Family Caregivers Of Stroke Survivors Research Articles

The relationship between family resilience, post-traumatic growth, and caregiver burden among family caregivers of stroke survivors: a cross-sectional study

ABSTRACT The study aimed to explore the relationship between family resilience, post-traumatic growth(PTG), and caregiver burden among family caregivers of stroke survivors. Researchers conducted a cross-sectional study to recruit 253 family caregivers of stroke survivors from a public hospital in Shandong Province, China. Caregivers completed sociodemographic information, the Shortened Chinese Version of the Family Resilience Assessment Scale, the Post-traumatic Growth Inventory, and the Zarit Caregiver Burden Interview. We used Amos 24.0 to construct structural equation models and examine the mediating effects of stroke survivors’ post-traumatic growth. Family resilience was positively associated with post-traumatic growth, and both family resilience and post-traumatic growth were negatively associated with caregiver burden. Post-traumatic growth partially mediated the relationship between family resilience and caregiver burden, and the mediating effect accounted for 21.27% of the total effect. Targeted interventions should address family resilience and post-traumatic growth as protective factors of caregiver burden.

THEORETICALLY BASED FACTORS ASSOCIATED WITH STROKE FAMILY CAREGIVER HEALTH

Abstract Background Most stroke survivors are cared for at home by family members, many of whom experience depressive symptoms and life changes as a result of providing care. While many studies have explored the factors associated with depressive symptoms and quality of life in family caregivers, few have focused on caregiver health. Purpose: To determine theoretically based factors associated with unhealthy days in stroke family caregivers. Methods A conceptual model derived from Lazarus’ theory of stress and coping was used to guide analysis. Secondary data analysis was conducted using baseline data from a large randomized controlled clinical trial testing the Telephone Assessment and Skill-building Kit (TASK II) program with 254 family caregivers of stroke survivors within 2 weeks of discharge from acute care and rehabilitation settings in participating Midwestern facilities. Data were analyzed using multiple regression with unhealthy days as the dependent variable, and theoretically based factors (i.e., caregiver task difficulty, level of optimism, threat appraisal, depressive symptoms, and life changes) as independent variables. All scales demonstrated evidence of internal consistency reliability with Cronbach alpha scores above .70. Results Caregivers were mostly female (78%), white (71%), spouses (47%) or adult children (30%). Caregivers reported 9 unhealthy days on average within the past month. Unhealthy days were significantly correlated with caregiver task difficulty (r=.32), level of optimism (r=-.29), threat appraisal (r=.44), depressive symptoms (r=.60), and life changes (r=-.40) (p<.05). 37.8% variance in unhealthy days was explained, with depressive symptoms being the only significant individual predictor due to shared variance.

Exploring the experiences of family caregivers of stroke survivors in Burkina Faso: A qualitative study protocol

Background: Stroke survivors in sub-Saharan Africa frequently require continuous assistance from their relatives for daily activities and personal hygiene care. In Burkina Faso, the experiences of these caregivers are not documented. Purpose: This protocol describes a study that aims to explore in-depth the experiences of the family caregivers of stroke survivors in this region in order to better understanding the real impacts of caregiving on their overall lives. Methods: A convenience sample of twenty family caregivers recruited from both urban and semi-urban regions will be used to conduct a qualitative study. Participants will take part in individual semi-structured online interviews using an interview guide pre-designed by the authors. The interviews will be recorded and transcribed verbatim. The data will then undergo abductive thematic analysis guided by the International Classification of Functioning, Disability, and Health (ICF) framework. Expected results: Four main potential themes could eventually emerge. 1) Health and well-being of family caregivers (e.g., physical, psychological, and social impacts, health management, conflicts, and priorities); 2) Balancing caregiving responsibilities and personal life (e.g., daily caregiving management and the impact of caregiving role on social participation); 3) Impact of environment on the caregiving role (e.g., social and physical environment factors); 4) Personal experience and perceptions of the caregiving role (e.g., self-assessment as a caregiver, expectations and needs). Conclusions: To the best of our knowledge, this will be the first study of its kind conducted in this country. Therefore, it will make a substantial contribution to stroke research in sub-Saharan Africa, specifically in Burkina Faso. Ethical approval: This study was approved by the Research Ethics Committee of the Burkina Faso Ministry of Health (No: 2023-07-183). It will be conducted following the prescribed guidelines respecting the confidentiality of participants.

