Caregivers: Do They Make a Difference to Patient Recovery in Subacute Stroke?

Abstract

ObjectiveTo evaluate the relationship between caregiver nature and availability, and rehabilitation outcomes in subacute stroke. DesignRetrospective cohort study. SettingFour community rehabilitation hospitals. ParticipantsPatients with subacute, first-time stroke (N=4042; 48.5% men; mean age ± SD, 70.12±10.4y; 51.5% women; mean age ± SD, 72.54 ±10.0y). InterventionsNot applicable. Main Outcome MeasuresRehabilitation effectiveness, defined as the percentage of potential improvement eventually achieved with rehabilitation; and rehabilitation efficiency, defined as the rate of functional improvement during rehabilitation. ResultsIn our cohort, 96.7% had available caregiver(s), of which 42.0% were primarily supported by foreign domestic workers (FDWs), 25.9% by spouses, 19.3% by first-degree relatives, 7.8% by other relatives, and 5.1% by other caregivers. Using quantile regression, we found that having a caregiver was independently associated with rehabilitation efficiency (β=−3.83; 95% confidence interval [CI], −6.99 to −0.66; P=.018). The relationship between caregiver availability and rehabilitation effectiveness was modified by patient sex in that the negative association was significantly greater in men (β=−22.81; 95% CI, −32.70 to −12.94; P<.001) than women (β=−5.64; 95% CI, −14.72 to 3.44; P=.223). Having a FDW as a caregiver compared with a spousal caregiver was negatively associated with rehabilitation effectiveness (β=−3.95; 95% CI, −6.94 to −0.95; P=.01) and rehabilitation efficiency (β=−1.83; 95% CI, −3.14 to −0.53; P=.006). The number of potential caregivers was only significantly associated with rehabilitation effectiveness at the bivariate level (P=.006). ConclusionsCaregiver identity, and possibly availability, appears to negatively affect rehabilitation outcomes in subacute stroke. A better understanding of these relationships has potential implications on clinical practice and policy directions.