Caregivers Of Stroke Patients Research Articles

Impact of support group intervention on family system strengths of rural caregivers of stroke patients in India.

The objective of this study is to evaluate the impact of support group intervention on family system strengths of rural caregivers of stroke patients. True experimental pretest and post-test design was adopted for the study. The study was conducted in Kattankulathur Block, a rural area in Kancheepuram district, India. Two hundred forty caregivers of stroke patients were selected by simple random sampling technique. Enrolment in self-help groups and attending meetings were used as the interventional strategy for the purpose of this study. The main outcome of the study was to evaluate the impact of support group intervention on family system strengths of rural caregivers of stroke patients. Following intervention, the mean score and the standard deviation of the experimental group increased to 44.73 and 5.83, respectively, the control group mean score remained at 22.08 and the standard deviation was 3.07 at t = 37.58. P value was 0.001, which is statistically significant at the confidence interval of 39.45%. It was found that there was a significant and positive increase in the family system strengths of caregivers who participated in the self-help group meetings, thereby suggesting that support group intervention programs are an effective nursing strategy that can be employed for improving the overall well-being of the caregivers of stroke patients.

An abbreviated German version of the Sense of Competence Questionnaire among informal caregivers of relatives who had a stroke: development and validation.

Caregiver burden is a main outcome domain in caregiver intervention research. A recommended instrument for measuring burden is the Sense of Competence Questionnaire (SCQ). In this study, we evaluated the psychometric properties of the German version of the SCQ with informal caregivers of stroke patients. Baseline data of a randomized controlled trial (n=122) and survey data (n=76) of caregivers of stroke patients were used. Data were collected at the caregiver's or the care receiver's home or over the telephone. We evaluated the homogeneity, the construct validity, and the clinical validity of the German version and the homogeneity of a new abbreviated version. The homogeneity of the SCQ indicates good reliability (Cronbach's alpha: 0.89). The three-factor structure of the SCQ was mostly confirmed through principal components analyses using oblimin rotation. Clinical validity was supported through correlations between sense of competence and burden (r=-0.51), depression (r=-0.52), and care recipient's cognitive function (r=0.36). Sixteen items with consistent factor loadings were extracted and proposed as a new abbreviated version of the SCQ (Cronbach's alpha: 0.84). The abbreviated German rendition of the SCQ version that was validated in this study offers a consistent version that can be applied across different languages and among caregivers of stroke survivors or people with dementia.

Korean Stroke Cohort for functioning and rehabilitation (KOSCO): study rationale and protocol of a multi-centre prospective cohort study.

BackgroundDevelopment of a long-term stroke care plan requires serial assessment of long-term patient function and consideration of caregiver mood. However, to date, few comprehensive cohort studies have included both stroke patients and caregivers.Methods/DesignKOSCO is a large, multi-centre prospective cohort study for all acute first-ever stroke patients admitted to participating hospitals in nine distinct areas of Korea. This study is designed as a 10-year, longitudinal follow-up investigating the residual disabilities, activity limitations, and quality of life issues arising in patients suffering from first-ever stroke. The main objectives of this study are to identify the factors that influence residual disability and long-term quality of life. The secondary objectives of this study are to determine the risk of mortality and recurrent vascular events in patients with acute first-ever stroke. We will investigate longitudinal health behaviors and patterns of healthcare utilization, including stroke rehabilitation care. We will also investigate the long-term health status, mood, and quality of life in stroke patient caregivers. In addition, we will identify baseline and ongoing characteristics that are associated with our secondary outcomes.DiscussionKOSCO is a prospective, multi-centre, 10-year longitudinal follow-up study investigating the residual disabilities, activity limitations, and quality of life issues arising in patients suffering from first-ever stroke.

