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Xu X, Chen H, Xu D, Tan F, Li X. A scoping review of hospital to home transitional care programmes for stroke survivors. J Clin Nurs 2024. [PMID: 38887147 DOI: 10.1111/jocn.17070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 06/20/2024]
Abstract
AIM The study was aimed at exploring the current scope of hospital to home transitional care programmes for stroke survivors. BACKGROUND Stroke survivors face the dilemma of solving many complex problems that leave survivors at high risk for readmission as they discharge from hospital. The transitional care model has proved to be effective in reducing readmissions and mortality, thereby improving health outcomes and enhancing patient satisfaction for survivors with stroke. DESIGN A scoping review. METHODS Conducted in accordance with the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. DATA SOURCES A comprehensive search was conducted in nine databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CINAHL, Medline, China Knowledge Net-work, Wanfang Database and China Biomedical Literature Database (SinoMed) from January 2014 to June 2023. RESULTS Title and abstract screening was performed on 10,171 articles resulting in 287 articles for full-text screening. Full-text screening yielded 49 articles that met inclusion criteria. CONCLUSION This study identified transitional care programmes for stroke survivors, as well as areas for future consideration to be explored in more depth to help improve transitional care for stroke survivors as they transition from hospital to home. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This study demonstrates that multidisciplinary collaboration becomes an integral part of the transitional care model for stroke survivors, which provides comprehensive and precise medical care to them. REPORTING METHOD PRISMA checklist for scoping reviews. PATIENT AND PUBLIC CONTRIBUTION No patient or public contribution was part of this study.
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Affiliation(s)
- Xuewei Xu
- Department of Nursing Humanities, School of Nursing, China Medical University, Shenyang, China
| | - Huijie Chen
- Department of Nursing Humanities, School of Nursing, China Medical University, Shenyang, China
| | - Dandan Xu
- Department of Nursing Humanities, School of Nursing, China Medical University, Shenyang, China
| | - Fengying Tan
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang, China
| | - Xiaohan Li
- Department of Nursing Humanities, School of Nursing, China Medical University, Shenyang, China
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Ganefianty A, Songwathana P, Damkliang J. Readiness for hospital discharge perceived by caregivers of patients with traumatic brain injury: A cross-sectional study. BELITUNG NURSING JOURNAL 2024; 10:209-214. [PMID: 38690311 PMCID: PMC11056832 DOI: 10.33546/bnj.3019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/08/2023] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
Background There is a growing emphasis on evaluating discharge readiness, particularly for those involved in the care of patients in transition. Caregivers supporting individuals with traumatic brain injury are a specific focus due to the potential impact of adequate discharge preparation on patient recovery and post-discharge outcomes. Objective This research aimed to evaluate the preparedness of caregivers for the discharge of patients with moderate or severe traumatic brain injury from the hospital. Methods This cross-sectional study was carried out in a tertiary hospital in Indonesia from January to April 2023 using the Indonesian adaptation of the Preparedness for Caregiving Scale. The study comprised seventy-four caregivers of individuals with traumatic brain injury, chosen through a purposive sampling approach based on pre-established inclusion and exclusion criteria. Data collection involved a questionnaire covering caregiver information (gender, age, education level, income, and psychological status) and discharge readiness. Descriptive statistics and correlation analyses, employing Pearson and chi-square, were conducted. Results Most caregivers were female (83.8%), spouses of patients (50%), and had a moderate education level (52.7%). The average age of caregivers was 43.7 ± 8.7 years, with an average duration of patient care of 4.22 ± 1.2 days and a monthly income of 220 US dollars. The mean score for readiness for hospital discharge was low (10.08 ± 1.91), indicating that caregivers were not adequately prepared for discharge. Age and education were significant factors (p <0.05) related to hospital discharge readiness. Conclusion This study emphasizes the importance of assessing caregiver readiness for the discharge of patients with traumatic brain injury from the hospital. Findings indicate a concerning trend of inadequate preparedness among caregivers, with factors such as age and education level significantly influencing readiness. The predominance of female caregivers, often spouses of patients, indicates the need for tailored support strategies. Prioritizing caregiver preparation and support, especially by nurses, is crucial for optimizing patient recovery and post-discharge outcomes.
