Carers Of Stroke Survivors Research Articles

Two-level multi-methodological evaluation of a new complex primary support programme for stroke care-givers in Germany

AbstractFamily care-givers are the backbone of the long-term support system for care receivers at home. Care for stroke survivors after rehabilitation primarily rests on the shoulders of family members, often of older age themselves. We report the outcomes of a new complex support programme, the Care-givers’ Guide, on both individual and system levels. Psycho-social support and personalised information were the main ingredients of this intervention. A two-level multi-methodological approach was needed, with two concurrent interconnected studies. Family care-givers reflected on outcomes at an individual level in a quant-QUAL study with a pre–post quantitative questionnaire and a post-intervention qualitative semi-structured interview. Practitioners participated in a QUAL-QUAL study ex post interview, reflecting on the outcomes on the care-givers and on their own stroke care system. Individual family care-givers showed an increase in health literacy and level of psycho-social health. Qualitative analysis revealed improvement in knowledge, capability to act and individual empowerment; and stabilisation of sense of certainty, life balance and emotional wellbeing. Practitioners observed an optimisation of the stroke support system by improving professionals’ daily routine, augmenting the institutional support offer, securing the quality of patient care and increasing inter-institutional co-operation attempts. Positive outcomes of the support programme were observed on both evaluation levels: family care-givers showed improved health literacy and psycho-social health, whereas the professionals noticed an optimisation of the support system.

Value and learning from carer involvement in a cluster randomised controlled trial and process evaluation - Organising Support for Carers of Stroke Survivors (OSCARSS)

BackgroundPatient, Carer and Public Involvement (PCPI) should be embedded in health care research. Delivering PCPI can be challenging, but even when PCPI is carried out it is rarely reported resulting in lost opportunities for learning. This paper aims to describe PCPI in the OSCARSS study, a pragmatic-cluster randomised controlled trial with an embedded economic and process evaluation.MethodsA carer research user group (RUG) co-developed OSCARSS to evaluate how to best deliver support to caregivers of stroke survivors. The PCPI activity involved regular meetings and preparatory work, from the initial conceptualisation of the study through to dissemination. Written reports, structured group discussions and individual interviews were carried out with the RUG and researchers to capture the added value and learning. This paper was co-authored by two of the RUG members with contributions from the wider RUG and researchers.ResultsThe core six members of the caregiver RUG attended the majority of the meetings alongside three researchers, one of whom was the co-chief investigator. PCPI was instrumental in changing many aspects of the research protocol, design and delivery and contributed to dissemination and sharing of good practice. There were challenges due to the emotional toll when PCPI members shared their stories and the extensive time commitment. Positive experiences of learning and fulfilment were reported by the individual researchers and PCPI members. Wider organisational administrative and financial support facilitated the PCPI. The researchers’ existing positive regard for PCPI and the clear focus of the group were key to the successful co-design of this research.ConclusionsThe value and learning from the PCPI collaborative work with the researchers was of benefit to the study and the individuals involved. Specific PCPI influences were a challenge to pinpoint as successful co-design meant the researchers’ and carers’ contributions were intertwined and decision-making shared.

COPING STRATEGIES BY STROKE CAREGIVERS: EVIDENCE FROM A QUALITATIVE STUDY IN SARAWAK, MALAYSIA

Caring for stroke survivors is inevitably a burden to caregivers. It is not uncommon for stroke survivors who are discharged from the hospital and found themselves at home without any help and care from the supposed caregivers. However, in instances where there are available and willing caregivers, a sudden and unpredictable task of caring for stroke survivors require the stroke caregivers to apply their coping strategies due to the demanding nature of looking after a survivor. This study aimed to determine coping strategies undertaken by stroke caregivers in caring for stroke survivors. This was an exploratory qualitative study and data was collected from the caregivers of stroke survivor using a semi-structured guided questionnaire. A total of 18 caregivers were included in the study. The data were collected from November 2015 until June 2016 at a selected community rehabilitation centre in Kuching, Sarawak. The qualitative data analysis revealed that the coping strategies undertaken by stroke caregivers include change of role in life, self-motivation, sharing with other people, crying, trying to forget things that happen, hoping survivors will get better, emotion suppression and self-blame. The study highlighted the experiences by the caregivers for caring for stroke patients and focused on the coping strategies undertaken by the caregivers. Better ununderstanding of these experiences does help the service providers to provide better support and resources for caregivers in caring for stroke survivors.

