Carers Of Stroke Survivors Research Articles

Stroke Survivors' Dependency Level and Informal Caregivers' Quality of Life in Kelantan, Malaysia: Examining the Mediating Role of Psychological Distress.

Caring for stroke survivors can affect the caregiver's life, especially with the increment of patients' dependency level. This led to depression, anxiety, and stress in the caregiver, impacting their quality of life (QoL). This study aims to model relationships between caregivers' factors and stroke survivors' factors with caregivers' QoLand to estimate the mediation effects of caregivers' depression, anxiety, and stress in the relationships between stroke survivors' dependency level and caregivers' QoL. Methods: Data from a cross-sectional study with a sample size of 250 subjects was analyzed. Linear regression was done to model the relationship between stroke survivors' factors and caregivers' factors with caregivers' QoL. Hayes's PROCESS macro model 4 for bootstrapping indirect effects was used to estimate the mediation effects of depression, anxiety, and stress in the relationship between stroke survivors' dependency level and caregivers' QoL. Stroke survivors' dependency levels that were measured by the Modified Barthel Index score (b=0.14; 95% CI: 0.07, 0.20), caregivers' depression score (b=-0.81; 95% CI: -1.44, -0.20), and caregivers' anxiety score (b=-0.73; 95% CI: -1.34, -0.12) were found to be associated with caregivers' QoL. Caregivers' depression score (effect=0.02; 95% CI for bootstrapping: 0.01, 0.04) and caregivers' anxiety score (effect=0.01; 95% CI for bootstrapping: 0.01, 0.04) were found as partial mediators in the relationship between stroke survivors' dependency level and caregivers' QoL. Stroke survivors' dependency level and caregivers' depression and anxiety significantly impact caregivers' QoL, with the latter factors partially mediating this relationship. Interventions such as providing caregivers with psychological support, stress management programs, and training in caregiving skills could help mitigate these impacts and improve caregivers' QoL.

Assessing the mediating role of family resilience between caregiver burden and caregiver capacity: a cross-sectional study among Chinese stroke survivors and family caregivers in a real-world setting

ObjectivesTo investigate the relationships among caregiver burden, family resilience, and caregiver capacity in the care of stroke survivors. We hypothesised that family resilience would mediate the relationship between caregiver burden...

Identifying Stroke Caregivers’ Coping Strategies: The Smile that has Struggled through the Tears-A Mixed-Method Research Approach

Background: Sudden stroke had caused the caregivers minimal time to prepare for their role as carers. Some stroke caregivers were overwhelmed to adjust and accept new responsibilities. They need to reorganise their functions and establish new daily life routines in response to the chronic illness that happens with stroke survivors.
 Objective: This study aimed to determine and explore coping strategies employed by stroke caregivers.
 Methods: This mixed-method study involved 32 stroke caregivers from a community-based stroke rehabilitation centre in Kuching, Sarawak. Results: From quantitative analysis, most stroke caregivers employed problem-focused coping strategies (mean=56.66, SD=10.79), followed by emotion-focused coping strategies (mean=55.63, SD=10.29) in confronting the challenges of caring for stroke survivors. Data from qualitative findings revealed eight themes of coping strategies: adjustment to daily life, selfmotivation, sharing with other people, acceptance, avoiding thinking about the problem, hoping stroke survivors will get better, emotion suppression and self-blame.
 Conclusion: This study’s outcomes provide crucial information about the burdens held by stroke caregivers when taking care of stroke survivors. Stroke caregivers need to adapt better and suitable coping strategies. This will prevent them from becoming overwhelmed by the accumulated stress from caring burdens. The long-term effect of coping strategies should positively assist stroke caregivers in managing the burdens effectively and fostering satisfaction in their life.
 Bangladesh Journal of Medical Science Vol. 23 No. 01 January’24 Page : 130-140

Feasibility of Screening for Food Insecurity in an Outpatient Stroke Care Setting (P6-9.004)