Needs of family caregivers of stroke patients: a longitudinal study of caregivers’ perspectives

BackgroundAfter a stroke, patients often suffer from varying degrees of disability that require acute inpatient treatment and extended care at home. Therefore, the caregivers assume multiple responsibilities that can result in stress, particularly when their own needs are inadequately addressed during the patient’s recovery.ObjectivesThis study aimed to explore the changing needs of family caregivers of stroke patients and factors related to the needs in four stages, before the transfer from intensive care unit to neurological unit, before discharge, 2 weeks post-hospitalization, and 3 months post-hospitalization.MethodsThe design of this study was based on longitudinal research, and the participants were family caregivers of stroke patients. Sixty family caregivers were recruited in this study. Data were collected at four time points by questionnaire.ResultsWe found that the total number of needs of family caregivers decreased as the illness duration increased and that needs differed significantly between the four time points (P<0.01). Although the needs were different in each stage, health information, professional support, and community networks were the leading need domains in all four stages. The major factors affecting the care needs of family caregivers were the National Institutes of Health Stroke Scale scores of patients on admission, length of hospital stay, and physical dependence of patients.ConclusionFamily caregivers expected to obtain assistance and related care information from professionals during the course of the disease. Assessing the needs of family caregivers is important for health care workers in understanding problems from the caregivers’ perspectives. Relevant information and counseling should be provided to family caregivers to help them access support when needed.

Impact on quality of life in caregivers of stroke survivors

Stroke is the first cause of disability in adults. Often, the care falls on the family and can affect their quality of life. To determine the health-related quality of life and the level of caregiver burden of a patient after a stroke. Descriptive and cross-sectional study. Caregivers, who had cared for a patient for more than six months and without pay, were included. This study had been approved by the Ethics Committee. Variables collected: sociodemographic, EuroQol-5D questionnaire, Zarit scale, mood and sleep problems. Forty-eight caregivers were included, with a mean age of 55.63 (SD: 13.48) and the majority were women (70.8%). The mean time of the care was 28.8 months (SD: 28.68), with 58% stated having a depressed mood, 31% had burden, and 89.6% had sleep problems. The dimensions that presented problems (moderate and severe) in the EQ-5D were pain-discomfort (66.7%) and anxiety-depression (68.8%). The score on the visual analog scale rating of quality of life was associated with a worse mood (75.5 vs. 32, p=0.0028), with the pain (81.94 vs. 38, p<0.001), and Zarit scale (r:<0.334, p=0.020). The role of caregivers of stroke patients often falls on women. To be a caregiver affects the quality of life, mainly in the pain-discomfort and anxiety-depression dimensions, regardless of the functional status of the patient. Nurses must identify the psychopathological needs and develop strategies on the prevention of the risk of burnout.

Measuring negative and positive caregiving experiences: a psychometric analysis of the Caregiver Strain Index Expanded

Objective: To compare the psychometric properties of the Caregiver Strain Index Expanded with those of the original Caregiver Strain Index among partners of stroke patients. Design and subjects: Cross-sectional validation study among 173 caregivers of stroke patients six months post-stroke. Main measures: Outcome measure: Caregiver Strain Index Expanded. Reference measures: Hospital Anxiety and Depression Scale, two questions on life satisfaction, Barthel Index and Montreal Cognitive Assessment. Additionally, National Institutes of Health Stroke Scale. Results: Neither the Caregiver Strain Index Expanded nor the original Caregiver Strain Index showed floor or ceiling effects. The sum score of the positive items showed a ceiling effect and was skewed to the right (2.20). Principal component analysis revealed no clear underlying item clustering. Alpha values of the Caregiver Strain Index Expanded and the original Caregiver Strain Index were good (0.82 and 0.83), but the alpha value of the positive subscale of the Caregiver Strain Index Expanded was too low (0.51). Convergent validity was confirmed for the Caregiver Strain Index Expanded, the original Caregiver Strain Index and the positive subscale. The Caregiver Strain Index Expanded and the original Caregiver Strain Index showed nearly identical correlations with the reference measures. Negative caregiving experiences were more strongly related to partners’ mood and life satisfaction than positive caregiving experiences. In the regression analyses, the positive subscale showed little added value in predicting partners’ mood and life satisfaction. Conclusion: The addition of five positively phrased items does not improve the psychometric properties of the Caregiver Strain Index.