Family Caregivers of Stroke Survivors: OT & Mental Health & Wellness

Abstract Date Presented 04/22/2023 Helping relatives with stroke can be demanding. This study explored how OTs address mental health and wellness with family caregivers. Findings can guide education of clinicians and contribute to policy change. Primary Author and Speaker: Emili Husain Additional Authors and Speakers: Kathleen Kniepmann Contributing Authors: Kathleen Kniepmann

Telerehabilitation for Family Caregivers of Stroke Survivors: A Systematic Review and Meta-Analysis

Aim. This systematic review aimed at evaluating the effectiveness of telerehabilitation on family caregivers of stroke survivors. Background. After discharge from the hospital, family caregivers of stroke survivors faced physical and psychological stress. Telerehabilitation seems crucial for family caregivers. However, the impact of telerehabilitation on family caregivers’ health outcomes remains to be studied. Evaluation. Six databases (PubMed, Embase, Cochrane Library, Web of Science, CINAHL, and PsycINFO) were searched up to June 16th, 2022, without language restrictions. The Revised Cochrane Risk-of-bias Tool for Randomized Trials was used to assess the quality of included studies. The GRADEpro (Grading of Recommendations Assessment, Development, and Evaluation Profile) tools were applied to assess the synthesized evidence quality. The subgroup analysis was performed according to the intervention formats. Statistical analysis was conducted using Review Manager 5.3, and the publication bias was calculated by Stata 14.0. Key Issue(s). A total of 16 studies containing 992 caregivers were pooled in this systematic review. Telerehabilitation significantly improved the caregiver burden (SMD = −0.18, 95% CI = −0.35∼−0.02, P = 0.03 , moderate-quality evidence), knowledge (SMD = 0.75, 95% CI = 0.03∼1.47, P = 0.04 , very low-quality evidence), and competence (SMD = 1.35, 95% CI = 0.82∼1.88, P < 0.001 , very low-quality evidence) but not depression (SMD = −0.04, 95% CI = −0.3∼0.21, P = 0.74 , moderate-quality evidence), anxiety (MD = 0.68, 95% CI = −0.68∼2.04, P = 0.32 , low-quality evidence), and self-efficacy (SMD = −0.30, 95% CI = −1.22∼0.61, P = 0.52 , very low-quality evidence) in family caregivers of stroke survivors. The subgroup analysis demonstrated that multi-form telerehabilitation (SMD = 1.86, 95% CI = 1.32∼2.40, P < 0.001 ) was significantly effective in improving caregiving competence. Conclusion. Telerehabilitation can effectively reduce the caregiver burden as well as improve the knowledge and competence of stroke caregivers. Implications for Nursing Management. The emergence of telerehabilitation can help relieve caregivers’ stress and provide a new form for nursing managers to make discharge plans for stroke.

Backbone of Care: Lived Experiences of Family Caregivers of Stroke Survivors in Guadalupe, Cebu City

This study explored the lived experiences of five family caregivers of stroke survivors in a village in Cebu City, Philippines. Data was gathered through individual in-depth interviews and underwent interpretative phenomenological analysis. Three themes emerged: (1) Altruism of caregiving: Of self and family, (2) Victories in caregiving, and (3) Burdens of caregiving. Themes illustrated the duality of roles, overcoming difficulties of caregiving, and sources of motivation in caregiving. Findings indicate that a need for collaborative efforts and active involvement between the communities and occupational therapy with the healthcare system to provide programs and support to family caregivers.

Contributing Factors to the Burden on Primary Family Caregivers of Stroke Survivors in South Korea.