<h3>Objective:</h3> To assess the feasibility of food insecurity (FI) screening and prevalence of other social determinants of health (SDOH) associated with FI among stroke survivors attending outpatient clinic visits in the Stroke Transitions Education and Prevention clinical program. <h3>Background:</h3> FI, defined as limited or uncertain access to adequate food due to economic hardship and social condition, is a SDOH resulting in barriers to a healthy diet. Stroke survivors at risk for FI are at higher risk for a recurrent stroke event. FI screening may help identify patients needing access to food resources as a preventive measure to reduce stroke reoccurrence. <h3>Design/Methods:</h3> Cross-sectional design. Patients presenting for their initial telemedicine, or in-person clinic visit were screened using the 2-item Hunger Vital Scale through electronic and paper-based self-report surveys between February 1-July 31, 2021. Multivariable logistic regression examined associations between SDOH and FI. <h3>Results:</h3> Among 476 stroke patients within the stroke clinic, 415 (87.2%) surveys were completed; 258 (62.2%) electronically and 157 (37.8%) paper-based. Overall, 13.9% of the patients experienced FI, and a higher prevalence of FI was observed among those who completed paper-based compared to electronic surveys (21.4% vs 9.9%, P=0.002). More Black patients (36.5%) reported FI compared to White (21.1%) and Hispanic (30.8%) patients (P&lt;0.05). Those who reported disability or unemployment had higher rates of FI compared to employed and retired patients (P=0.000). Black patients had higher odds of reporting FI compared to White patients (AOR=3.02, 95% CI: 1.04; 8.79). <h3>Conclusions:</h3> FI screening is feasible. FI is more prominent in the current sample of stroke survivors compared to the national average. SDOH prevalent characteristics, Black and unemployed patients, align with the literature on structural disparities affecting communities. The results provide information needed to create a social-risk informed index that can be used to target care in stroke survivors. <b>Disclosure:</b> Ms. Almohamad has nothing to disclose. Dr. Mofleh has nothing to disclose. Prof. Altema-Johnson has nothing to disclose. Ms. Ahmed has nothing to disclose. Dr. Fries has nothing to disclose. Ms. Okpala has nothing to disclose. Ms. Cohen has nothing to disclose. Prof. Hernandez has nothing to disclose. The institution of Dr. Sharrief has received research support from NIH. The institution of Dr. Sharrief has received research support from University of Houston . Dr. Sharrief has a non-compensated relationship as a Consultant with Abbot that is relevant to AAN interests or activities.

Development of the Family-Based Care Model for Stroke Survivors to Promote Healthy Family Dynamics: Participatory Action Research

In many cultures around the world, including those in Thailand, family caregivers have different views on caring for stroke survivors. These views affect the caring process, which tends to be a heavy burden for caregivers. This study used participatory action research to develop the Family-Based Care Model for Stroke Survivors to Promote Healthy Family Dynamics. Stroke survivors and their family caregivers were recruited via purposive sampling from two primary care units in Nonthaburi, Thailand. Fourteen caregivers participated in four cycles of activities for 16 weeks and they were divided into two groups of seven. Data were collected using family group discussions, observations, home visits, telephone, LINE application, and field notes, as well as a family demographic questionnaire. Participants in each group created caregiving strategies to balance family life tailored for stroke survivors’ families. Individual and collective self-reflective cycles were used as a method that contained four steps: planning, acting, observing, and reflecting. Qualitative data were analyzed using the ATLAS.ti 8.0 program to develop data categorization and themes. The four major themes emerged and described the participatory process in caring stroke survivors: 1) Assessing problems and developing strategies; 2) Making collaboration for changing strategies; 3) Balancing the body and mind to empower themselves; and 4) Healthy family dynamics. This study demonstrated that there were five main phenomena affecting care: caregiver characteristics, family functions and relationships, assistant support, community resources, and community nurses. The model developed in this study can help direct nurses to promote healthy family dynamics in Thai stroke survivors, however, it is necessary to be further tested through research before being applied in practice.

Perception of the factors contributing to family happiness among caregivers of stroke survivors in a suburban community in Thailand: A qualitative study.