The Prognostic Value of Reversed Ophthalmic Artery Flow Direction in Acute Stroke Patients with Ipsilateral Extra Cranial Carotid Artery Stenosis

Abstract Background According to the World Health Organization, about 15 million people suffer a stroke each year with roughly one-third resulting in death and another one-third sustaining severe permanent disability. Even in developed nations, stroke is the third leading cause of death. It also costs billions of dollars through lost productivity, premature mortality and care for stroke survivors. The evaluation of hemodynamics, autoregulation and collaterals is cardinal for clinical outcomes. The Use of Transcranial Doppler (TCD) in detecting reversal of blood flow direction especially in anterior communicating and ophthalmic arteries, and flow diversion between anterior and posterior circulation provide critical information on ipsilateral collateral status. The impact of collateral status has been correlated with clinical symptoms, reperfusion success and functional outcome at discharge. A rationale now exists for imaging assessment to guide physicians in the precision medicine of stroke care. Aim of the work This study is performed for evaluation of hemodynamics in ophthalmic artery as a collateral and its value as a prognostic factor in patients with carotid artery extra cranial stenosis in acute cerebrovascular stroke. Patients and Methods 30 patients with acute cerebrovascular stroke were recruited in this cross-sectional study admitted in stroke unit at the department of neurology of Ain Shams University hospitals. Results There was a statistically significant difference between the Modified Rankin Scale on discharge and follow up after 3 months in patients suffering from acute cerebrovascular stroke with ipsilateral severe extra cranial carotid artery stenosis and reversed ophthalmic artery flow direction (p value =0.042), compared to the group with direct ophthalmic artery flow direction where the (p = 0.086). Conclusion Transcranial Duplex is a diagnostic tool that provides a non-invasive, real time, safe technique information data on intracerebral hemodynamics. It was used in this study to detect that there is a significant difference in functional outcome between patients with forward and reversed ophthalmic artery flow direction with acute cerebrovascular stroke and ipsilateral extracranial carotid artery stenosis.

The integrated care pathway for managing post stroke patients (iCaPPS\xa9) in public primary care Healthcentres in Malaysia: impact on quality adjusted life years (QALYs) and cost effectiveness analysis

BackgroundThe delivery of post stroke care is fragmented even in advanced public healthcare systems, globally. Primary care teams are entrusted to provide longer term care for stroke survivors in most developing countries. The integrated Care Pathway for Post Stroke patients (iCaPPS©) was designed to guide primary care teams to incorporate further rehabilitation and regular screening for post stroke complications among patients residing at home in communities, using the shared-care approach, especially in areas with limited access to specialist stroke care services. The iCaPPS© addressed coordination of rehabilitation and screening for post stroke complications which were absent in the current conventional care of patients managed at public primary care healthcentres. This study aimed to evaluate the cost effectiveness and impact of iCaPPS© on quality-adjusted- life-years (QALY) compared with current conventional monitoring at public primary care healthcentres.MethodsA pragmatic healthcentre-based cluster randomised controlled trial-within trial on 151 post stroke patients from 10 public primary care facilities in Peninsular Malaysia was conducted to evaluate QALY of patients managed with iCaPPS© (n = 86) vs conventional care (n = 65) for 6 months. Costs from societal perspective were calculated, using combination of top down and activity-based costing methods. The 5-level EQ5D (EQ-5D-5 L) was used to calculate health state utility scores. Cost per QALY and incremental cost effectiveness ratio (ICER) were determined. Differences within groups were determined using Mann-Whitney tests.ResultsTotal costs for 6 months treatment with iCaPPS© was MYR790.34, while conventional care cost MYR527.22. Median QALY for iCaPPS© was 0.55 (0,1.65) compared to conventional care 0.32 (0, 0.73) (z = − 0.21, p = 0.84). Cost per QALY for iCaPPS© was MYR1436.98, conventional care was MYR1647.56. The ICER was MYR1144.00, equivalent to 3.7% of per capita GDP (2012 prices).ConclusionsManagement of post stroke patients in the community using iCaPPS© costs less per QALY compared to current conventional care and is very cost effective.Trial registrationTrial Registration number ACTRN12616001322426. Registered 21 September 2016. (Retrospectively registered).

