Effectiveness of a Dysphagia Management Education Program for Caregivers of Stroke Patients Receiving Home Care: Randomized Controlled Study

Objective: This study aimed to determine the effect of discharge training and telephone counseling service on patients’ functional status and caregiver burden after stroke. Methods: This study was conducted as a randomized controlled trial in 69 stroke patients and their caregivers. Discharge training and telephone counseling were given to the caregivers in the intervention group. Caregivers also received telephone counseling by calling researcher when needed. Information form for participants, Modified Rankin Scale, Barthel Index and The Zarit Caregiver Burden Scale were used for data collection. Pre-tests were applied to the intervention and control groups before discharge. Three months after discharge post-tests were performed for the two groups. Results: Three months after discharge, caregivers’ burden was significantly lower in the intervention group compared to the control group. The mean Modified Rankin Scale score of the patients in the intervention group was significantly lower than the control group three months after discharge. Although the mean Barthel Index score of the patients in the intervention group was statistically significant higher than before discharge, but the difference between the groups was not statistically significant. Conclusion: Discharge training and telephone counseling provided to the caregivers of stroke patients reduced the caregiver burden and had a positive effect on the improvement of the functional status of the patients.

Cancer affects not only patients but also their family caregivers, causing increased caregiving burden and reduced quality of life. The aim of this study was to evaluate the impact of a psychoeducation intervention on improving the quality of life and reducing caregiving burden among caregivers of cancer patients. This study employed a non-blinded randomized controlled trial design involving 66 family caregivers of cancer patients undergoing chemotherapy in Shahroud, Iran in 2024. Of the 69 caregivers initially approached, one declined to participate, and two were excluded due to lack of smartphone access, leaving a final sample of 66 caregivers. Participants were assigned to either the psychoeducation intervention program or the control group using the quadruple block randomization method. The intervention spanned 3 months and consisted of six online group sessions lasting 35-45 min each. The psychoeducation intervention was delivered by trained psychiatric nurse. Data were collected before and 1 month after the intervention using the SF-36 quality of life questionnaire and the Novak and Guest care burden inventory. Statistical analysis was conducted using chi squared, independent t-tests, and the linear regression analysis with a significance level set at 0.05. The primary outcome of this study was the change in caregivers' quality of life and caregiver burden. Initially, both groups exhibited similar average scores for care burden and quality of life (p > 0.05). The intervention group showed a significant reduction in caregiving burden by 4.1 ± 13.7, whereas the control group experienced a slight increase of 2.5 ± 12.0. Similarly, quality of life scores improved by 4.7 ± 16.9 in the intervention group but declined by 8.6 ± 15.3 in the control group. Regression analysis indicated that the psychoeducation group demonstrated significantly lower caregiving burden scores and higher quality of life scores following the intervention compared to the control group. Caregivers of cancer patients often face significant burdens that impact their quality of life. Psychoeducational interventions focusing on coping, problem-solving, and stress management should be integrated into cancer care plans to provide essential support. https://irct.behdasht.gov.ir/trial/54613, identifier IRCT20180728040617N3.

To test the hypothesis that a screening and treatment intervention for early cryptococcal infection would improve survival among HIV-infected individuals with low CD4 cell counts. Newly enrolled patients at Family AIDS Care and Education Services (FACES) in Kenya with CD4≤100 cells/μl were tested for serum cryptococcal antigen (sCrAg). Individuals with sCrAg titre≥1:2 were treated with high-dose fluconazole. Cox proportional hazard models of Kaplan-Meier curves were used to compare survival among individuals with CD4≤100 cells/μl in the intervention and historical control groups. The median age was 34years [IQR: 29,41], 54% were female, and median CD4 was 43 cells/μl [IQR: 18,71]. Follow-up time was 1224 person-years. In the intervention group, 66% (514/782) were tested for sCrAg; of whom, 11% (59/514) were sCrAg positive. Mortality was 25% (196/782) in the intervention group and 25% (191/771) in the control group. There was no significant difference between the intervention and control group in overall survival [hazard ratio (HR): 1.1 (95%CI:0.9,1.3)] or three-month survival [HR: 1.0 (95%CI:0.8,1.3)]. Within the intervention group, sCrAg-positive individuals had significantly lower survival rates than sCrAg-negative individuals [HR:1.8 (95%CI: 1.0, 3.0)]. A screening and treatment intervention to identify sCrAg-positive individuals and treat them with high-dose fluconazole did not significantly improve overall survival among HIV-infected individuals with CD4 counts≤100 cells/μl compared to a historical control, perhaps due to intervention uptake rates or poor efficacy of high-dose oral fluconazole.