Caring for stroke survivors in primary care settings substantially impacts family life and health. Caregivers of stroke survivors have different challenging experiences in providing care in relation to family happiness. This study aimed to explore family happiness and its contributing factors among family members caring for stroke survivors in suburban Thailand. Qualitative semi-structured interviews and observations were conducted among 54 family caregivers in suburban Thailand communities from January to July 2020. Interviews and focus group discussions were digitally recorded, independently transcribed and analysed using ATLAS.ti 8.0. Qualitative data analysis method was used. Family happiness was found to help a family function and be satisfied with caring. The analysis revealed three themes for achieving family happiness: 1) ideal caregiver characteristics: virtue, love and gratitude, experience in caring, good health and self-care ability, good management of emotions and freedom to manage problems and obstacles; 2) family function: family structure, roles and duties, relationships and management of family problems; and 3) resource support: financial, health and environmental supports. The findings demonstrate how life adaptations can improve family happiness within families of stroke survivors. Understanding caregivers' perceptions of their experiences in caring for stroke survivors is a challenge for healthcare providers; overcoming this could transform an unpleasant life into caregiving happiness. Appropriate and practical support from healthcare authorities could empower families of stroke survivors to succeed in caregiving and achieve family happiness.

Explorative Survey on the Usage and Needs of Mobile Health Applications (mHealth) amongst Caregivers in Taking Care of Stroke Survivors

Mobile health (mHealth) applications may assist stroke caregivers in answering the unmet needs of inadequate information and support from healthcare professionals. This study aimed to explore the usage and needs of mHealth applications among stroke caregivers and its associated factors. This cross-sectional study involved 207 stroke caregivers attending hospital and community-based stroke clinics in Kuala Lumpur between December 2020 until March 2021. The survey was done through newly developed self-administered bilingual questionnaires using face to face interviews, telephone interviews and Google form. Most caregivers (77.8%) used at least one mHealth application for self-care or during the caregiving process. The three most types of mHealth applications were contacting healthcare professionals (89.9%), disease monitoring (89.4%) and health information (89.4%). The three most features of mHealth applications were free to download/use (94.7%), simple interface (93.7%) and data security/privacy (93.7%). Chi-square test of association showed managing appointment (χ2(1) = 5.65, p = 0.017), health information (χ2(1) = 6.72, p = 0.01), disease monitoring (χ2(1) = 9.58, p = 0.002), contacting healthcare professional (χ2 (1) = 6.27, p = 0.012) and patient disability level (χ2(1) = 4.29, p = 0.038) were significantly associated with specific types of mHealth applications. In conclusion, the overall usage of mHealth applications among stroke caregivers was high, with the need of specific types and features in mHealth applications among stroke caregivers.

Can Post Stroke Walking Improve With Telerehabilitation? A Systematic Review in Adults With Stroke

<h3>Objective(s)</h3> To analyze and synthesize primary studies investigating the effects of telerehabilitation on gait-specific outcomes in the treatment of adult stroke survivors. <h3>Data Sources</h3> PubMed, Embase and CINAHL databases were searched from January 2000 to February 2022 using combinations of several keywords such as: "telerehabilitation", "stroke", and "gait". Results were limited to human clinical studies in adults with stroke published in the English language. <h3>Study Selection</h3> Studies were included if they administered telerehabilitation via a bidirectional form of videoconferencing with assessor presence on one interface and an assessment of walking function was administered in study participants, irrespective of stroke phase. Included articles aimed to study the feasibility and investigate the effectiveness of telerehabilitation protocols on improvement in overall walking function. <h3>Data Extraction</h3> Data extraction was performed from each full text by one author, and quality and bias were assessed using the Physiotherapy Evidence Database (PEDro). <h3>Data Synthesis</h3> A total of 302 nonduplicate articles were screened by one author, resulting in 30 articles for full-text review. Eight studies were included after full-text review, with a total sample size of 248 participants. Statistically significant improvements were seen in all outcome measures of walking function, which included walking, balance, and motor function tests, in seven out of eight total studies. Five studies included a control group out of which two observed greater statistically significant improvement in the telerehabilitation group compared to conventional in-person therapy. Differences in frequency, training duration, intervention, and absence of a conventional therapy control group were identified as causes of variation between studies. <h3>Conclusions</h3> These findings provide evidence supporting the use of telerehabilitation as an effective mode of therapy in providing a better continuum of care in stroke survivors and improving walking related outcomes, especially those pertaining to balance and endurance. Telerehabilitation was safe, feasible and showed good adherence which resulted in the observed improvement. Future research with a focus on real-time supervision is necessary to further improve understanding of cost-effectiveness and caregiver strain and to confirm long-term benefits. <h3>Author(s) Disclosures</h3> Authors declare no conflicts of interest.