QUALITY OF LIFE OF STROKE PATIENT CAREGIVERS AT SRINAGARIND HOSPITAL, KHON KAEN PROVINCE, THAILAND

Stroke is a chronic disease requiring patients to be treated for a long period of time. Patients need to been given close and attentive care, and this has an impacton the health and daily lives of caregivers. The aim of this cross-sectional descriptive study was to investigate the quality of life of stroke patient caregivers at Srinagarind Hospital, Khon Kaen Province, Thailand. The subjects were 166 caregivers of all stroke patients who received treatment at Srinagarind Hospital during the period 1 July 10 September, 2011. The research tool was a questionnaire which was intwo parts: Part 1 was designed to collect baseline data about the patients and their caregivers, and Part 2 was the Thai version of the brief WHO quality of life assessment instrument (WHOQOL-BREF-THAI). Data were collected from the patients medical histories and from interviews conducted by the researchers and were analyzed using descriptive statistics. The results showed that the overall quality of life of caregivers was at a moderate level with a mean score of92.5. In terms of each component domain of the quality of lifeinstrument, the mean scores for physical health, mental health, social relationships, and the environment were24.1, 21.3, 10.7, and 29.3 points, respectively.Even though the quality of life of caregivers was moderatelyhigh, medical professionals who provide care for stroke patients should assist and support caregivers in various ways by, for example, giving advice on sources of information which are useful to the caregivers themselves and for the physical and mental health care of the patients in. They should also provide assistance to families when they require help in continuing to care for the patients in their own homes.

Factors Influencing the Burden on Caregivers of Stroke Patients with Hemiplegia Living at Home

Objective: The purpose of this study was to clarify the factors influencing burden on the caregivers of stroke patients with hemiplegia who live at home under their family’s care. Methods: From July 2009 to July 2013, 20 hemiplegic stroke patients who provided written informed consent and met the following criteria were included in the study: Brunnstrom recovery stage<4, living at home at 6 months after discharge, and Barthel index<95 at 6 months after discharge. Age, sex, number of caregivers, Barthel index, frequency of using nursing-care services, and frequency of voluntary standing or walking training were evaluated as independent variables. Results of the Zarit Burden Interview, which reflects the burden for caregivers, were evaluated as dependent variables. Variables were analyzed with a stepwise regression analysis. Results: Factors that influenced the burden on caregivers were frequency of using nursing-care services, number of caregivers, sex of patients, and frequency of voluntary training. Conclusion: In stroke patients with a high dependence on nursing-care services, the burden on caregivers was large. Caution must be used in extending the findings of this study to general practice, but our study suggests that a higher frequency of voluntary training and a larger number of caregivers reduces the burden on caregivers of stroke patients after discharge.

The mediating effect of caregiver burden on the caregivers' quality of life.

[Purpose] Quality of life (QoL) can be closely related to caregiver burden, which may be a potential mediating effect on the relationships among stroke patient caregivers. This study investigated the predictors of caregiver’s QoL based on patient and caregiver characteristics, with caregiver burden as a mediator. [Methods] This study was conducted using surveys, a literature review, and interviews. Survey data were collected from 238 subjects, who were diagnosed with stroke, and their family caregivers from October 2013 to April 2014. [Results] Caregiver health status, income, spouses caring for patients, and duration of hospitalization were identified as significant predictors of caregivers’ QoL with a mediating effect of caregiver burden. The time spent on caregiving per day and patient education level were the only direct predictors of caregivers’ QoL. [Conclusion] The responsibility of caring for patients with stroke, in particular for a spouse, must be administered by means of a holistic family-centered rehabilitation program. In addition, financial support and availability of various health and social service programs must be comprehensively provided in order to maintain caregivers’ well-being.

2014 Canadian Stroke Congress Abstracts

d’Esterre, CD1, 3 Qazi, E1, 3 Patil, S1, 3 Almekhlafi, M3, 1 Lee, T2, 3 Demchuk, A1, 3 Goyal, M1, 3 Menon, B1, 3; 1. University of Calgary, Calgary, AB; 2. University of Western Ontario, London, ON; 3. Calgary Stroke Program, Calgary, AB Background : For ischemic stroke, CT Perfusion (CTP) may change thrombolytic/endovascular treatment decisions when compared to NCCT/CTA alone. Two distinct thresholds may be useful in this regard: separation of 1) non-salvageable tissue (infarct core) from salvageable electrically silent tissue (penumbra), and 2) penumbra from benign oligemia (hypoperfused, but will survive if clot persists). Methods : CTP (120s,8cm) was performed on 180 patients within 12hrs of ischemic stroke. Two patient cohorts were analyzed: (1) recanalization (TICI 2b,3) 6s. For group (2) CBF, CBV, and Tmax values were obtained from within the final infarct region, and total ipsilateral hemisphere, excluding infarction. CBF, CBV and Tmax were used in univariate regression models. Results : For group (1)[n=11], mean time from CTP to recanalization was 60±19min. CBF parameter (thresholds for gray and white matter 7.2 and 5.2 ml•min-1•(100g)-1) had the highest sensitivity (90.9%) and specificity (81.8%) for infarction. For group (2)[n=15], the Tmax parameter (thresholds for gray and white matter 11.3s and 11.8s) had the highest sensitivity (86.6%) and specificity (80.0%) for penumbra. Conclusion : Knowing the status of recanalization within 90mins of CTP allows for accurate delineation of infarct core, as …