The present study aims to determine the effect of Orem's self-care model on the quality of life in adolescents with diabetes type 1. A randomized controlled trial was conducted at Guilan University of Medical Sciences in Rasht, Iran. Adolescents diagnosed with type 1 diabetes constituted the study's participants. The research enrolled 80 diabetic patients, divided randomly into two groups: the control group and the intervention group. The study employed four blocks labeled A, B, C, and D, selecting the initial block through a lottery-based method. The intervention group received a series of eight training sessions structured by the Orem’s self-care model. In contrast, the control group received standard routine education without the structured sessions aligned with the aforementioned model. The data collection instruments used in this study comprised a demographic information questionnaire, an Orem’s health status questionnaire, and an SF-36 quality of life questionnaire. The study comprised 80 diabetic type 1 patients, with 40 assigned to the control group and 40 to the intervention group. The average age of the participants was 13.40 (SD=2.25). Notably, a substantial difference was observed in the change of scores about the physical dimension between the intervention and control groups (P=0.03). Additionally, a significant disparity in mental dimension scores was observed between the intervention and control groups (P=0.02). Our investigation demonstrated that the development and execution of an educational training program grounded in the Orem's self-care model yielded an enhancement in the quality of life among adolescent patients diagnosed with type 1 diabetes.

This study aimed to investigate the effect of progressive muscle relaxation on the caregiver burden and level of depression among the caregivers of older patients with a stroke. This randomized, controlled experimental study was conducted between December, 2015 and July, 2017 with the caregivers of older patients with a stroke who had been admitted to the home care unit of a state hospital. The caregivers were randomly assigned to intervention (n = 23) and control (n = 21) groups, based on the study's inclusion criteria. The caregivers in the intervention group practiced progressive muscle relaxation exercises at home 3 days per week for 8 weeks. The control group had no intervention. The mean age of the older patients with a stroke was 80.15 ± 9.86 years and the mean duration of the disease was 39.07 ± 44.69 months. The mean age of the caregivers was 50.29 ± 12.62 years, 84.1% of whom were female, 38.6% were elementary school graduates, and 86.4% were married. It was found that there was a statistically significant decrease in the mean Zarit Caregiver Burden Scale and Beck Depression Scale scores of the caregivers in the intervention group after practicing progressive muscle relaxation, but this decrease was not statistically significant when the intervention and control groups were compared. This study showed that there was a statistically significant decrease in the caregiver burden and level of depression among the caregivers in the intervention group after progressive muscle relaxation exercises, but that there was no statistically significant difference when the intervention and control groups were compared.

Prolonged sitting and poor posture can contribute to musculoskeletal pain and have a negative effect on health-related quality of life (HRQoL) among young adults. Any prolonged posture leads to static loading of soft tissues and causes discomfort. Seated posture leads to inactivity causing an accumulation of metabolites, accelerating disk degeneration and musculoskeletal pain. Regular exercise has major contributions to the prevention and treatment of some health problems such as musculoskeletal disorders. This study aimed to assess the impact of online posture exercises on musculoskeletal pain and health related quality of life among university students receiving distance education during the COVID-19pandemic. This randomized controlled trial involved 72students divided into intervention (n= 35) and control (n= 37) groups. The intervention group followed an 8-week online stretching and posture exercise program. Baseline and 8-week results were measured using the SF-36 QoL Questionnaire and Cornell Musculoskeletal Discomfort Questionnaire (CMDQ). Students spent an average of 5.4 ± 2.5hours daily at computers. While there was no difference between the scores of any region in the CMDQ in the control group, there was a decrease in the neck, right shoulder, left shoulder, waist, left upper leg, right lower leg, and left lower leg discomfort scores in the intervention group (p< 0.05). There was a significant difference between the intervention and control groups in the total score of SF-36 and the sub-dimensions of vitality and mental health (p< 0.05). The online posture exercise program led to notable reductions in musculoskeletal pain and improvements in QoL among university students. Examining the effectiveness of online exercise programs in different age groups is important for health benefits during quarantines.