Exploring challenges affecting resilience in carers of stroke survivors: a qualitative descriptive study

Purpose To develop an intervention to build resilience in carers of stroke survivors this study aimed to understand these carers’ (1) Challenges that adversely affect their resilience, and (2) suggestions for a relevant intervention to build resilience. Methods Individual semi-structured interviews were used. Participants included carers of stroke survivors (stroke duration > six months). Transcripts were analysed using the General Inductive Approach. This study followed guidelines of Consolidated criteria for Reporting Qualitative research (COREQ). Results Four themes were identified that affected resilience: (1) carer psychosocial outcomes, (2) stroke’s sudden and unexpected impact, (3) financial stressors, and (4) carer exclusion in care planning. Carers suggested an intervention comprising information sharing and training in coping skills, positive communication, problem-solving, and connection with “people who have gone through this” to improve resilience. Most supported a group, monthly delivery of the intervention. Conclusion These findings provide direction for a suitable intervention. Further, they suggest that stroke rehabilitation could be improved by adopting a family-centered model of care so that carers can be included as active partners in care process. Protecting carers from the negative impact of caring role on their resilience may sustain their ability to provide long-term care for the stroke survivor. IMPLICATIONS FOR REHABILITATION The provision of informal care to stroke survivors can be associated with significant emotional consequences, withdrawal from social activities, and poor quality of life for the carers. The abruptness of stroke presentation along with its long-term nature can negatively affect the resilience of informal carers. Exploration of challenges affecting carer resilience is important to develop interventions to build resilience in carers of stroke survivors. Integrating interventions focusing on carers’ resilience as part of the stroke rehabilitation process is imperative to ensure well-being of carers and sustainability of the care provided to the stroke survivor.

Abstract WP70: Racial-ethnic Differences In Reintegrating To Normal Living Among Stroke Survivors

Background: In the continuum of care for stroke survivors, racial-ethnic disparities are most prominent during post-stroke rehabilitation. This includes reintegration of stroke survivors to normal living, an important component in stroke rehabilitation and predicts stroke survivors’ participation in typical daily activities and post-stroke depression. We assessed the association between racial-ethnic factors and ability of survivors to reintegrate to normal living at one-year post stroke. Methods: Using data from the DESERVE (Discharge Educational Strategies for Reduction of Vascular Events) trial, we assessed reintegration to normal living (RNL) using the RNL index of 335 participants with acute stroke. Race and ethnicity were asked at baseline and the survivors’ RNL index was assessed at one-year follow-up. The RNL index was calculated from 11 questions rating survivor’s reintegration from 0-10 (no to complete integration). We used linear regression to assess variations in race-ethnicity on RNL index adjusting for intervention, age, sex, education, living arrangement, stroke history, and severity of recent stroke. Results: At baseline, 27.8% identified as Non-Hispanic (NH) white, 31.6% identified as NH black, 34.9% identified as Hispanic and 5.7% identified as NH other. Crude mean RNL index was greater in the intervention arm than the usual care arm for Hispanics and NH blacks (Figure). In adjusted models, NH whites (5.88, CI: -2.9,14.8) and NH Blacks (6.63, CI: -1.1,14.3) had higher RNL index compared to Hispanics. Conclusion: Racial-ethnic differences may play a clinically important role in reintegrating stroke survivors to normal living. Future interventions must be aimed at understanding fundamental causes of disparities that may lead to inequities in stroke survivors’ rehabilitation to better implement preventative strategies well before stroke incidence.