Does informal care impact utilization of healthcare services? Evidence from a longitudinal study of stroke patients

Understanding the interplay between informal care and formal healthcare is important because it sheds light on the financial implications of such interactions and may result in different policies. On the basis of a major database on 532 Italian stroke patients enrolled in the period 2007–2008, we investigate whether the presence of a potential caregiver and the amount of informal care provided influences the use and the costs of healthcare services, and in particular rehabilitation, in the post-acute phase. Primary caregivers of stroke patients were interviewed at 3, 6 and 12 months after the acute event and use of healthcare and informal care were documented. The panel dataset included socio-demographic, clinical and economic data on patients and caregivers. A longitudinal log-linear model was applied to test the impact of informal care on total healthcare costs in the observation period. A double hurdle model was used to investigate the impact of informal care on rehabilitation costs. A total of 476 of stroke survivors in 44 hospitals were enrolled in the study and presence of informal caregiver was reported in approximately 50% of the sample (range 48.2–52.5% across the three periods). Healthcare costs at 12 months after the acute event are €5825 per patient, with rehabilitation costs amounting to €3985 (68.4%). Healthcare costs are significantly different between the patients with and without caregiver in all three periods. The presence of the caregiver is associated with 54.7% increase in direct healthcare costs (p < 0.01). Instead, the amount of informal care provided does not influence significantly direct healthcare costs. The presence of caregiver significantly increases the probability of access to rehabilitation services (β = 0.648, p = 0.039) while, once the decision on access is made, it doesn't influence the amount of services used. Our results suggest that informal caregivers facilitate or even promote the access to healthcare services.

Analysis of care burden evaluation in caregivers of stroke patients and the enlightenment of care benefits

The negative experience such as burden and positive experience such as benefits may engender in caregivers in the process of caring for stroke patients,which present both mutual independence and coexistence.Negative experience was paid more attention,but positive experience received less.The article analyzed the current situation of assessment in care burden of stroke patients' caregivers,summarized the shortcomings,made suggestions.Based on these summaries,the care benefits were suggested to do research on three levels (individual,family and social). Key words: Stroke; Care burden; Care benefits

Abstract W P375: The Relationship between the State of Preparedness, Social Support, Coping Strategies, and Family Circumstances of Family Caregivers of Stroke Patients before Transition to Home in Japan

Background: In recent years, the early return home of stroke patients has been promoted in Japan, and families must consider at-home care not long after the patient’s stroke. There is, therefore, a need to examine methods of home care assistance from an early stage. Purpose: This study aims to elucidate the relationship between the state of preparedness, social support, coping strategies, and family circumstances of family caregivers of stroke patients before transition to home in Japan. Methods: This study was an exploratory study of factor relationships. Data on family caregivers of stroke patients prior to discharge was gathered using demographic data, the Japanese version of the Preparedness for Caregiving Scale, the Japanese version of the Social Support Questionnaire short-form, and the caregivers’ coping strategies scale. Pearson’s correlation coefficient and a Student’s t-test were used for the analysis. Results: There were 95 subjects (approximately 70% of whom were caring for their spouse). Approximately 80% patients were experiencing paralysis, and the mean number of days until transfer from hospital to home was 21.8 days (SD ± 26.7).The state of preparedness had correlation between social support(r=.362, p=.001) and coping strategies(r=.604, p=.001). State of preparedness was higher in non-spouses (t=-2.406, p=.05) and tended to be higher when someone else was living in the house . Furthermore, social support was higher when a care collaborator was present (t=2.714, p=.005). The age and employment of the caregiver, as well as the degree of activities of daily living independence of the patient and number of days until discharge, had no relation to state of preparedness. Conclusion: We concluded that family caregivers of stroke patients before moving home in Japan improve their state of preparedness by receiving support from surrounding individuals and improving their own coping strategies; the state of the patient and family circumstances, however, have no influence. The results of this study suggest that nurses need to provide incrementally improving support from an early stage to increase the support capabilities of those surrounding the patient’s family and enhance the care capabilities of family caregivers.