Social support impacts recovery after stroke. Patient centered navigation programs provide social support and have shown benefit with other patient populations. The purpose of this study is to determine if there is a difference in outcomes for stroke survivors and caregivers who receive navigation services post-discharge. The study used a multi-center quasi-experimental before-after design to examine the impact of a telephone-based stroke navigation. Selected recruitment sites were nine facilities without navigation programs. Facilities provided information to survivors and caregivers about Stroke Recovery Navigator (SRN) prior to discharge and made referrals to the program. Participants were randomized into control and intervention groups using a computer-generated coin flip. Navigators completed telephone assessments within a week of referral. Navigators received the following trainings: Patient Navigation Fundamentals, motivational interviewing, and mental health first aid. The Reintegration to Normal Living (RNLI) scale was completed by all survivors and the Zarit Caregiver Burden scale was completed by all caregivers. The control group completed the initial and final assessments using these tools. In addition to these assessments, the intervention group received an individualized navigation plan and weekly contact by the SRN. The study randomized 301 individuals (82 caregivers, 219 survivors), with completion rate of 32%. Caregiver demographic characteristics and baseline caregiver burden scores were not statistically significant. Caregiver burden in the intervention group were lower compared to the control group, but not statistically significant (p=0.25). Demographic characteristics for survivors were similar between groups. RNLI score for survivors was slightly higher for the intervention group (p&lt;0.10). To achieve statistical significance additional participants were needed. In conclusion differences in quality of life for survivors and caregivers were not statistically significant between the groups. Additional information on the benefits of an SRN program is needed to support its implementation. However, important lessons were learned to improve such program and its design.

Purpose: This study was conducted to examine the effect of acceptance and commitment-based counseling on smoking cessation and quality of life in Turkish society. Materials and Methods: The study was conducted as a randomized controlled trial with experimental design with 35 individuals including 17 in the intervention group and 18 in the control group. The data of the study were collected using the Personal Information Form, SF-36 Quality of life Questionnaire, and Fagerstrom Test for Nicotine Dependence (FTND). 6 sessions of acceptance and commitment-based counseling was given to the intervention group including 1 session per week for 6 weeks. Results: The intervention and control groups had similar demographic characteristics. It was determined that there was a significant decrease in the mean number of cigarettes a day and FTND intervention follow-up measurement mean scores after the intervention and in the follow-up measurements in the intervention group and this decrease was significantly lower than the mean number of cigarettes per day by the participants in the control group. In the intragroup evaluation of SF-36 Quality of Life subscale scores of the intervention group, significant score increases were observed in all subscales other than physical role functioning, pain, and emotional role functioning. Conclusion: Acceptance and commitment-based counseling was found to be effective in smoking cessation and quality of life in Turkish society. This study provide useful evidence-based information for healthcare professionals in the nursing practice.

ObjectivesThe family caregivers of patients undergoing coronary artery bypass graft (CABG) surgery experience considerable physical and emotional distress. This study aimed to investigate the effect of an educational support programme on caregiver burden among the family caregivers of patients undergoing CABG surgery in Iran.MethodsThis non-randomised controlled clinical trial was conducted from January to April 2017 at a cardiovascular centre in Tehran, Iran. A total of 80 family caregivers of patients undergoing CABG surgery were sequentially selected and non-randomly assigned to intervention and control groups. The control group received routine care, whereas the intervention group received additional education sessions at baseline, prior to surgery, the day after surgery and before discharge. Caregiver burden was compared at baseline and six weeks post-discharge using the Persian-language versions of the Caregiver Burden Inventory (CBI) and Katz Index of Independence in Activities of Daily Living (IADL).ResultsA significant difference was observed between family caregivers in the control and intervention groups with regards to pre-post differences in mean CBI scores (+1.67 ± 19.23 versus +17.45 ± 9.83; P <0.001), with an effect size of −1.14. In addition, there was a significant increase in mean post-discharge IADL scores among CABG patients in the intervention group compared to the control group (4.42 ± 1.05 versus 3.07 ± 1.09; P <0.001).ConclusionAn educational support programme significantly reduced caregiver burden among the family members of patients undergoing CABG surgery in Iran. As such, in addition to routine care, healthcare providers should provide educational support to this population to help mitigate caregiver burden.