Abstract WP77: Racial Disparities Of Post-stroke Hospital Discharge

Objective: Early post-acute care for stroke survivors affect their morbidity, mortality, and long term disability and quality of lives. This study aimed to understand the utilization of post-acute services among different racial/ethnicity population. Methods: We examined the discharge destinations amongst patients admitted directly from the emergency department for ischemic stroke and transient ischemic attack (TIA) in 2017-2018 using the National Inpatient Sample, a 20% stratified sample of all discharges from U.S. community hospitals. Results: This study included 1,000,645 live ischemic stroke/TIA discharges with good racial/ethnicity representations (Table). Compared to their White counterpart, Hispanic patients were more likely to be discharged to home without home health care (49.1% vs 42.1%, OR 1.33, 95% CI 1.27-1.38), as well as Native Americans (47.5%, OR 1.24, 95% CI 1.06-1.46). Conversely, Hispanics are less likely to be discharged to inpatient rehabilitation or skilled nursing facilities than White (29.1% vs 36.5%, OR 0.71, 95% CI 0.68-0.74), as well as Native Americans (32.7%, OR 0.85, 95% CI 0.72-0.99). Facility discharge rates were comparable among Black and White (OR 0.99, 95% CI 0.97-1.03). Conclusion: Hispanics and Native Americans are more likely to be discharged to home without home health care and less likely to be discharged to facilities after stroke. Further study are need to understand the attributes of the discharge disparities after stroke hospitalization.

Trajectories of stroke recovery of impairment, function, and quality of life in response to 12-month mobility and fitness intervention.

Gait deficits and functional disability are persistent problems for many stroke survivors, even after standard neurorehabilitation. There is little quantified information regarding the trajectories of response to a long-dose, 12-month intervention. We quantified treatment response to an intensive neurorehabilitation mobility and fitness program. The 12-month neurorehabilitation program targeted impairments in balance, limb coordination, gait coordination, and functional mobility, for five chronic stroke survivors. We obtained measures of those variables every two months. We found statistically and clinically significant group improvement in measures of impairment and function. There was high variation across individuals in terms of the timing and the gains exhibited. Long-duration neurorehabilitation (12 months) for mobility/fitness produced clinically and/or statistically significant gains in impairment and function. There was unique pattern of change for each individual. Gains exhibited late in the treatment support a 12-month intervention. Some measures for some subjects did not reach a plateau at 12 months, justifying further investigation of a longer program (>12 months) of rehabilitation and/or maintenance care for stroke survivors.

Burden of informal care in stroke survivors and its determinants: a prospective observational study in an Asian setting

BackgroundInformal caregiving is an integral part of post-stroke recovery with strenuous caregiving demands often resulting in caregiving burden, threatening sustainability of caregiving and potentially impacting stroke survivor’s outcomes. Our study aimed to examine and quantify objective and subjective informal care burden after stroke; and to explore the factors associated with informal care burden in Singapore.MethodsStroke patients and their informal caregivers were recruited from all five tertiary hospitals in Singapore from December 2010 to September 2013. Informal care comprised of assistance provided by informal caregivers with any of the activities of daily living. Informal care burden was measured by patients’ likelihood of requiring informal care, hours of informal care required, and informal caregivers’ Zarit’s Burden Score. We examined informal care burden at 3-months and 12-months post-stroke. Generalized linear regressions were applied with control variables including patients’ and informal caregivers’ demographic characteristics, arrangement of informal care, and patients’ health status including stroke severity (measured using National Institute of Health Stroke Scale), functional status (measured using Modified Rankin Scale), self-reported depression, and common comorbidities.ResultsThree hundred and five patients and 263 patients were examined at 3-months and 12-months. Around 35% were female and 60% were Chinese. Sixty three percent and 49% of the patients required informal care at 3-months and 12-months point, respectively. Among those who required informal care, average hours required per week were 64.3 h at 3-months and 76.6 h at 12-months point. Patients with higher functional dependency were more likely to require informal care at both time points, and required more hours of informal care at 3-months point. Female informal caregivers and those caring for patients with higher functional dependency reported higher Zarit’s Burden. While informal caregivers who worked full-time reported higher burden, those caring for married stroke patients reported lower burden at 3-months point. Informal caregivers who co-cared with foreign domestic workers, i.e.: stay-in migrant female waged domestic workers, reported lower burden.ConclusionsInformal care burden remains high up to 12-months post-stroke. Factors such as functional dependency, stroke severity, informal caregiver gender and co-caring with foreign domestic workers were associated with informal care burden.