The purpose of this study is to identify the factors associated with the burden on primary family caregivers of stroke patients at home without care services. For this study, the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) data were used. Of the total 8010 caregivers, 1133 family caregiver burden was assessed with the shortened Caregiver Burden Inventory (CBI) 3 months after stroke. Patient and caregiver-related factors affecting the heavier burden of caregivers were identified by comparing the heavier caregiver burden group and the lighter caregiver burden group, which divided according to the CBI scores. The 719 (63.5%) family caregiver cared for patients at home without care services. Logistic regression analysis showed that four or more comorbidities (p = 0.002), neurological impairment at early onset (p < 0.001), dependence on daily life (p < 0.001), aphasia (p = 0.024), and depression(p < 0.001) were associated with a heavier burden of care. According to the shortened CBI, caregivers tended to be concerned more about psychological stress than physical strain. The findings suggest the importance of proactively guiding the emotional support services to caregivers who are at high risk of the heavier burden of patient care.

A different way of life: a qualitative study on the experiences of family caregivers of stroke survivors living at home.

There are approximately 1.3 million stroke survivors in the UK, with the majority of them relying on family caregivers for support. However, the needs of family caregivers are not routinely assessed by most services. The aim of this study was to explore the experiences of stroke family caregivers following the implementation of the Care Act, 2014. A total of 16 semi-structured, digitally recorded face-to-face qualitative interviews were conducted with a purposive sample of stroke family caregivers in north-west England. Thematic analysis was undertaken. Two themes were identified: the effects of caregiving and the unmet needs of the family caregivers. Despite changes to legislation, family caregivers of stroke survivors continue to experience challenges, such as financial problems, information needs, and a lack of respite and emotional support when providing care. Existing approaches to identifying and supporting caregiver needs are insufficient. Proactive approaches are required to ensure the needs of family caregivers are identified and addressed on a regular basis.

Influence of psychological responses of caregiving on the perceived health of family caregivers to acute stroke survivors.

Family caregivers provide round-the-clock care to their family members who had a stroke. The detrimental effects of caregiving on caregiver’s health would lead to the abandonment of caregiver role and institutionalization of stroke survivors. This study aims to determine the factors associated with the perceived health status of family caregivers to stroke survivors. This study conducted a secondary analysis of the baseline data of 142 family caregivers of stroke survivors nested within a longitudinal randomized controlled trial. Potential factors were identified according to the Pittsburgh Mind-Body Center model and were analyzed with hierarchical multiple regression models. The results indicated that stroke caregivers exhibited comparable perceived physical health with general population but poorer perceived mental health. Severity of depressive symptoms (β = −0.37, P < .001) remained the strongest and most significant factor associated with perceived mental health, followed by confidence in problem-solving (β = −0.21, P < .05). Moreover, caregiving competence (β = 0.29, P < .001) was the sole significant psychological factor associated with perceived physical health. Caregiving competence, problem-solving abilities, and severity of depressive symptoms are significant modifiable correlates of the perceived health of caregivers. Intervention for improving these psychological responses of caregivers is suggested incorporated in stroke rehabilitation programs.

Needs of family members caring for stroke survivors in china: A deductive qualitative content analysis study by using the caregiver task inventory-25

BackgroundIn China, family caregivers are usually the main carers of relatives after stroke due to traditional Chinese culture and the limited development of the primary healthcare system. This responsibility often results in burdens and negative health outcomes. However, family caregivers seldom receive support. To improve informal care, as well as the health and well-being of family caregivers, it is important to identify their needs.ObjectiveThis study aimed to deductively explore the needs of family members caring for stroke survivors in China.MethodsTwenty-six semi-structured interviews were performed with family caregivers of stroke survivors who were selected from one city and three communities by purposive sampling. A deductive qualitative content analysis method was performed by using the Caregiver Task Inventory-25 (CTI-25), an instrument measuring the needs of family caregivers, as a framework.ResultsAll subscales, as well as all belonging items in the CTI-25, were identified in the present study, meaning that the family caregivers had needs related to learning to cope with new role, providing care according to care-receiver’s needs, managing own emotional needs, appraising supportive resources, and balancing caregiving needs and one’s own needs. Moreover, needs related to financial support, both direct and indirect, were identified but not part of the CTI-25.ConclusionThese findings identified that family caregivers of stroke survivors in China had various needs, which is important knowledge when assessing needs and improving health care for family caregivers. Cultural adjustments and modifications should be made if CTI-25 is used in mainland China. This study also indicated a comprehensive and holistic perspective (individual, community, and social level) when identifying, assessing needs or implementing interventions to support family caregivers.

Effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors: a randomised controlled trial

ObjectivesTo evaluate the effectiveness of a tailored multidimensional intervention in reducing the care burden of family caregivers of stroke survivors. This intervention considered caregivers’ perceived needs and incorporated three evidence-based...

Support system diversity among family caregivers of stroke survivors: a qualitative study exploring Asian perspectives

BackgroundCaregiving is a global phenomenon which is bound to increase in tandem with the aging population worldwide. Stroke is a condition common in older people that requires complex caregiving necessitating provision of adequate support to the caregivers. Past literature consists of limited accounts of types and organization of support arrangements needed by different caregivers. We aimed to describe the support system of caregivers of stroke survivors in Singapore, highlighting differences across the different caregiver identities (i.e. spouse, adult-child, etc.).MethodsWe conducted a qualitative descriptive study in the community setting involving 61 purposively sampled and recruited stroke survivors and caregivers. Semi-structured interviews were conducted, and transcripts were analysed using thematic analysis.ResultsOur findings were summarized across the following 4 themes: 1) cultural influence and caregiving; 2) caregiver support system with the following sub-themes: 2.1) dyadic caregiver support type, 2.2) extended caregiver support type, 2.3.) distributed caregiver support type and 2.4) empowering caregiver support type; 3) breaks in care of stroke survivor and 4) complex relationship dynamics. We operationalized the caregiver support system as comprising of type, people and activities that enable the caregiver to participate in caregiving activities sustainably. While spouse caregivers preferred dyadic and extended support systems positioning themselves in a more central caregiving role, adult-child caregivers preferred distributed support system involving family members with paid caregivers playing a more central role.ConclusionsOur findings highlight caregiver identity as a surrogate for the differences in the caregiver support systems. Practical implications include imparting relationship-building skills to the stroke survivor-caregiver dyads to sustain dyadic support system and educating clinicians to include differences in caregiving arrangements of stroke survivors in practising family-centred care.

Effectiveness of a Two-Tier Family-Oriented Intervention in Enhancing the Family Functioning and Care Capacity of the Family Caregivers of Stroke Survivors: Protocol for a Randomized Controlled Trial.

BackgroundStroke has profound impacts on families. Often, family members, including stroke survivors and the person who takes up the role of the primary caregiver, would encounter demands on finances, rehabilitation arrangement, and even conflicts. Hence, a family-oriented intervention is expected to enable families to rebuild internal and external resources to achieve optimal rehabilitation and community reintegration.ObjectiveThis study aims to describe a design of a two-tier family-oriented care management intervention for enhancing the family functioning and care capacity of the caregivers of stroke survivors.MethodsThe two-tier care management intervention was guided by a standardized protocol conducted by trained professional care managers (first tier) with the support of trained volunteers (second tier), which lasted for 8-12 weeks. Participants were recruited through collaborating hospitals according to inclusion and exclusion criteria. In order to examine the effectiveness and cost-effectiveness of the two-tier care management intervention, a two-arm randomization multicenter study was designed, including an active comparison group, which was guided by a standardized protocol conducted by trained volunteers. Dyadic participants, including both stroke survivors and their primary caregivers for both groups, were invited to participate in a questionnaire survey using standardized and purposefully developed measures 3 times: before the intervention, immediately after the intervention, and 2 months after the intervention. The primary outcome was family functioning measured by the Family Role Performance Scale and Family Assessment Device-General Functioning Scale. The secondary outcomes included caregiving burden, depressive symptoms, care management strategies, and the incremental cost-effectiveness ratio.ResultsRecruitment began in January 2017 and was completed at the end of April 2019. Data collection was completed at the end of March 2020. As of March 2020, enrollment has been completed (n=264 stroke caregivers). A total of 200 participants completed the baseline questionnaires. We aim to publish the results by mid-2021.ConclusionsThis study successfully developed a two-tier care management protocol that aims to enhance the family functioning of the caregivers of stroke survivors. Guided by a standardized protocol, this family-oriented two-tier intervention protocol was found to be feasible among Chinese families.Trial RegistrationClinicalTrials.gov NCT03034330; https://ichgcp.net/clinical-trials-registry/NCT03034330International Registered Report Identifier (IRRID)RR1-10.2196/16703

A Validation Study of the Revised Caregiving Burden Instrument in Korean Family Caregivers of Stroke Survivors.