Abstract WP242: Using Systems Redesign in the Development, Implementation, and Evaluation of a Care Transitions and Hypertension (catch) Management Program for Veterans With Ischemic Stroke

Introduction: Systems Redesign approaches have the potential to be used to develop, implement, and evaluate the implementation of post-ischemic stroke hypertension quality improvement initiatives. Methods: The CAre Transitions and Hypertension (CATcH) management program is a bundled, multi-faceted, provider- and healthcare-systems level pilot-intervention designed to enhance care coordination using infrastructure routinely available within a Veterans Health Administration (VHA) medical center delivering suboptimal post-stroke hypertension care. A rapid process improvement workshop with local personnel from internal medicine, neurology, clinical pharmacy, and facility leadership. The team process mapped out the current state of post-stroke blood pressure (BP) control from the hospitalization period to outpatient follow-up, and conceptualized a future state where there was enhanced care coordination between inpatient and outpatient providers, generalists and specialists, and increased engagement of underutilized talent within clinical pharmacy and telehealth. The CATcH bundle also included a Transition in Care note to improve communication between providers. The team decided to meet weekly to determine newly identified and ongoing needs for patients. Chart review was conducted to determine healthcare utilization. Results: In the six-months prior to the implementation of CATcH, facility-level pass rate for BP control (i.e., obtaining BP < 140/90 mmHg) was 50% (18/36). Stroke survivors were neither discharged with telehealth for BP monitoring nor received clinical pharmacy appointments. In the six-months after CATcH implementation, facility-level pass rate for BP control was 69% (22/32). Nineteen percent were enrolled in telehealth whereas all patients received and attended at least two clinical pharmacy appointments post-discharge. All patients discharged during the intervention period were recipients of the CATcH program. Conclusions: A Systems Redesign approach could be used to eliminate waste and minimize variability in the process of post-stroke hypertension management while using readily available hospital infrastructure to improve hypertension care for stroke survivors.

Effect of a Passive Intervention on Carers of Stroke Survivors During the Early Poststroke Period.

Care partners of stroke survivors are often characterized by high burden levels and depression. Passive and active interventions have been proposed to help reduce burden and depression. The aim of this quality improvement report was to evaluate the effects of a single passive intervention on reported burden and depression in carers of stroke survivors. A quality improvement report was conducted on carers who participated in a short passive intervention (n = 56) and a control group (n = 44). The Family Strain Questionnaire-Short Form (FSQ-SF) and the Beck Depression Inventory II were administered in both groups at patients' admission and before discharge, with the intervention taking place between the 2 data collection periods. No significant difference between groups was observed in FSQ-SF score and prevalence of depression at admission and in FSQ-SF at discharge. However, compared with admission, FSQ-SF at discharge was significantly reduced only in the intervention group (pre: 14, and interquartile range, 12-15; post: 9, and interquartile range, 9-13; P < .01). Moreover, a smaller proportion of carers classified as "depression" was found at discharge in the intervention group compared with controls (4% vs 28%, respectively; P < .01). Results encourage the development and use of short passive intervention to reduce burden and depression in care partners of stroke survivors.

