lay counselors/coaches are as effective as licensed clinicians. The study participants will be 320 low-income, racially diverse homebound seniors who are served by a home-delivered meal (HDM) program and other aging-service agencies in Central Texas. The lay counselors/coaches will be co-located in the HDM program for seamless referral and care coordination. In a 4-arm, pragmatic clinical trial with randomization prior to consent (a preferred public health approach), the participants in the integrated Tele-BA and FP (TBF hereafter) arm will receive 5 Tele-BA sessions and 4 in-home FP sessions. Those in the Tele-BA or FP alone arms will receive the respective intervention and 4 bimonthly telephone check-in (booster) calls, and those in the AC arm will receive 5 weekly telephone check-in calls followed by 4 bimonthly follow-up calls. Study hypotheses are: At 12, 24, and 36 weeks after baseline, (1) TBF will be more effective than Tele-BA or FP alone, and Tele-BA or FP alone will be more effective than AC in reducing depression (the 24-item Hamilton Rating Scale for Depression), falls, and fall injuries; (2) TBF than Tele-BA alone or FP alone will be more effective in reducing disability (WHODAS 2.0) and healthcare and social service use; and (3) TBF will be more cost effective than Tele-BA alone or FP alone. Cost-effectiveness analysis (CEA) will be based on depression free days, prevented falls, and health-related quality adjusted life-year measured by EuroQol-5 (EQ-5D). We will also conduct budget impact analysis (BIA) of TBF relative to Tele-BA or FP. Both CEA and BIA will employ a hybrid public program perspective of the Administration for Community Living and the Centers for Medicare and Medicaid. Public health significance of this study is that it will provide empirical data needed for real-world adoption of an intervention delivery model that targets to intervene for the two most frequent sources of disability acceleration and healthcare use among a rapidly growing, underserved population. (We use the terms older adults and seniors interchangeably because the latter term is frequently used in aging services.)

Being tested
Behavioral Activation, Fall Prevention, Telephone support
Medical subject headings
Depressive Disorder

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Behavioral ActivationBehavioural

    Also called Tele-BA

    In BA, depressive symptoms are viewed as depressive behaviors. Compared to those without depression, people with depression engage in fewer overt behaviors that provide positive reinforcement and pleasure/enjoyment and in more behaviors that function to escape or avoid aversive stimuli (e.g., staying in bed all day).55-59 Thus, BA is aimed at increasing and reinforcing meaningful, healthy, and enjoyable behaviors while decreasing depressive behaviors and is well-suited to help depressed, disabled older adults increase mood-enhancing activities, self-care management skills, and social connectedness.

  • Fall PreventionBehavioural

    Also called FP

    Following FP psychoeducation based on the Centers for Disease Control and Prevention (CDC)'s STEADI tool kits, lay coaches will assist clients in implementing evidence-based FP strategies that have been adapted for low-income homebound seniors. These include referrals to healthcare providers as needed, home safety checks, practice of safe ambulation/transfer and mobility aid use, medication review, and in-home exercise routines with an innovative, gamified tablet-based exercise app for balance and strength building.

  • Telephone supportOther

    Also called AC

    Subjects in this arm will receive 9 weekly support calls last 30 minutes each. These calls are intended to provide an opportunity for social support and check safety.

Study groups in NCT05011864
Study groupRoleWhat they receive
Tele-Behavioral Activation and Fall PreventionExperimentalEach subject will participate in five 1-hour, weekly Tele-BA sessions followed by four 1-1.5 hour, weekly in-home FP sessions with the same provider
Receives: Behavioral: Behavioral Activation; Behavioral: Fall Prevention
Tele-Behavioral ActivationExperimentalEach subject in this arm will participate in five 1-hour, weekly Tele-BA sessions followed by four weekly check-in (booster) calls of up to 30 minutes each.
Receives: Behavioral: Behavioral Activation
Fall PreventionExperimentalEach subject will participate in four 1-1.5 hour, weekly in-home (or tele, if COVID continues) FP sessions followed by four weekly check-in (booster) calls of up to 30 minutes each.
Receives: Behavioral: Fall Prevention
Attention Control (Telephone Support Call)Active comparatorAC participants in this study will receive five weekly telephone calls of up to 45 minutes each and four weekly check-in calls of up to 30 minutes each from a research assistant (RA) who will employ genuine regard and attentive listening and provide nonspecific support.
Receives: Other: Telephone support