Background: The purpose of the present study was to examine the internal consistency reliability and construct validity of the Caregiving Burden Instrument in Korean informal caregivers of stroke survivors. Methods: A descriptive survey design was used with a convenience sample of 208 primary caregivers of stroke survivors. Internal consistency reliability was assessed using Cronbach’s alpha coefficients. Construct validity was assessed using exploratory and known-group analysis. Results: Each subscale and the total scale demonstrated satisfactory internal consistency reliability. Exploratory factor analysis identified five factors: family support, patient’s dependency, physical health, financial burden, and psychological health, which together accounted for 62.7% of the variance. Known-group analysis indicated that caregivers with more than one year of experience reported significantly higher mean scores for the total burden score and its five subscales compared to those with less than one year. Conclusions: This 23-item instrument demonstrates good internal consistency reliability and construct validity. The tool can be used to effectively assess burden in caregivers of stroke survivors and the data obtained can form the basis for the development of family interventions.

Determinants of Health Promotion Behaviors among Family Caregivers of Stroke Survivors.

Purpose:To record the health promotion behaviors of family caregivers of stroke survivors, as well as potential determinants that could affect these behaviors. Methods: A cross-sectional study was carried out through home visits in the Attica region using the convenience sampling method. The studied population included 109 survivors who had suffered a stroke and experienced functional problems, and their 109 primary caregivers, who were family members, lived in the same house and were fully responsible for their care. The dependent variables were the caregivers’ health promotion behaviors, while the independent variables were the survivors and caregivers’ demographic characteristics, survivors’ functional capacity, depression, social support and changes in caregivers’ lives from caring. Results: Better health promotional behaviors were associated with the following: patient having advanced age and a high level of functionality, caregivers assessing their own state of health as “good”, greater social support, a higher educational level and a higher income level. In addition, more hours of patient care were associated with a less healthy lifestyle for caregivers. Conclusions: Promoting the health of family caregivers of stroke survivors is crucial for both survivors and caregivers. For this reason, it is of great importance to detect factors that affect the health promotion behaviors of caregivers in order to carry out appropriate interventions and improve their quality of life.

Effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors: study protocol for a randomised controlled trial

IntroductionCaring for stroke survivors creates high levels of care burden among family caregivers. Previous initiatives at alleviating the care burden have been unsuccessful. The proposed study aims to evaluate the...

Depressive Symptom Trajectories in Family Caregivers of Stroke Survivors During First Year of Caregiving.

The purpose of this study was to identify patterns of depressive symptom trajectory and examine the associations of the symptom trajectory with caregiving burden, family function, social support, and perceived health status of caregivers of stroke survivors during the first year of caregiving after discharge from rehabilitation center. Caregivers of stroke survivors completed a survey of depressive symptoms, caregiving burden, family function, perceived availability of social support, and perceived health status at postdischarge and 1 year. Patterns of depressive symptom trajectory (ie, symptom-free, symptom relieved, symptom developed, and persistent symptom groups) were identified by grouping depressive symptoms based on 2 assessments using the Center for Epidemiologic Studies-Depression. Repeated-measures analysis of variance and multinomial logistic regression were used to examine the associations. Of the 102 caregivers, 57.8% were symptom-free, 20.6% experienced persistent depressive symptoms, 11.8% relieved depressive symptoms, and 9.8% developed depressive symptoms. There were significant changes in family function (Wilks λ = 0.914, P = .038) and perceived health status (Wilks λ = 0.914, P = .033) among the groups during the first year of caregiving. The persistent symptom group reported the highest level of burden and the lowest level of family function and perceived availability of social support at both assessment times. Compared with symptom-free caregivers, caregivers with persistent depressive symptoms were 7 times more likely to have fair/poor health rather than excellent/very good health at 1 year (odds ratio, 7.149; P = .012). Caregivers with persistent depressive symptoms are the most vulnerable to negative psychosocial outcomes and poor perceived health status during the first year of caregiving from discharge for stroke survivors.