Living on the edge: Family caregivers' experiences of caring for post-stroke family members in China: A qualitative study

BackgroundGlobally, one-third of the 15 million people with stroke suffer permanent physical, cognitive, and emotional impairment. Because of traditional Chinese culture and the limited development of the primary healthcare system, most stroke survivors are cared for and live with their family after hospital discharge. However, previous literature shows a lack of qualitative studies on family caregivers’ experience of caring for their relatives in China. ObjectivesThe aim of this study was to explore the experience of family caregivers taking care of stroke survivors in China. MethodsAn explorative design was used wherein qualitative semi-structured interviews were conducted with family caregivers in China. Family caregivers were selected from one city and three communities using a purposive sampling method until no new data were generated (n = 26). A thematic analysis was used for the data analysis in this study. FindingsFamily caregivers’ experience was described as living on the edge, which pulled their lives in multiple directions, created an unstable situation, and reduced their well-being and health. The participants believed they had total responsibility and felt that this was expected from both themselves and society. Little external understanding and insufficient support was emphasised, resulting in the caregivers feeling all alone, drained by caring, and like prisoners in their own lives. The family caregivers had to face all of the family events and make all of the decisions by themselves. They expressed love for their family members with stroke, but this was often overshadowed by feelings of sadness, depression, sensitivity, and anger. This resulted in an inability to see how things could improve and in the family caregivers being uncertain about the future. ConclusionAll of these findings increased understanding and added knowledge of this topic that has been seldom studied in China. Healthcare authorities and professionals should recognise and understand the lives and situations of family caregivers since their relatives had a stroke to further identify their difficulties and needs. Appropriate and effective support, both from government and society, should be planned and implemented for family caregivers to relieve them from caring for their relatives with stroke and maintaining the quality of their own lives.

Organising Support for Carers of Stroke Survivors (OSCARSS): study protocol for a cluster randomised controlled trial, including health economic analysis

BackgroundStroke often results in chronic disability, with partners and family members taking on the role of informal caregiver. There is considerable uncertainty regarding how best to identify and address carers’ needs. The Carer Support Needs Assessment Tool (CSNAT) is a carer-led approach to individualised assessment and support for caregiving that may be beneficial in palliative care contexts. CSNAT includes an implementation toolkit. Through collaboration, including with service users, we adapted CSNAT for stroke and for use in a UK stroke specialist organisation providing long-term support. The main aims of OSCARSS are to investigate the clinical and cost-effectiveness of CSNAT-Stroke relative to current practice. This paper focuses on the trial protocol, with the embedded process evaluation reported separately.MethodsLongitudinal, multi-site, pragmatic, cluster randomised controlled trial with a health economic analysis. Clusters are UK services randomised to CSNAT-Stroke intervention or usual care, stratified by size of service. Eligible carer participants are: adults aged > 18 years; able to communicate in English; referred to participating clusters; and seen face-to-face at least once by the provider, for support. The ‘date seen’ for initial support denotes the start of intervention (or control) and carers are referred to the research team after this for study recruitment. Primary outcome is caregiver strain (FACQ - Strain) at three months after ‘date seen’. Secondary outcomes include: caregiver distress; positive caregiving appraisals (both FACQ subscales); Pound Carer Satisfaction with Services; mood (HADs); and health (EQ-5D5L) at three months. All outcomes are followed up at six months. Health economic analyses will use additional data on caregiver health service utilisation and informal care provision.DiscussionOSCARSS is open to recruitment at the time of article submission. Study findings will allow us to evaluate the clinical and cost-effectiveness of the CSNAT-Stroke intervention, directed at improving outcomes for informal carers of stroke survivors. Trial findings will be interpreted in the context of our embedded process evaluation including qualitative interviews with those who received and provided services as well as data on treatment fidelity. OSCARSS will contribute to knowledge of the unmet needs of informal stroke caregivers and inform future stroke service development.Trial registrationISRCTN Registry, ISRCTN58414120. Registered on 26 July 2016.