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Affiliation(s)
- Amelia Ganefianty
- Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
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Ganefianty A, Songwathana P, Damkliang J, Imron A, Latour JM. A Mobile Health Transitional Care Intervention Delivered by Nurses Improves Postdischarge Outcomes of Caregivers of Patients with Traumatic Brain Injury: A Randomized Controlled Trial. World Neurosurg 2024; 184:191-201. [PMID: 38244683 DOI: 10.1016/j.wneu.2024.01.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE Caring for patients with traumatic brain injury (TBI) during the transition from hospital to home can be psychologically challenging to caregivers. This study aimed to assess the effectiveness of a novel mobile health (m-health) transitional care intervention to reduce stress and burden of caregivers of patients with TBI and to reduce readmissions. METHODS A randomized controlled trial was conducted with 74 caregivers of adult patients with moderate or severe TBI admitted to a referral hospital in Indonesia. An m-health application for Android mobile phones was designed including education and information for caregivers. The application included an online chat feature with weekly monitoring. The m-health transitional care intervention also included face-to-face education before hospital discharge. Primary outcomes were caregivers' stress and burden. Outcomes were measured at 3 time points: at hospital discharge, 2 weeks postdischarge, and 4 weeks postdischarge. Random Allocation Software was used for randomization of study participants. RESULTS Final analysis included data of 37 caregivers in the intervention group and 37 caregivers in the control group. Stress within the intervention group decreased over time (P < 0.001, mean difference = 11.05). Between both groups, stress was significantly different at 2 weeks and 4 weeks postdischarge (P < 0.001). Caregiver burden showed similar results (2 weeks postdischarge P < 0.001 and 4 weeks postdischarge P < 0.001). Only 1 patient in the control group was readmitted to the hospital. CONCLUSIONS The m-health transitional care intervention reduced stress and burden of caregivers of patients with moderate or severe TBI. Nurses should consider using m-health technologies to support caregivers in the transition from the hospital into the community.
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Affiliation(s)
- Amelia Ganefianty
- Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand; Department of Nursing, Hasan Sadikin Hospital, Bandung, Indonesia
| | | | | | - Akhmad Imron
- Department of Neurosurgery, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Jos M Latour
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK; School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
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Saragih ID, Everard G, Saragih IS, Lee BO. The beneficial effects of transitional care for patients with stroke: A meta-analysis. J Adv Nurs 2024; 80:789-806. [PMID: 37727124 DOI: 10.1111/jan.15850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/21/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Transitional care interventions have emerged as a promising method of ensuring treatment continuity and health care coordination when patients are discharged from hospital to home. However, few studies have investigated the frequency and duration of interventions and the effects of interventions on physical function. Therefore, this study aimed to determine the efficacy of transitional care for patients with stroke. METHODS Six databases and the grey literature were searched to obtain relevant articles from October 1, 2022 to March 10, 2023. The primary outcomes studied were motor performance, walking speed, activities of daily living (ADLs) and caregiver burden following hospital-to-home transitional care. The quality of the studies was assessed with Cochrane risk of bias version 2. The quality and sensitivity of the evidence were assessed to ensure rigour of the findings. Meta-analyses were performed using stata 17.0. RESULTS A total of 2966 patients were identified from 23 studies. Transitional care improved post-stroke motor performance, walking speed and ADLs, and reduced caregiver burden. CONCLUSION The findings suggest that provision of transitional care model implementation in patients with stroke is important because it reduces disability in stroke patients and helps to decrease caregivers' burden. IMPACT The findings of the study emphasize the importance of transitional care programmes for stroke patients after they are discharged from the hospital and returned to their homes. To meet the needs of patients, all levels of health professionals including nurses should be aware of the discharge process and care plan.