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Changes from baseline depressive symptom at 12, 24, and 36 weeks

    24-item Hamilton Rating Scale for Depression score (score range: 15-40; decreased score since baseline is a positive outcome)

    Measured: at 12, 24, and 36 weeks after baseline

  2. Changes from baseline fall count and injury at 12, 24, and 36 weeks

    Changes in six monthly falls calendar data (reduced number of falls since baseline is a positive outcome)

    Measured: monthly (form 12 weeks to 36 weeks)

  3. Changes from baseline EuroQol-5D score at 12, 24, and 36 weeks

    Cost-effectiveness measure (score range: 0-20; decreased score since baseline is a positive outcome)

    Measured: at 12, 24, and 36 weeks after baseline

  4. Changes from baseline physical and mental health service use

    Changes in Cornell Services index data (decreased ED visits and hospitalization since baseline is a positive outcome)

    Measured: at 12, 24, and 36 weeks after baseline

  5. Changes from baseline disability score at 12, 24, and 36 weeks

    Changes in 12-item World Health Organization Disability Assessment Schedule score (score range: 0-46; decreased score since baseline is a positive outcome)

    Measured: at 12, 24, and 36 weeks after baseline

  6. Changes from baseline social engagement and activities score at 12, 24, and 36 weeks

    Changes in 10-item Social Engagement and Activities Questionnaire score (score range: 0-50; increased score since baseline is a positive outcome)

    Measured: at 12, 24, and 36 weeks after baseline

  7. Changes from baseline satisfaction with social roles & activities at 12, 24, and 36 weeks

    C (score range: 0-32; increased score since baseline is a positive outcome)

    Measured: at 12, 24, and 36 weeks after baseline

Secondary outcomes (2)
  1. Changes from baseline fear of falling at 12, 24, and 36 weeks

    Changes in 7-item Falls Efficacy Scale International score (score range: 7-28; decreased score since baseline is a positive outcome)

    Measured: at 12, 24, and 36 weeks after baseline

  2. Changes from baseline exercise frequency at 12, 24, and 36 weeks

    Changes in RAPA (Rapid Assessment of Physical Activities) (score range: 1-9; increased score since baseline is a positive outcome)

    Measured: at 12, 24, and 36 weeks after baseline

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Aug 2021
  2. Study start1 Nov 2021
  3. Primary completion31 Dec 2026 (estimated)
  4. Study completion31 Dec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
In a pragmatic RCT design with randomization prior to consent rather than the traditional consent-to-randomization design, we will follow six steps in recruitment, enrollment, and intervention delivery: 1) identification of potential participants by case managers / social workers during in-home or telephone assessments and referral to the research team; 2) randomization into TBF (combined Tele-behavioral activation and fall prevention), Tele-BA, FP, and Attention Control (AC: telephone support calls) arms by the research team; 3) calling each person for consent for telephone eligibility screening; 4) conducting in-depth, in-home screening and baseline assessment for eligible, consenting seniors; 5) delivering TBF, Tele-BA alone, FP alone, or AC; and 6) conducting follow-up assessments.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
320 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05011864
Sponsor's protocol ID
2R01MD009675-07
Acronym
TBF
Status last verified
Jan 2024
First submitted
6 Aug 2021
Last updated
9 Jan 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Behavioral Activation, Fall Prevention and Telephone support in people with Depression, Unipolar and Fall, run by University of Texas at Austin at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 9 Jan 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Namkee G Choi, PhD (5122329590, nchoi@austin.utexas.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Changes from baseline depressive symptom at 12, 24, and 36 weeks (time frame: at 12, 24, and 36 weeks after baseline). The study lists 7 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Jan 2024.

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