Influence of Duration of Caregiving on the Burden and Quality of Life of Informal Caregivers of Stroke Survivors

Introduction: Providing care to stroke survivors takes a huge toll on caregivers, both physically and emotionally. This study evaluated the influence of duration of caregiving on the burden and Quality of Life (QOL) of informal caregivers (CGs) of stroke survivors. Material and Method: The cross-sectional survey study recruited 100 consenting stroke survivors and their CGs using purposive sampling technique. Caregiving duration and daily caregiving hours were assessed using data capture form. Burden and QOL were assessed with Zarit burden interview and WHOQOL BREF respectively. Data were analysed with Chi-square and Kruskal-Wallis as tests of associations and differences between variables respectively using SPSS version 20 at p=0.05 alpha. Findings: The CGs comprised 56(56%) females and 44(44%) males with mean age of 31.73± 12. About 31% of the CGs had mild burden while 53% had good QOL. Significant association exist between daily caregiving hours and each of CGs QOL (X2=14.716; P=0.003) and burden (X218.23; P=0.003). There were significant differences in the QOL and Burden of CGs based on the daily hours of caregiving (P 0.05). Conclusion: Stroke CGs who perform caregiving tasks for twelve or more daily caregiving hours are likely to experience enormous burden and deterioration of their QOL. But duration of caregiving in months or years has no significant influence on the burden and QOL of CGs.

EFFECTIVENESS OF A FAMILY-BASED CARE MANAGEMENT MODEL FOR STROKE CAREGIVERS: A RANDOMIZED CONTROLLED TRIAL

AbstractBackground and Objective: Every year, around 22,000 people who suffer from stroke discharge to home or institutional care in Hong Kong. Existing evidence-based services targeting stroke patients are mostly patient-oriented. Family-oriented intervention is under-developed. Stroke causes profound impacts not only on the patient but also on the whole family. It often disrupts existing family dynamics, affecting almost each of the family member. We initiated “WeRISE: Stroke Family Empowerment Project” to test a family-oriented care management intervention on its effectiveness to reduce caregiver burden and enhance family functioning. Methodology: A standardized protocol on case referral procedure, inclusion and exclusion criteria for case recruitment, and five care management intervention sessions were developed and executed. A randomized controlled trial was piloted with 95 families within a twelve months of period, including 48 families in experimental group and 47 in control group. Standardized assessments including patients ADLs, IADLs and mobility status, and caregivers’ burden, perceived support, and family functioning at recruitment, immediately and 2 months after intervention were measured. Findings: As compared to control group participants, experimental group participants recorded significant increase on perceived support and reduced caregiving burden. Conclusion: Family-oriented care management is found to be effective in supporting families who are taking care of stroke survivors. Service implications were discussed.

Burden of Stroke Caregivers: Evidence from a Qualitative Study in Sarawak, Malaysia

Background: Stroke survivors experience long-term physical, psychosocial and cognitive impairment that are formidable challenges to caregivers because caring for stroke survivors needs explicit knowledge and caregivers have to endure the stressfulness as a result of caring. In addition, little is known about perceived benefits of the stroke care giving experience.Objectives: This study was aimed to determine the caregivers’ burden and challenges as reported by caregivers of stroke survivors.Materials and Methods: This was a cross-sectional study involving 18 stroke caregivers. The data were collected from November 2015 to June 2016 at a conveniently selected community rehabilitation centre in Kuching, Sarawak.Results: The qualitative data analysis revealed that the burden was aggravated by financial problems, multiple responsibilities hold by the caregivers, behavioural changes of the stroke survivors and lack of social support during care giving.Conclusion: This study highlighted the experiences by the caregivers in caring for the stroke survivors that focused on the different needs of the caregivers. Understanding these experiences may help the service providers to provide better support and resources for caregivers in caring for stroke survivors.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.593-599

Caring for stroke survivors: experiences of family caregivers in Sri Lanka – a qualitative study