Portuguese validation of the Adult Carer Quality of Life Questionnaire (AC-QoL)

Abstract Background Assuring informal carers' quality of life (QoL) must be a priority for public health policies and practices. The Adult Carer Quality of Life Questionnaire (AC-QoL) is a recent and valid instrument, overpassing limitations of previous tools, and being already used among informal stroke carers. This study aimed to assess the feasibility, reliability and validity of the AC-QoL among Portuguese informal carers of stroke survivors. Methods The linguistic adaptation of the AC-QoL was performed. Informal carers (n = 212) of stroke survivors hospitalized between September 2018 and August 2019 in all Stroke Units of the North of Portugal (n = 12) were invited to participate, 18 to 24 months post-stroke. Data on sociodemographic characteristics, psychological profile, burden and QoL were collected using a structured questionnaire. The psychometric properties of the AC-QoL were investigated through exploratory and confirmatory factor analyses. Cronbach's alpha was used to measure internal consistency. Construct validity was assessed through the association of the overall score of AC-QoL with anxiety and depressive symptoms, burden and sociodemographic characteristics. Results Exploratory factor analysis supported the original eight-factor structure of the AC-QoL, revealing an adequate goodness of fit to the study sample (X2(674)=1145.926; CFI=0.916; TLI=0.908; RMSEA=0.058). The AC-QoL showed a high degree of reliability, with Cronbach's scores for the subscales ranging from 0.64 to 0.97 and a Cronbach's alpha of 0.91 for the overall score. Anxiety symptoms (p &amp;lt; 0.001), depression symptoms (p &amp;lt; 0.001) and burden (p &amp;lt; 0.001) were inversely associated with the overall score of AC-QoL. Younger (p = 0.032) and employed (p = 0.021) informal carers presented more frequently higher scores of overall QoL, than those older and unemployed. Conclusions The Portuguese version of the AC-QoL is a comprehensive, simple, reliable and valid instrument to assess informal stroke carers' QoL. Key messages The Portuguese version of the AC-QoL is a comprehensive and valid instrument with a high degree of reliability, that can be briefly and easily applied to informal carers of stroke survivors. A comprehensive and brief assessment of informal carers’ QoL will contribute to devise strategies to promote well-being and social integration of stroke survivors and their informal carers.

The Effect of Histone Deacetylase Inhibitors Panobinostat or Entinostat on Motor Recovery in Mice After Ischemic Stroke.

Using rigorous and clinically relevant experimental design and analysis standards, in this study, we investigated the potential of histone deacetylase (HDAC) inhibitors panobinostat and entinostat to enhance recovery of motor function after photothrombotic stroke in male mice. Panobinostat, a pan-HDAC inhibitor, is a FDA-approved drug for certain cancers, whereas entinostat is a class-I HDAC inhibitor in late stage of clinical investigation. The drugs were administered every other day (panobinostat-3 or 10mg/kg; entinostat-1.7 or 5mg/kg) starting from day 5 to 15 after stroke. To imitate the current standard of care in stroke survivors, i.e., physical rehabilitation, the animals run on wheels (2h daily) from post-stroke day 9 to 41. The predetermined primary end point was motor recovery measured in two tasks of spontaneous motor behaviors in grid-walking and cylinder tests. In addition, we evaluated the running distance and speed throughout the study, and the number of parvalbumin-positive neurons in medial agranular cortex (AGm) and infarct volumes at the end of the study. Both sensorimotor tests revealed that combination of physical exercise with either drug did not substantially affect motor recovery in mice after stroke. This was accompanied by negligible changes of parvalbumin-positive neurons recorded in AGm and comparable infarct volumes among experimental groups, while dose-dependent increase in acetylated histone 3 was observed in peri-infarct cortex of drug-treated animals. Our observations suggest that add-on panobinostat or entinostat therapy coupled with limited physical rehabilitation is unlikely to offer therapeutic modality for stroke survivors who have motor dysfunction.