BackgroundConsidering the prevalence of endometriosis and consequent depression and anxiety as well as the resultant effects on the body, mind, and quality of life of patients, this study aimed to determine the effects of self-care counselling on depression and anxiety (primary outcome) and on quality of life (secondary outcome) among women with endometriosis.MethodThis randomized controlled clinical trial was conducted on 76 women with endometriosis who were treated at Al-Zahra Teaching and Treatment Center of Tabriz within the 2015–2019 period. The random blocking method was employed to divide the patients into intervention (counselling) and control groups. In the intervention group, seven self-care group counselling sessions were held on a weekly basis. The control group received routine care. A sociodemographic questionnaire, Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory (STAI) and the SF-36 Quality of Life Questionnaire were completed by the researcher through an interview before and 4 weeks after the intervention.ResultsThere was no significant difference between the intervention and control groups in terms of sociodemographic characteristics (p > 0.05). After the intervention, the mean scores of state anxiety (mean difference: − 0.12, 95% confidence interval: − 9.6 to − 14.4, p < 0.001) and trait anxiety (mean difference: − 10.9: 95% confidence interval: − 9.1 to − 12.7, p = 0.001) were significantly lower in the counselling group than those of the control group. The mean score of depression was lower in the counselling group than in the control group; however, it was not significant (p = 0/565). The mean score of quality of life for physical health (mean difference = 17.2, 95% confidence interval: 13.8 to 20.5, p < 0.001) and for mental health (mean difference = 12.0, 95% confidence interval: 9.0 to 14.9, p < 0.001) were significantly higher in the counselling group than in the control group.ConclusionSelf-care counselling affects the anxiety and quality of life of women with endometriosis. Therefore, in addition to other therapies, this method is proposed to improve quality of life and mental health of patients with endometriosis.Trial registrationIRCT Registration Number: IRCT 20111219008459 N13, registered on February 10, 2019 (https://irct.ir/user/trial/35915).

Heart failure (HF) is the fastest growing cardiovascular condition globally; associated management costs and hospitalizations place an immense burden on healthcare systems. Wearable electronic devices (WEDs) may be useful tools to enhance HF management and mitigate negative health outcomes. We aimed to perform a systematic review to examine the potential of WEDs to support HF self-care in ambulatory patients at home. Five databases were searched for studies published between 2007 and May 2022, including OVID MEDLINE, EMBASE (OVID), APA PsycINFO (OVID), Cochrane Central Register of Controlled Trials (OVID), and CINAHL Plus with Full Text (Ebsco). After 6210 duplicates were removed, 4045 records were screened and 6 were included for review (2 conference abstracts and 4 full-text citations). All studies used WEDs as 1 component of a larger intervention. Outcome measures included quality of life, physical activity, self-efficacy, self-care, functional status, time to readmission, social isolation, and mood. Studies were of moderate to high quality and mixed findings were reported. Enhanced exercise habits and motivational behavior to exercise, as well as decreased adverse symptoms of fatigue and dyspnea, were identified in 2 studies. However, improvements in exercise capacity and increased motivational behavior did not lead to exercise adherence in another 2 studies. The findings from this review suggest that WEDs may be a viable health behavior improvement strategy for patients with HF. However, studies of higher quality, with the primary intervention being a WED, and consistent outcome measures are needed to replicate the positive findings of studies identified in this review.