ABSTRACTBackground: Stroke is a life-changing event for both stroke survivors and their family caregivers. After receiving acute care at the hospital, family members are expected to take care of stroke survivors at home and to continue treatment and rehabilitation. The new role of “informal caregiver” is a challenge that creates many difficulties for family caregivers that are not explicit in the Sri Lankan context.Objectives: This study aimed at exploring family caregivers’ experiences of providing informal care for dependent stroke survivors.Methods: The sample was chosen by purposive sampling with a maximum variation by age, ethnicity, religion, educational level, relationship, and monthly income. Ten informal family caregivers to stroke survivors with hemiplegia who had been treated at the National Hospital of Sri Lanka participated in in-depth interviews analyzed using conventional content analysis.Results: Qualitative content analysis of data resulted in an overriding theme, “Caring with love, against all odds,” along with four categories, “Life alterations,” “Lack of resources,” “Compassionate care,” and “Coping strategies.” Although the increased workload, restricted social life, physical problems, and knowledge and financial deficits were challenging for the family caregivers, self-strength and supportive social networks helped them to compassionately care for their stroke survivor.Conclusions: The phenomenon of family caregivers providing informal care for stroke survivors was explicated as compassionate care, notwithstanding numerous difficulties. The findings motivate further research and strategies to minimize family caregivers’ burden and facilitate the positive aspects of caregiving to promote the health and well-being of both stroke survivors and their families.

Abstract WMP7: Cost-Effectiveness of Combined Thrombectomy with Intravenous Thrombolysis vs Thrombectomy Alone for Acute Ischemic Stroke

Introduction: Meta-analysis of 13 studies suggested that combined mechanical thrombectomy (MT) with intravenous thrombolysis (IV-tPA) is more effective than MT alone. Limited economic analyses have explored this topic. We aimed to determine the cost-effectiveness of combined vs MT alone therapy in patients with large-vessel occlusive stroke. Hypothesis: Combined MT with IV-tPA is more cost-effective than MT alone. Methods: Markov model was constructed to simulate health outcomes and costs of two therapies (combined MT with IV-tPA, MT alone) over a 20 years lifetime horizon. The model incorporated an acute phase (0-90 days) and a rest of life phase (&gt;90 days) with modified Rankin categories at 90days as the primary health states. Probabilities, utilities, and cost data were obtained from published sources. Incremental costs, quality-adjusted life-year (QALY), net monetary benefits, incremental cost-effectiveness ratio (ICER) were derived from the models. The willingness-to-pay was set to ICER $50,000/QALY. Results: Table 1 summarizes the base-case values and cost-effectiveness outcomes. Combined MT and IV-tPA led to improved quality-of-life and increased life expectancy; however, it was at slightly higher costs compared to MT alone. Combined MT with IV-tPA yielded 13.5 QALYs and accrued $220,227 in lifetime costs, whereas MT alone yielded 12.5 QALYs and accrued $185,714 in lifetime costs. Combined MT with IV-tPA costs $1,468 per QALY higher than MT alone group. The higher costs in combined therapy were driven by the costs of long-term care in stroke survivors with severe disability. Net monetary benefit was higher in the combined therapy by 14,988 points suggesting that combined MT with IV-tPA was more cost-effective than MT alone. Conclusions: Combined MT with IV-tPA is more cost effective than MT alone in patients with large vessel occlusive stroke. Randomized clinical trials to directly compare between combined MT with IVT vs MT alone seem warranted.

Biopsychosocial Intervention for Stroke Carers (BISC): protocol for a feasibility randomised controlled trial (RCT)

IntroductionReducing length of hospital stay for stroke survivors often creates a shift in the responsibility of care towards informal carers. Adjustment to the caregiving process is experienced by many carers...