Community care coordination for stroke survivors: results of a complex intervention study

BackgroundOutpatient follow-up care for stroke survivors is often inadequate and mostly self-organized by the patients themselves. In the German health care system, there are no standard care programs for patients after they are discharged from the hospital to support them with their multifaceted and heterogeneous health care needs. The objective of this complex intervention study was to evaluate the effectiveness of a post-stroke care coordination program in comparison to standard care in the first year after a stroke.MethodsPatients aged 55 and older who had survived a stroke or a transient ischemic attack (TIA) within the last 6 months before enrollment were included. Participants received care coordination either by telephone or face-to-face for up to 1 year. Patients’ health insurance claims data were used to measure outcomes. The control group consisted of stroke survivors receiving standard care and was constructed by exact matching based on six criteria. Outcome measures were health services utilization, rate of recurrent events, readmissions and accompanying costs, and mortality. Outcomes were tested using different multiple models.ResultsIn total, N = 361 patients were included in the analyses. Intervention participants had seen an outpatient neurologist more often (OR = 4.75; 95% CI: 2.71–8.31) and were readmitted to a hospital less frequently (IRR = 0.42; 95% CI: 0.29–0.61), resulting in lower hospital costs (IQR = €0–1910 in the intervention group, IQR = €0–4375 in the control group). There were no substantial group differences in the rate of recurrent events and mortality.ConclusionThis study showed the beneficial potential of care coordination for a vulnerable patient population: the utilization rate of important health services was increased, and the rate of hospital readmissions decreased as a result. Future research should focus on the risk of recurrent strokes and the long-term effects of improved care.Trial registrationDRKS00017526 on DRKS – German Clinical Trials Register (retrospectively registered: 21 June 2019).

Health related quality of life and satisfaction with care of stroke patients in Budapest: A substudy of the EuroHOPE project.

Disadvantaged socioeconomic status is associated with higher stroke incidence and mortality, and higher readmission rate. We aimed to assess the effect of socioeconomic factors on case fatality, health related quality of life (HRQoL), and satisfaction with care of stroke survivors in the framework of the European Health Care Outcomes, Performance and Efficiency (EuroHOPE) study in Hungary, one of the leading countries regarding stroke mortality. We evaluated 200 consecutive patients admitted for first-ever ischemic stroke in a single center and performed a follow-up at 3 months after stroke. We recorded pre- and post-stroke socioeconomic factors, and assessed case fatality, HRQoL and patient satisfaction with the care received. Stroke severity at onset was scored by the National Institutes of Health Stroke scale (NIHSS), disability at discharge from acute care was evaluated by the modified Rankin Score (mRS). To evaluate HRQoL and patient satisfaction with care we used the EQ-5D-5L, 15D and EORTC IN PATSAT 32 questionnaires. At 3 months after stroke the odds of death was significantly increased by stroke severity (NIHSS, OR = 1.209, 95%CI: 1.125-1.299, p<0.001) and age (OR = 1.045, 95%CI: 1.003-1.089, p = 0.038). In a multiple linear regression model, independent predictors of HRQoL were age, disability at discharge, satisfaction with care, type of social dwelling after stroke, length of acute hospital stay and rehospitalization. Satisfaction with care was influenced negatively by stroke severity (Coef. = -1.111, 95%C.I.: -2.159- -0.062, p = 0.040), and positively by having had thrombolysis (Coef. = 25.635, 95%C.I.: 5.212-46.058, p = 0.016) and better HRQoL (Coef. = 22.858, 95%C.I.: 6.007-39.708, p = 0.009). In addition to age, disability, and satisfaction with care, length of hospital stay and type of social dwelling after stroke also predicted HRQoL. Long-term outcome after stroke could be improved by reducing time spent in hospital, i.e. by developing home care rehabilitation facilities thus reducing the need for readmission to inpatient care.