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Affiliation(s)
| | - Gauthier Everard
- Centre Interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Québec, QC, Canada
- Pole d'Hépato-Gastro-Entérologie, Institut de Recherche Expérimentale et Clinique, UCLouvain, Bruxelles, Belgium
| | - Ice Septriani Saragih
- Department of Medical Surgical Nursing, STIkes Santa Elisabeth Medan, Medan, Indonesia
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Chiayi, Taiwan
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Zhang XY, Sha KH, Ma XY, Li XM, Zhang MH. Dyadic psycho-social interventions for stroke survivors and family caregivers: A systematic review and meta-analysis of randomized controlled trials. J Adv Nurs 2023; 79:3707-3726. [PMID: 37439492 DOI: 10.1111/jan.15781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
AIMS AND OBJECTIVES To describe dyadic psycho-social intervention measures and to evaluate their influence on stroke survivors and caregiver's functional independence, quality of life, depression, anxiety, self-efficacy and coping ability. BACKGROUND Because of the importance of dyadic intervention and the seriousness of the psycho-social problems of stroke survivors and caregivers, understanding the influence of dyadic psycho-social interventions is vital. DESIGN A systematic review and meta-analysis based on PRISMA guidelines. DATA SOURCES Nine databases were systematically searched for randomized controlled trials submitted from 1910 to 4 July 2022. METHODS The included papers were evaluated for quality, and quantitative data were standardly extracted and analysed by meta-analysis, followed by synthesis. The meta-analysis was carried out using Review Manager 5.4 software. RESULTS Fifteen randomized controlled trials were included (n = 2190 for patients, and n = 1933 for caregivers). Study results showed that dyadic psycho-social interventions significantly alleviated the depressive symptoms of patients, obviously improved the ability to function independently of patients and more quickly alleviated the care burden of caregivers. CONCLUSIONS This study provided moderate support for the benefits of dyadic psycho-social intervention in improving survivor and caregiver's functional independence, quality of life, depression, anxiety, self-efficacy and care burden. Nevertheless, due to limitations of the study, it was deemed necessary that this topic is studied further. RELEVANCE TO CLINICAL PRACTICE This review suggests that dyadic psycho-social interventions should be considered as effective strategies for decreasing psycho-social problems of stroke survivors and caregivers, and provides evidence for the formulation of targeted intervention programs. The personalized implementation of such interventions should be the focus of clinical practice. NO PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution.
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Affiliation(s)
- Xin-Yue Zhang
- School of Nursing, Binzhou Medical University, Binzhou, Shandong, China
| | - Kai-Hui Sha
- School of Nursing, Binzhou Medical University, Binzhou, Shandong, China
| | - Xue-Ying Ma
- The Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, China
| | - Xue-Mei Li
- The Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, China
| | - Ming-Hui Zhang
- School of Nursing, Binzhou Medical University, Binzhou, Shandong, China
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Wang W, Wang X, Vellone E, Zhang Z. Effectiveness of a smartphone-enabled dyadic self-care programme (SDSCP) for stroke survivors and caregivers: study protocol for a randomised controlled trial. BMJ Open 2023; 13:e073016. [PMID: 37666544 PMCID: PMC10481751 DOI: 10.1136/bmjopen-2023-073016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION The promotion of self-care has begun to serve as a central response strategy to the rising burden of stroke. In fact, stroke self-care can be recognised to be a dyad phenomenon having an effect on the health of stroke survivors and their caregivers. While studies have confirmed the effectiveness of smartphone-based interventions in improving self-care among stroke survivors, there remains a lack of evidence specifically regarding dyadic self-care interventions for both patients and caregivers. AIM The present single-blinded, two-arm, randomised controlled trial aims to verify the effectiveness of a smartphone-enabled dyadic self-care programme (SDSCP) for stroke survivors and their caregivers. METHODS AND ANALYSIS The estimated sample size is 152 stroke survivor-caregiver dyads. The participants will be randomly classified (1:1) into either a control (N=76) or an experimental group (N=76) through block randomisation. The participants classified into the experimental group will be provided with SDSCP, and during the initial home visit, the research team members will provide instructions to all patients and caregivers on how to download and use the smartphone application. While the participants in the control group will be given the existing stroke standard care. The main outcome measures of stroke survivors will consist of the Self-Care of Stroke Inventory and a short version of the Stroke Specific Quality of Life Scale. The outcome measures of stroke caregivers will primarily cover the Caregiver Contribution to Self-Care of Stroke Inventory and Zarit burden interview. The data of this study will be collected at three time points, including baseline, 1 month and 6 months from the baseline. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of Zhengzhou University (ZZUIRB 2021-115) in January 2021. The results achieved in this study will facilitate the clinical practice to improve self-care of stroke survivors and promote dyadic health outcomes for stroke patients and caregivers. TRIAL REGISTRATION NUMBER The study was registered with the Chinese Clinical Trial Registry and the registration number is ChiCTR2100053591.