Gaps in care for patients with memory deficits after stroke: views of healthcare providers

BackgroundStroke is a common cause of physical disability but is also strongly associated with cognitive impairment and a risk for future dementia. Despite national clinical guidelines, the service provided for stroke survivors with cognitive and memory difficulties varies across localities. This study critically evaluated the views of healthcare professionals about barriers and facilitators to their care.MethodsSeventeen semi-structured individual interviews were conducted by a single interviewer with both primary and secondary care clinicians in regular contact with stroke-survivors. This included stroke medicine specialists, specialist nurses, physiotherapists, occupational therapists, general practitioners and primary care nurses. Topics included individual experiences of the current care offered to patients with cognitive impairment, assessment processes and inter-professional communication. Interviews were audio recorded and transcribed verbatim. Transcripts were thematically analysed and themes grouped into broad categories to facilitate interpretation.ResultsData analysis identified four key themes as barriers to optimal care for stroke-survivors with memory difficulties: 1) Less focus on memory and cognition in post-stroke care; 2) Difficulties bringing up memory and cognitive problems post-stroke; 3) Lack of clarity in current services; and, 4) Assumptions made by healthcare professionals introducing gaps in care. Facilitators included stronger links between primary and secondary care in addition to information provision at all stages of care.ConclusionsThe care provided by stroke services is dominated by physical impairments. Clinicians are unsure who should take responsibility for follow-up of patients with cognitive problems. This is made even more difficult by the lack of experience in assessment and stigma surrounding potential diagnoses associated with these deficits. Service development should focus on increased cohesiveness between hospital and community care to create a clear care pathway for post-stroke cognitive impairment.

Abstract TP391: Barriers and Facilitators to Self Care in Stroke Survivors

Background: Stroke is a major cause of long-term disability and loss of quality of life. People living with stroke face enormous challenges particularly after discharge from acute care adjusting to a new life. Stroke self-care is an important element in preventing stroke recurrence by direct survivors’ attention to stroke secondary prevention. Self-care helps survivors to recapture or learn new skills to manage their daily activities. However, several factors hinder the self-care and interfere with healthcare behaviors. Therefore, identifying the barriers and facilitators for stroke self-care is the key element for improving stroke self-care Purposes: To analyze the state of the science in regard to the barriers and facilitators for self-care Methods: The electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature , and PsycInfo were searched. Inclusion criteria included: peer reviewed primary English studies; self-care or self-management as the primary outcome; adult stroke survivors; and published after 2005. The integrative review guidelines were used for analysis. Results: From an original of 794 studies identified, 23 met the inclusion criteria and were reviewed. Self-care and self-management concepts were used interchangeably. The barriers to stroke self-care were classified into three categories: individual factors, psychological factors, social and environmental factors. The individual factors were lack of knowledge, decrease individual capacity such as lack of self-confidence and learning capabilities, lack of self-efficacy and motivation, non-adherence to medication, and physical impairment. The psychosocial factors included depression, anxiety, and cognitive impairment. Social and environmental factors were lack of family and social support, lack of professional support, lack of trust in healthcare providers, lack of transportation, low socioeconomic status, and lack of the resources. The facilitators were motivation and social support. Conclusions: Overall, quality of the studies was limited by small sample sizes in the intervention studies. Managing healthcare behaviors through understanding the barriers and facilitators will help nurses and stroke survivors in improving self-care.

Abstract 167: An Innovative mHealth-based Care Model for Improving Hypertension Control in Stroke Survivors

Background: Hypertension (HTN) is the most important modifiable risk factor for stroke prevention. Unfortunately, HTN is considerably under-treated in stroke survivors. Purpose: Our AHRQ funded study (R21 HS021794) examined the usability and feasibility of a mHealth (mobile health technology) based care model for improving HTN control rates in stroke survivors. Methods: Design was a 2 group randomized controlled trial. Total study duration was 120 days. HTN control was defined as Systolic BP (SBP) less than 140 mm Hg based on the AHA stroke guidelines. HTN control was evaluated in participants at study enrollment and completion. Intervention Group: Patients used a smart phone and wireless BP monitor to measure their BP. Patients were requested to measure their BP daily which was transmitted automatically to the study database. Study investigators (Physician + PharmD) reviewed BP weekly and, made needed medication adjustments bi-weekly. Primary care providers (PCP) were involved in the decision making via the electronic medical record. Control Group: Patients received a digital BP monitor and were educated on the importance of HTN control and asked to follow up with their PCP as usual (usual care). Intervention patients completed a Marshfield System Usablity Survey. Possible responses to usability questions were 1=strongly disagree, 2=agree, 3=neither agree or disagree, 4=agree, 5=strongly agree. Results: Total 50 patients completed the study (Table). Intervention patients transmitted BP a total of 92% of observation days and, rated mHealth as highly usable, Mean Marshfield System Usability Survey question response “I thought the system was easy to use” was 4.7. HTN control was significantly more effective in the intervention group (Table). Conclusion: A mHealth based model of HTN care was highly feasible and clinically more effective than usual care in stroke survivors. We propose that this care model be evaluated at a health system level.