Caregiving burden and its determinants in Polish caregivers of stroke survivors.

IntroductionDespite the growing body of literature on the consequences of providing non-professional care to stroke survivors, the determinants of caregiving burden are still not fully recognized. Identification of significant determinants can facilitate caregiver intervention programs. The aim of this study was to evaluate the level of burden borne by caregivers of stroke patients and to identify the most important determinants of burden at 6 months after hospitalization.Material and methodsData were collected from 150 pairs of stroke patients/caregivers. Caregiver burden was assessed on the Caregiver Burden scale (CB). Several characteristics were measured as potential predictors of the burden. Special attention was paid to the caregiver's sense of coherence (SOC) and anxiety. Regression analysis was employed to test the hypothesized relationships between these variables and the burden.ResultsForty-seven percentage of the caregivers reported a substantial burden (severe or moderate). Caregiver SOC (p < 0.001), anxiety (p < 0.001) and the patients’ functional status (p < 0.001) were the most important predictors of the overall burden and the most consistent predictors of the majority of aspects included in the CB scale. Caregiver health, patient's gender, time spent caregiving and social support were also factors related to the burden. The identified predictors explained 67% of the variance in the overall burden.ConclusionsClinicians and other professionals should focus on the coping abilities of caregivers, their emotional state and the level of patients’ dependency, as these are the vital and modifiable factors affecting caregiver burden following stroke.

The Effect of Rehabilitation Education Program on Family Caregivers of Stroke Patients

The purpose of this study was to investigate the effects of a rehabilitation education Program for family caregivers of stroke patients and to analyze the effects of their depression and burden. Subjects were recruited in R hospital, located in Gyeonggi-do and the period of the study was from April of 2013 to May of 2013. The subject pool was composed of 32 caregivers. Subjects were randomly assigned to either the experimental or nonintervention control conditions with equal number. Control group was taken conventional physical therapy and experimental group was taken conventional physical therapy with rehabilitation education program. Data was analyzed by Chi-square tests, t-tests and paired t-tests using PASW 18.0. This study shows the following results. First, the results showed that the total score of depression decreased significantly after the rehabilitation education program. Second, the results showed that the total score of burden after rehabilitation education Program decreased significantly. The finding indicates that rehabilitation education program for family with CVA patients was effective for reducing depression and burden. In this study, rehabilitation education program showed more effective and significant impact on reducing depression and burden of family caregivers with stroke patients. Especially, the conventional physical therapy with rehabilitation education program is considered as a more effective method than the therapy without rehabilitation education program.

Assessment of the needs of caregivers of stroke patients at state-owned acute-care hospitals in southern Vietnam, 2011.

IntroductionCare for stroke patients has improved steadily in southern Vietnam. Medical treatments such as thrombolytic therapy have been implemented at several hospitals, and stroke-care units composed of a team of various health professionals have been created. However, little attention has been focused on providing support to caregivers of stroke patients. This study aimed to characterize the caregivers of stroke patients who were treated in state-owned acute-care hospitals and to learn about their needs when patients are discharged. Such information can be used to enhance the caregiver’s support system.MethodsWe used questionnaires to conduct a descriptive study in 2011 at a state-owned acute-care hospital in southern Vietnam. We recruited study participants from among caregivers of stroke patients who had been informed of their hospital discharge date. We assessed 8 caregiver characteristics, and caregiver participants selected their needs from the survey’s list of 15 possible needs. We analyzed the data by using the independent sample t test and logistic regression.ResultsOf the 93 caregivers who consented to participate, 86 (92.5%) completed the survey and indicated their concerns at discharge. The most frequently cited need was information on how to prevent stroke recurrence (72, 83.7%), followed by which drugs are most effective in preventing a relapse (62, 72.1%), how long recovery would take (61, 70.9%), and availability of hospitals in the patient’s hometown (60, 69.8%). A little over half of caregivers indicated financial concerns. A caregiver’s need for information on diet for a stroke survivor increased with the caregiver’s education level.ConclusionsThis study revealed several needs among caregivers of stroke survivors in southern Vietnam that are similar to those found by studies of caregivers of stroke survivors in high-income countries. Our findings suggest that comprehensive stroke care that includes caregiver education about healthful diets and prevention of stroke recurrence is needed at state-owned acute-care hospitals in southern Vietnam.