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Affiliation(s)
- Wenna Wang
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoxuan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Ercole Vellone
- Department of Biomedicine and Prevention, Universita degli Studi di Roma Tor Vergata, Roma, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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Hildebrand MW, Geller D, Proffitt R. Occupational Therapy Practice Guidelines for Adults With Stroke. Am J Occup Ther 2023; 77:7705397010. [PMID: 37862268 DOI: 10.5014/ajot.2023.077501] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
IMPORTANCE Stroke is a leading cause of disability. Occupational therapy practitioners ensure maximum participation and performance in valued occupations for stroke survivors and their caregivers. OBJECTIVE These Practice Guidelines are meant to support occupational therapy practitioners' clinical decision making when working with people after stroke and their caregivers. METHOD Clinical recommendations were reviewed from three systematic review questions on interventions to improve performance and participation in daily activities and occupations and from one question on maintaining the caregiving role for caregivers of people after stroke. RESULTS The systematic reviews included 168 studies, 24 Level 1a, 90 Level 1b, and 54 Level 2b. These studies were used as the basis for the clinical recommendations in these Practice Guidelines and have strong or moderate supporting evidence. CONCLUSIONS AND RECOMMENDATIONS Interventions with strong strength of evidence for improving performance in activities of daily living and functional mobility include mirror therapy, task-oriented training, mental imagery, balance training, self-management strategies, and a multidisciplinary three-stages-of-care rehabilitation program. Constraint-induced therapy has strong strength of evidence for improving performance of instrumental activities of daily living. Moderate strength of evidence supported cognitive-behavioral therapy (CBT) to address balance self-efficacy, long-term group intervention to improve mobility in the community, and a wearable upper extremity sensory device paired with training games in inpatient rehabilitation to improve social participation. Practitioners should incorporate problem-solving therapy in combination with CBT or with education and a family support organizer program. What This Article Adds: These Practice Guidelines provide a summary of strong and moderate evidence for effective interventions for people with stroke and for their caregivers.
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Affiliation(s)
- Mary W Hildebrand
- Mary W. Hildebrand, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA
| | - Daniel Geller
- Daniel Geller, EdD, MPH, OTR/L, is Assistant Professor of Rehabilitation and Regenerative Medicine, Programs in Occupational Therapy, Columbia University, New York, NY
| | - Rachel Proffitt
- Rachel Proffitt, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Missouri, Columbia
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Veroniki AA, Soobiah C, Nincic V, Lai Y, Rios P, MacDonald H, Khan PA, Ghassemi M, Yazdi F, Brownson RC, Chambers DA, Dolovich LR, Edwards A, Glasziou PP, Graham ID, Hemmelgarn BR, Holmes BJ, Isaranuwatchai W, Legare F, McGowan J, Presseau J, Squires JE, Stelfox HT, Strifler L, Van der Weijden T, Fahim C, Tricco AC, Straus SE. Efficacy of sustained knowledge translation (KT) interventions in chronic disease management in older adults: systematic review and meta-analysis of complex interventions. BMC Med 2023; 21:269. [PMID: 37488589 PMCID: PMC10367354 DOI: 10.1186/s12916-023-02966-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Chronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults. METHODS Design: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT. ELIGIBILITY CRITERIA Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care). INFORMATION SOURCES We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database's inception to March 2020. OUTCOME MEASURES Sustainability, fidelity, adherence of KT interventions for CDM practice, quality of life (QOL) and quality of care (QOC). Data extraction, risk of bias (ROB) assessment: We screened, abstracted and appraised articles (Effective Practice and Organisation of Care ROB tool) independently and in duplicate. DATA SYNTHESIS We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data. RESULTS We included 158 RCTs (973,074 participants [961,745 patients, 5540 caregivers, 5789 providers]) and 39 companion reports comprising 329 KT interventions, involving patients (43.2%), healthcare providers (20.7%) or both (10.9%). We identified 16 studies described as assessing sustainability in 8.1% interventions, 67 studies as assessing adherence in 35.6% interventions and 20 studies as assessing fidelity in 8.7% of the interventions. Most meta-analyses suggested that KT interventions improved QOL, but imprecisely (36 item Short-Form mental [SF-36 mental]: MD 1.11, 95% confidence interval [CI] [- 1.25, 3.47], 14 RCTs, 5876 participants, I2 = 96%; European QOL-5 dimensions: MD 0.01, 95% CI [- 0.01, 0.02], 15 RCTs, 6628 participants, I2 = 25%; St George's Respiratory Questionnaire: MD - 2.12, 95% CI [- 3.72, - 0.51] 44 12 RCTs, 2893 participants, I2 = 44%). KT interventions improved QOC (OR 1.55, 95% CI [1.29, 1.85], 12 RCTS, 5271 participants, I2 = 21%). CONCLUSIONS KT intervention sustainability was infrequently defined and assessed. Sustained KT interventions have the potential to improve QOL and QOC in older adults with CDM. However, their overall efficacy remains uncertain and it varies by effect modifiers, including intervention type, chronic disease number, comorbidities, and participant age. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018084810.