Balancing satisfaction and stress: carer burden among White and British Asian Indian carers of stroke survivors

ABSTRACTObjectives: This paper presents the findings of a qualitative study exploring White and British Indian informal stroke carers’ experiences of caring, factors contributing to their stress, and strategies used to overcome stress.Design: A qualitative approach involving in-depth interviews was used to explore informal carers’ experiences of caring for stroke survivors and the stress of caring at one and three to six months from the onset of stroke. Interviewers bilingual in English and Gujarati or Punjabi conducted interviews with carers. Socio-demographic data of carers and stroke survivors were collected at one, and three to six months by dedicated stroke research nurses.Results: A total of 37 interviews with carers caring for stroke survivors with a wide range of physical and mental impairments were completed. A majority of carers had assumed the task of caring within a few weeks of the stroke. Irrespective of ethnicity, carers’ emotional and physical well-being was undermined by the uncertainty and unpredictability of caring for stroke survivors, and meeting their expectations and needs. The strain of managing social obligations to care was common to all carers irrespective of gender and ethnicity, but the higher levels of anxiety and depression reported by Indian British female carers appeared to stem from the carers’ pre-existing physical ailments, their cultural and religious beliefs, and household arrangements. Carers’ strain in extended households was exacerbated by the additional responsibility of caring for other dependent relatives.Conclusion: Since the role of carers is clearly indispensable in the successful rehabilitation of survivors, it is vital to ensure that their well-being is not undermined by a lack of information and training, and that their need for professional support is prioritised.

Abstract TP383: Creating Educational Modules for Family Caregivers to Reduce Potentially Preventable Hospitalizations in Stroke Survivors

Background and Issues: Preventable hospitalization utilization among stroke survivors is common. Although about 1/3 of potentially preventable hospitalizations are attributed to recurrent ischemic stroke, other comorbidities that lead to hospitalization are prevalent and need to be monitored. Timely and appropriate care for community-dwelling stroke survivors is critical. Since family caregivers provide the majority of care in the home, support and education of caregivers is essential to monitoring comorbid conditions. Purpose: This project’s aim was to develop brief educational modules on common comorbid conditions (e.g. chronic obstructive pulmonary disease, congestive heart failure, gastroenteritis); have family caregivers and nurse practitioners (NPs) review the content for validity; and then construct 8-10 minute voice-over PowerPoint presentations for each module. Methods: Based on evidence from randomized controlled trials, these modules were developed to provide caregivers with needed information to competently care for stroke survivors. Each module was concisely written at an 8th grade reading level and consists of: 1) a short introduction to the topic and key points; 2) what caregivers can do to alleviate the condition, should watch for, and should report to healthcare providers; 3) linked websites for more information and references; and 4) a four-question assessment about what they learned. Results: Once developed, these modules were evaluated by family caregiver (n=10) and NP (n=5) reviewers. The caregivers thought that the modules were appropriate in length to facilitate easy reading and understanding. The NPs noted that some content needed to be added, such as additional websites and drug information, but overall believed the modules contained supportive resources for caregivers. To provide an alternate learning modality, audio-presentations that highlight pertinent information for each module were then constructed. Conclusions: Registered nurses are well-suited to assess, teach, and support family caregivers. These modules are appropriate for inclusion in web-based or in-person education/support for these caregivers.