Pilot testing of the “First You Should Get Stronger” program among caregivers of older adults with dementia

Objectives : This research aimed at investigating the relationship between compliance and quality of life among adolescents with diabetes mellitus type 1 (DMT1). The study explored the impact of an information giving intervention on compliance and quality of life in adolescents with DMT1 and factors related to compliance and its effect on the quality of life. Methodology : This study was a randomised control trial, with an intervention and wait list control group. In this study, data was collected from participants aged 16 to 19 years. Main outcomes: Compliance to treatment, impact about diabetes and worries about diabetes were highly significant at follow up in the intervention group and seemed to have had impacted positively in the lives of the adolescents and also influenced positive behaviour change to the treatment regime prescribed to them by the doctors. This indicated that there was a relationship between compliance and quality of life among adolescents with diabetes mellitus type 1. Measures : Instruments used by the researcher at both pre intervention and post intervention periods included: Social demographic questionnaire, the rating scale for compliance (RSC) and Diabetes Quality of Life Scale modified for youths (DQOL) Procedure : Permission was obtained from the study site. Approval was obtained from Research Ethics committee, University of Zambia. The baseline measures for intervention and control group was done in week 1(time 1), where the 40 adolescents answered the demographic questionnaire, quality of life scale modified for youths and the rating scale for compliance. In week 2 to week 9, the researcher was with the intervention group and had 1 meeting with them once in a week. In week 10; time 2, follow up measure (same used at time 1 with intervention and control group) was done. The researcher met both groups at the Diabetes Association of Zambia Centre DAZ in University teaching hospital UTH. The participants were asked to complete the demographic questionnaire, rating scale for compliance and the diabetes quality of life scale modified for youths. These questionnaires were completed one after the other in both baseline intervention and follow up (post assessment). Instructions were read to them before they started answering each questionnaire in a plenary setup. Results : The demographic results indicate an even distribution of participants by age in both the control and intervention groups. The results showed that there was a significant difference between the control and intervention group at follow up in compliance to treatment were P= .000, impact of diabetes P= 0.045 and worries about diabetes P=.001. However, satisfactions with life showed a significant difference between the control and intervention group at follow up were P= .000, the control group showed more satisfaction with life compared to the intervention group at follow up. Conclusion : The information that the adolescents received during the intervention period seemed to have had impacted positively in the lives of the adolescents and also influenced positive behaviour change to the treatment regime prescribed to them by the doctors. Key words : Adolescents, diabetes, compliance, quality of life

Home caregivers have a large amount of responsibility, and many have difficulty in fulfilling their care-giving roles. Previous studies have shown that when caregivers are supported socially, psychologically, and culturally, there is a positive improvement in caregivers’ coping skills, quality of live, and a decrease in health problems. The purpose of this study was to evaluate the effect of a family support program based on the nurse-led case management model on home caregivers by measuring quality of life, caregiver burden, and family functionality level. In this study 27 home caregivers were randomly divided into intervention and control groups. The family support program based on a 5-stage nurse-led case management model was administered for the caregivers in the intervention group (n = 13) for 6 months. The caregivers in the control group (n = 14) were monitored by home health services through routine follow-ups. Baseline and postintervention assessments included the Zarit Caregiver Burden Scale, the World Health Organization Quality of Life–Brief Turkish Form, and the Family APGAR Scale. It was found out that there was a statistically significant difference among caregiver burden, quality of life, and family functionality level total scores of caregivers in the intervention and control groups ( p &lt; .05). A family support program based on nurse-led case management model has a supportive role for caregivers, where web-based education and counseling services are available, patients and their relatives are monitored by a multidisciplinary health team, and their educational needs are met.

This study aimed to determine the effect of a home visit program on the perceived care burden of family caregivers of adults with asthma. A single-blind randomized controlled trial. The study was conducted with 30 participants in both the intervention and control groups. Care burden was measured via the Zarit Caregiver Burden Scale during the first interview at the pulmonology outpatient clinic and after the last home visit. A nurse-led home visit program with five visits over three months included education and health counseling with the intervention group. Control group received standard education given in the outpatient clinic. The mean Zarit Caregiver Burden Scale scores of the intervention group in the post-test were significantly lower than the control group. The current study revealed that the nurse-led home visit program, including education and health counseling, was effective in reducing the care burden for family caregivers of adults with asthma. Nurses can play an active role in preventing the negative effects of caregivers' burden of care, protecting their sense of control, and improving their health. Home visits integrated into the health care system could be effective in reducing the care burden of family members.