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Affiliation(s)
- Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
| | - Charlene Soobiah
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Yonda Lai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Patricia Rios
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Heather MacDonald
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Paul A. Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Marco Ghassemi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Fatemeh Yazdi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO USA
- Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO USA
| | - David A. Chambers
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD USA
| | - Lisa R. Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON Canada
- Department of Family Medicine David Braley Health Sciences Centre, McMaster University, 100 Main Street West, Hamilton, ON Canada
| | - Annemarie Edwards
- Canadian Partnership Against Cancer, 1 University Avenue, Toronto, ON Canada
| | - Paul P. Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226 Australia
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON Canada
| | - Brenda R. Hemmelgarn
- Department of Medicine, University of Alberta, C MacKenzie Health Sciences Centre, WalterEdmonton, AB 2J2.00 Canada
| | - Bev J. Holmes
- The Michael Smith Foundation for Health Research (MSFHR), 200 - 1285 West Broadway, Vancouver, BC Canada
| | - Wanrudee Isaranuwatchai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - France Legare
- Département de Médecine Familiale Et Médecine d’urgenceFaculté de Médecine, Université Laval Pavillon Ferdinand-Vandry1050, Avenue de La Médecine, Local 2431, Québec, QC Canada
- Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec 1050, Chemin Sainte-Foy, Local K0-03, Québec, QC Canada
| | - Jessie McGowan
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON Canada
| | - Janet E. Squires
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - Henry T. Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB Canada
| | - Lisa Strifler
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Trudy Van der Weijden
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Debeyeplein 1, Maastricht, The Netherlands
| | - Christine Fahim
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Andrea C. Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Epidemiology Division & Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, ON Canada
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Allida SM, Hsieh CF, Cox KL, Patel K, Rouncefield-Swales A, Lightbody CE, House A, Hackett ML. Pharmacological, non-invasive brain stimulation and psychological interventions, and their combination, for treating depression after stroke. Cochrane Database Syst Rev 2023; 7:CD003437. [PMID: 37417452 PMCID: PMC10327406 DOI: 10.1002/14651858.cd003437.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Depression is an important morbidity associated with stroke that impacts on recovery, yet is often undetected or inadequately treated. OBJECTIVES To evaluate the benefits and harms of pharmacological intervention, non-invasive brain stimulation, psychological therapy, or combinations of these to treat depression after stroke. SEARCH METHODS This is a living systematic review. We search for new evidence every two months and update the review when we identify relevant new evidence. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review. We searched the Specialised Registers of Cochrane Stroke, and Cochrane Depression Anxiety and Neurosis, CENTRAL, MEDLINE, Embase, five other databases, two clinical trials registers, reference lists and conference proceedings (February 2022). We contacted study authors. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing: 1) pharmacological interventions with placebo; 2) non-invasive brain stimulation with sham stimulation or usual care; 3) psychological therapy with usual care or attention control; 4) pharmacological intervention and psychological therapy with pharmacological intervention and usual care or attention control; 5) pharmacological intervention and non-invasive brain stimulation with pharmacological intervention and sham stimulation or usual care; 6) non-invasive brain stimulation and psychological therapy versus sham brain stimulation or usual care and psychological therapy; 7) pharmacological intervention and psychological therapy with placebo and psychological therapy; 8) pharmacological intervention and non-invasive brain stimulation with placebo and non-invasive brain stimulation; and 9) non-invasive brain stimulation and psychological therapy versus non-invasive brain stimulation and usual care or attention control, with the intention of treating depression after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risk of bias, and extracted data from included studies. We calculated mean difference (MD) or standardised mean difference (SMD) for continuous data, and risk ratio (RR) for dichotomous data, with 95% confidence intervals (CIs). We assessed heterogeneity using the I² statistic and certainty of the evidence according to GRADE. MAIN RESULTS We included 65 trials (72 comparisons) with 5831 participants. Data were available for: 1) 20 comparisons; 2) nine comparisons; 3) 25 comparisons; 4) three comparisons; 5) 14 comparisons; and 6) one comparison. We found no trials for comparisons 7 to 9. Comparison 1: Pharmacological interventions Very low-certainty evidence from eight trials suggests pharmacological interventions decreased the number of people meeting the study criteria for depression (RR 0.70, 95% CI 0.55 to 0.88; P = 0.002; 8 RCTs; 1025 participants) at end of treatment and very low-certainty evidence from six trials suggests that pharmacological interventions decreased the number of people with inadequate response to treatment (RR 0.47, 95% CI 0.32 to 0.70; P = 0.0002; 6 RCTs; 511 participants) compared to placebo. More adverse events related to the central nervous system (CNS) (RR 1.55, 95% CI 1.12 to 2.15; P = 0.008; 5 RCTs; 488 participants; very low-certainty evidence) and gastrointestinal system (RR 1.62, 