Care of stroke survivors in community: a case study of rural Thai community

PurposeThis study aims to describe survivors of stroke circumstances, issues with providing care for survivors of stroke and services expected by caregivers and survivors of stroke.Design/methodology/approachA qualitative research design was conducted in Singburi Province. Data collection methods included in-depth interviews, focus groups and participatory observations. Semi-structured in-depth interview guides, quality-of-life scale and depression scale were used to collect data from survivors of stroke, their caregivers, health personnel, local governors and village health volunteers. Naturalistic research tradition was used for qualitative data analysis and descriptive statistics for quantitative data analysis.FindingsThe majority of survivors of stroke had hemiplegic limb and severe deficits in their activities of daily living. Caregivers were family members, and they often developed depression. Issues with providing care to stroke survivors included lack of knowledge about stroke and home care, inadequacy and discontinuity of care and the shortage of stroke care personnel in the community. A stakeholder's expected stroke services included the provision of effective continuing care, community participation in care and enhancing the village health volunteer's capacity.Originality/valueThis study illustrated the stroke service systems in rural Thai communities. The study's findings could be applied when planning future research using community participation to test a model of care for stroke survivors to promote better outcomes and be responsive to the needs of stroke survivors, especially those who are disabled.

Optimizing a stroke caregiver support programme in practice with Participatory Action Research

Abstract Family caregivers (FCG) play a key role in the day-to-day care of stroke survivors. Most FCG support programmes are complex public health interventions. Often, they are designed top-down without key stakeholder participation. Hence, when implementing these programmes in real world settings, they may experience “teething problems”. Optimization in practice and actively engaging its stakeholders to accurately fit the programme to the needs in practice may enhance the programmés chance of success. The Participatory Action Research (PAR) strategy was chosen for the optimization of a German primary prevention programme for stroke FCGs. Immediately after the development of the preliminary support concept (5 Conceptual Building Blocks - CBB), conducted top-down by the academic research team, iterative PAR-cycles (observe - reflect - plan - act) were applied. Together with the stakeholders (service providers and FCG), three steps were taken: (1) verifying and fitting the preliminary CBBs, (2) detecting, developing, verifying and fitting new blocks, and (3) prioritizing all blocks. For data collection a multi-methodological design was chosen. Through PAR, a matured FCG support concept was obtained, containing eight CBBs. The five preliminary CBBs: ‘Content’, ‘Human resources’, ‘Personalized approach’, ‘Timing’, and ‘Setting’, were optimized and prioritized as core blocks, providing the base for individual caregiver support. Three new CBBs: ‘Network building’, ‘Communication’, and ‘Social safety-net’ were assigned as facilitating blocks, interlinking and securing the programme within the existing support system. PAR was found to be essential for both systematically detecting conceptual weaknesses of the preliminary concept and adjusting its components to the needs of the key stakeholders, before full-scale implementation. Involvement of stakeholders, with high levels of participation, will enhance the acceptance of the matured concept and its feasibility in practice.

Integrated care in stroke survivors: When and how much?

Ischaemic stroke is not only a severe acute illness, survivors of such an event remain at high cardiovascular risk, often due to treatable cardiovascular comorbidities [1]. Unfortunately, post stroke and TIA work-up and care often comes to a halt at discharge. Increasing economic pressure shortens in-hospital stays, reducing access to team-based specialized treatment and rehabilitation. In the transition to outpatient care, motivation and expertise in optimal post-stroke management often decrease markedly.