Family Caregiver’s Positive, Negative, and Ambivalent Feelings Towards Stroke Survivors: Association with Psychological Well-Being

Ambivalence is the simultaneous experience of positive and negative feelings toward a specific person. Recent research suggested ambivalence is negatively associated with psychological well-being, and this association was mainly driven by negative feelings and not affected by the presence of positive feelings. This paper questioned the assumption and aimed to examine the relationship between caregiving ambivalence and psychological well-being, by disaggregating the positive and negative components of ambivalence. The study comprised data from a cross-sectional questionnaire survey with 190 family caregivers of stroke survivors (56 ± 14.3 years old; 70% female) in Hong Kong. The positive feelings and negative feelings towards a care recipient were separately measured, and these two composite scores were used to create an indirect measure of ambivalence. Psychological well-being was measured by caregivers’ positive role appraisals and depressive symptoms. Hierarchical multiple regression showed that the positive feeling was associated with positive aspects of caregiving (β = 0.54, p < 0.001) whereas negative feeling was associated with depressive symptoms (β = 0.61, p < 0.001). There was no positive X negative interaction on depressive symptoms and positive aspects of caregiving. The indirect measure of ambivalence only associated with depressive symptoms (β = 0.75, p < 0.001). Findings indicate the association between caregiving ambivalence and psychological well-being is varied by dominating valence as well as the method to combine the effects of positive and negative feelings. The positive and negative feelings associated with corresponding dimensions of psychological well-being but not to the opposite-valence outcomes. The indirect measure of ambivalence mainly reflects its negative component.

Benefits finding among Chinese family caregivers of stroke survivors: a qualitative descriptive study

ObjectivesThe caregiving experience includes both caregiver burdens and benefits finding. However, the benefits obtained by family caregivers of stroke survivors in Chinese community dwellings are unknown. The objective of this...

Creating a Caregiver Benefit Finding Scale of Family Caregivers of Stroke Survivors: Development and Psychometric Evaluation.

In recent years, increased attention has been paid to the benefit finding of family caregivers due to the important role they play. Although some instruments measure benefit finding of caregivers, they do not comprehensively address it in terms specific to the family caregivers of stroke survivors, who require long-term, consistent care. This study is the first effort to develop a comprehensive Caregiver Benefit Finding Scale for the family caregivers of stroke survivors in a Chinese cultural setting. First, 50 items were extracted from a systematic literature review, and a semi-structured interview was conducted with 20 stroke family caregivers to develop the preliminary version of the scale (Version 1). Second, Delphi procedures with 20 experts were used to revise the first version and create Version 2 (37 items). Another six experts were recruited for content validation. Item content validity index (I-CVI) values ranged from 0.83 to 1.00, and the value of the scale CVI was 0.97. Third, 309 family caregivers completed the Version 2 questionnaire and the Chinese version of the Positive Aspects of Caregiving. Two weeks later, 35 family caregivers once again completed the questionnaires. An exploratory factor analysis produced four components (personal growth, health promotion, family growth, and self-sublimation) and 26 items for Version 3 (the cumulative proportion variance was 74.14%). Subsequently, 311 family caregivers completed Version 3. A confirmatory factor analysis confirmed the structure. The goodness of fit index (GFI) = 0.921, adjusted GFI = 0.901, normal fit index = 0.951, incremental fit index = 0.990, comparative FI = 0.990, and the root mean square error of approximation = 0.02 were within the acceptable range. Criterion-related validity was equal to 0.803. The model-based internal consistency index was 0.845 and the values of the Cronbach’α coefficient of the four dimensions were 0.885–0.953. The split-half reliability was 0.92, and the test-retest reliability was 0.994. These findings provide preliminary evidence of the validity and reliability of the Caregiver Benefit Finding Scale. The scale can help researchers and clinicians to achieve a more comprehensive understanding of stroke family caregivers’ positive experience. This understanding is necessary for future efforts to address issues in benefit finding by targeting the underlying mechanism and intervention.