95% CI 1.19 to 2.19; P = 0.002; 4 RCTs; 473 participants; very low-certainty evidence) were noted in the pharmacological intervention than in the placebo group. Comparison 2: Non-invasive brain stimulation Very low-certainty evidence from two trials show that non-invasive brain stimulation had little to no effect on the number of people meeting the study criteria for depression (RR 0.67, 95% CI 0.39 to 1.14; P = 0.14; 2 RCTs; 130 participants) and the number of people with inadequate response to treatment (RR 0.84, 95% CI 0.52, 1.37; P = 0.49; 2 RCTs; 130 participants) compared to sham stimulation. Non-invasive brain stimulation resulted in no deaths. Comparison 3: Psychological therapy Very low-certainty evidence from six trials suggests that psychological therapy decreased the number of people meeting the study criteria for depression at end of treatment (RR 0.77, 95% CI 0.62 to 0.95; P = 0.01; 521 participants) compared to usual care/attention control. No trials of psychological therapy reported on the outcome inadequate response to treatment. No differences in the number of deaths or adverse events were found in the psychological therapy group compared to the usual care/attention control group. Comparison 4: Pharmacological interventions with psychological therapy No trials of this combination reported on the primary outcomes. Combination therapy resulted in no deaths. Comparison 5: Pharmacological interventions with non-invasive brain stimulation Non-invasive brain stimulation with pharmacological intervention reduced the number of people meeting study criteria for depression at end of treatment (RR 0.77, 95% CI 0.64 to 0.91; P = 0.002; 3 RCTs; 392 participants; low-certainty evidence) but not the number of people with inadequate response to treatment (RR 0.95, 95% CI 0.69 to 1.30; P = 0.75; 3 RCTs; 392 participants; very low-certainty evidence) compared to pharmacological therapy alone. Very low-certainty evidence from five trials suggest no difference in deaths between this combination therapy (RR 1.06, 95% CI 0.27 to 4.16; P = 0.93; 487 participants) compared to pharmacological therapy intervention and sham stimulation or usual care. Comparison 6: Non-invasive brain stimulation with psychological therapy No trials of this combination reported on the primary outcomes. AUTHORS' CONCLUSIONS Very low-certainty evidence suggests that pharmacological, psychological and combination therapies can reduce the prevalence of depression while non-invasive brain stimulation had little to no effect on the prevalence of depression. Pharmacological intervention was associated with adverse events related to the CNS and the gastrointestinal tract. More research is required before recommendations can be made about the routine use of such treatments.
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Affiliation(s)
- Sabine M Allida
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Cheng-Fang Hsieh
- Division of Geriatrics and Gerontology, Department of Internal Medicine and Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Katherine Laura Cox
- Mental Health Program, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kulsum Patel
- Faculty of Health and Care, University of Central Lancashire, Preston, Lancashire, UK
| | | | - C Elizabeth Lightbody
- Faculty of Health and Care, University of Central Lancashire, Preston, Lancashire, UK
| | - Allan House
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Maree L Hackett
- Faculty of Health and Care, University of Central Lancashire, Preston, Lancashire, UK
- Mental Health Program, The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
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10
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Mroz EL, Piechota A, Ali T, Matta-Singh TD, Abboud A, Sharma S, White MA, Fried TR, Monin JK. "Been there, done that:" A grounded theory of future caregiver preparedness in former caregivers of parents living with dementia. J Am Geriatr Soc 2023; 71:1495-1504. [PMID: 36571504 PMCID: PMC10175151 DOI: 10.1111/jgs.18209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/09/2022] [Accepted: 12/03/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Family caregivers offer essential support to persons living with dementia (PLWD). Providing care for more than one family member or close other across adulthood is becoming increasingly common, yet little is known about the ways that caregiving experiences shape caregiver preparedness. The current study presents a grounded theory of future caregiver preparedness in former caregivers of PLWD. METHOD A coding team (five coders and two auditors) used Consensual Qualitative Research and grounded theory techniques to analyze transcripts from 32 semi-structured interviews with midlife former caregivers of parents who died following advanced Alzheimer's disease and related dementias. RESULTS Qualitative analysis revealed two dimensions of future caregiver preparedness: caregiving confidence and caregiving insights. Narratives from caregiving experiences informed participants' descriptions of their future caregiver preparedness. Though some former caregivers described a positive (i.e., boosted or sustained) sense of caregiving confidence following care for their parents, others described a diminished (i.e., restricted or impeded) sense of confidence. Regardless of their confidence, all caregivers described specific caregiving insights related to one or more categories (i.e., caregiving self-conduct, care systems and resources, and relating with a care partner). CONCLUSIONS Preparedness for future caregiving following recent care for a PLWD varies: For some, past experiences appear to offer cumulative advantages in anticipating future care roles, whereas for others, past experiences may contribute to apprehension towards, or rejection of, future care roles. Entering new caregiving roles with diminished confidence may have negative consequences for caregivers' and care partners' wellbeing. Multidimensional assessment of future caregiver preparedness in former caregivers of PLWD may support development of resources for former caregivers entering new caregiving roles.