Clinical indicators of ‘caregiver role strain’ in caregivers of stroke patients

The main objectives of this study were to investigate the prevalence of the nursing diagnosis caregiver role strain (CRS) in caregivers of patients with stroke and to identify the accuracy of this diagnosis’s clinical indicators. A total of 42 stroke patient caregivers who provided in-home care services in a city in north-eastern Brazil. The sensitivity, specificity, and predictive value of clinical indicators of nursing diagnosis ‘CRS’ were analyzed. Study participants were mostly female, married and the daughters of stroke patients. CRS was present in 73.8% of caregivers. The presence of the clinical indicators, specifically, lack of time to meet personal needs (p = 0.011), increased emotional lability (p = 0.001), withdrawal from social life (p = 0.002), and changes in leisure activities (p = 0.002), presented high values for statistical measures of diagnostic accuracy.

Clinical indicators of “caregiver role strain” in caregivers of stroke patients

Clinical indicators of “caregiver role strain” in caregivers of stroke patients

The Relationship Between Perceived Life Changes and Depression in Caregivers of Stroke Patients

Most people with stroke are being cared for at home by family caregivers. Giving care is stressful, and family caregivers are predisposed to care-related complications such as life changes and depression. This article is a report of a study that examined the relationship between the perceived care-related life changes and depression in family caregivers of people with stroke, and it identified predictors influencing depression and perceived care-related life changes. A convenience sample of 60 family caregivers completed one demographic data sheet and two questionnaires: Bakas Caregiving Outcomes Scale and Center for Epidemiologic Studies Depression Scale. Data were collected in a 1-month period in 2008. According to the findings, the mean score of the subjects on the Bakas Caregiving Outcomes Scale was -5.70, representing an overall negative change related to the caregiving role. The prevalence of people at a risk of depression or being depressed was 40%. Correlation analysis showed that, as perceived life changes score decreases (change for the worst), the score for the feeling of depression increases (r = -.692, p ≤ .001). Stroke survivors' functional disability significantly predicted both perceived care-related life changes and depression in caregivers. Assessment of caregivers of people with stroke for depressive symptoms should be incorporated in the initial nursing assessment process. The perceived life changes among caregivers should be closely monitored, and follow-up meetings should be planned to support caregivers. The functional disability in people with stroke could be a valuable criterion for planning care for their caregivers.

Application of discharge planning on the caregivers of stroke patients

Objective To explore the effect of discharge planning on caregivers of stroke patients.Methods A total of 112 patients were randomly divided into control group and intervention group,and each group had 56 patients.The caregivers in control group received routine interventions,while caregivers in intervention group received discharge planning nursing interventions based on routine interventions.The care ability and demand satisfaction of caregivers in two groups pre-intervention and post-intervention were observed.Results Care ability score and demand satisfaction score of intervention group and control group respectively were [(46.51 ± 5.01) vs (47.28 ± 4.63) and (1.84 ± 0.52) vs (1.67 ± 0.63)],and the differences were statistically significant (t ＝-0.84,1.56 ; P ＞ 0.05).After discharge planning,care ability score of intervention group was significantly higher than that of control group in 4th weeks after discharge [(53.71 ± 3.56) vs (48.49 ± 3.63)] (t ＝ 7.68,P ＜ 0.05).Demand satisfaction score of intervention group was significantly higher than that of control group [(3.55 ± 0.47) vs (2.29 ± 0.79)] (t ＝ 10.26,P ＜ 0.05).Conclusions The implementation of discharge planning can significantly improve the care ability and need satisfaction of caregivers of stroke patients. Key words: Nursing; Stroke; Caregivers; Discharge planning