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Affiliation(s)
- Emily L Mroz
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Amanda Piechota
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Talha Ali
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Anissa Abboud
- Department of Health Policy, Yale School of Public Health, New Haven, Connecticut, USA
| | - Shubam Sharma
- Department of Psychological Science, Kennesaw State University, Kennesaw, Georgia, USA
| | - Marney A White
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Terri R Fried
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joan K Monin
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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11
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Mou H, Lam SKK, Chien WT. The effects of a family-focused dyadic psychoeducational intervention for stroke survivors and their family caregivers: A randomised controlled trial. Int J Nurs Stud 2023; 143:104504. [PMID: 37149953 DOI: 10.1016/j.ijnurstu.2023.104504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/08/2023] [Accepted: 04/08/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Stroke can cause a variety of physical and psychosocial disturbances for both survivors and their family caregivers (i.e., stroke dyads). Dyadic psychoeducation appears to be a promising approach for providing knowledge of stroke and self-care or caregiving skills to improve stroke dyads' health outcomes. Therefore, a family-focused psychoeducation intervention was designed and tested to improve the health outcomes of stroke dyads. OBJECTIVE To examine the effects of a family-focused dyadic psychoeducational intervention on the functional and psychosocial outcomes of stroke survivors and family caregivers. DESIGN A single-blinded, parallel-group randomised controlled trial with repeated-measures design. SETTINGS Two general hospitals and one rehabilitation facility in Jinan, China. PARTICIPANTS Stroke survivors and family caregivers (N = 162 dyads). METHODS The dyads were randomly allocated to either psychoeducation or control group with usual care only (N = 81 dyads per group). The intervention included three structured face-to-face education sessions (one hour per session) in hospital pre-discharge and four weekly telephone counselling calls post-discharge. Study outcomes included survivor functioning and caregiver burden (primary outcomes), and other secondary outcomes (i.e., caregiving competence, dyads' coping, depressive and anxiety symptoms, family functioning, and dyadic relationship, as well as survivor healthcare utilisation and caregiving-related injury). Data were collected at baseline (T0) and immediately (T1) and 3 months post-intervention (T2). The intervention effects were estimated using generalised estimating equation models. RESULTS Participants in the psychoeducation group revealed significantly greater reductions on caregiver burden than the control group at T1 (β = -6.01, p = 0.026) and T2 (β = -6.73, p = 0.039), but non-significant effects on survivor functioning, except in emotion domain at T1 (β = 7.22, p = 0.015). In addition, the intervention demonstrated significantly greater improvements on caregiving competence (β = 0.98, p = 0.013; β = 1.58, p < 0.001), survivors' depressive symptoms (β = -1.56, p = 0.007; β = -2.06, p = 0.005), and dyadic relationship (β = 0.26, p = 0.012; β = 0.27, p = 0.022) at T1 and T2, as well as on survivor coping at T2 (β = 6.73, p = 0.008). CONCLUSIONS Our study added values on the benefits of family-focused dyadic psychoeducation to routine stroke rehabilitation and family care. Future research can evaluate its long-term effects for families of stroke survivors with diverse socio-demographic and stroke-related characteristics. REGISTRATION Chinese Clinical Trial Registry (ChiCTR2100042684). Recruitment: March to June 2021.
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Affiliation(s)
- Huanyu Mou
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Stanley Kam Ki Lam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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12
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Prather JG, Stanfill AG. An Integrative Review of the Utilization of the Perceived Stress Scale in Stroke Recovery. J Neurosci Nurs 2023; 55:65-71. [PMID: 36727780 DOI: 10.1097/jnn.0000000000000695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT BACKGROUND: Stroke survivors (SS) may experience alterations in physical and cognitive processes that increase stress and reduce well-being. Timely and accurate measurement of stress throughout the continuum of recovery is necessary to inform targeted interventions that will improve quality of life for this group. OBJECTIVE: The aim of this study was to describe the utilization of the Perceived Stress Scale (PSS) during recovery in SS. METHODS: A comprehensive literature search was conducted using CINAHL, PsycINFO, PubMed, and Scopus databases. Studies were included if they captured primary data collection using any version of the PSS at any time point in the poststroke recovery period and were published in English between 2011 and 2022. Systematic reviews and meta-analyses were excluded. Evidence was synthesized, and themes were discussed. RESULTS: Among 397 studies, a total of 13 met inclusion criteria. Of these, 8 were cross-sectional studies, 3 were longitudinal studies, 1 was a randomized controlled trial, and the remaining study was a prospective nonrandomized trial. The PSS-10 (n = 7, 54%) was the most used version of the instrument, followed by the PSS-14 (n = 3, 23%) and PSS-4 (n = 2, 15.4%), with the modified PSS-10 being used in only 1 (7.6%) study. The PSS surveys were administered at various time points, ranging from the first day of admission to 3, 6, 9, or 12 months after discharge. Perceived stress may continue to negatively influence SS's psychological and physical well-being throughout the chronic phase of recovery. CONCLUSIONS: Stress is a unique and individualized experience that influences recovery trajectories in SS, an experience often overlooked or marginalized by clinicians and healthcare providers. To help mobilize strategies to achieve long-term health and wellness goals, future studies should explore and tailor interventions to minimize the influence of stress, as identified by the PSS, on well-being and quality of life during poststroke recovery.
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13
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Kwon BM, Lee HH, Sohn MK, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Chang WH, Lee J, Kim YH. Contributing Factors to the Burden on Primary Family Caregivers of Stroke Survivors in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2760. [PMID: 36768126 PMCID: PMC9914967 DOI: 10.3390/ijerph20032760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
- Bo Mi Kwon
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University Yangsan Hospital, Pusan National University, Yangsan-si 50612, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu 41566, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University College of Medicine l, Jeju-si 63241, Republic of Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon-si 24252, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Suwon 06351, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Suwon 06351, Republic of Korea
- Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Healthcare, SAIHST, Sungkyunkwan University, Suwon 06351, Republic of Korea
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14
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Petrizzo A, Lyons KS, Bartoli D, Simeone S, Alvaro R, Lee CS, Vellone E, Pucciarelli G. The moderating role of caregiver preparedness on the relationship between depression and stroke-specific quality of life in stroke dyads: a longitudinal study. Eur J Cardiovasc Nurs 2023; 22:53-63. [PMID: 35670198 DOI: 10.1093/eurjcn/zvac037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 02/03/2023]
Abstract
AIMS To examine the moderating role of caregiver preparedness on the association between stroke survivors' depression and stroke-specific quality of life dimensions. METHODS AND RESULTS We used a multilevel modelling approach to analyse trajectories of change in the eight Stroke Impact Scale 3.0 subscales [i.e. strength, communication, mobility, activities of daily living (ADL)/instrumental activities of daily living (IADL), memory, emotion, hand function, participation] using Hierarchical Linear Modeling. Caregiver preparedness significantly moderated the association between survivor depressive symptoms and survivor communication (B = -0.95, P < 0.01), mobility (B = -0.60, P < 0.05), and ADL/IADL (B = -0.73, P < 0.01) at baseline; linear change for strength (B = 0.83, P < 0.05) and communication (B = 0.66, P < 0.05); and quadratic change for strength (B = -0.19, P < 0.01). Although caregiver preparedness did not significantly moderate the association between survivor depressive symptoms and strength at baseline, there was a significant moderating effect for change over time. Higher levels of caregiver preparedness were significantly associated with higher survivor scores of emotion, hand function, and participation at baseline. CONCLUSIONS Including immediate caregivers in the care process, through a psycho-educational training, would mean having better-prepared caregivers and consequently more-healthy stroke survivors. Given that preparedness includes coping with stress, responding and managing emergencies, assessing help and information may require tailored interventions aimed at improving the caregivers' skills and knowledge about stroke survivors' management.
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Affiliation(s)
- Antonello Petrizzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
| | - Karen S Lyons
- Boston College, William F. Connell School of Nursing, Boston, MA, USA
| | - Davide Bartoli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
| | - Silvio Simeone
- Department of Clinical and Experimental Medicine, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
| | - Christopher S Lee
- Boston College, William F. Connell School of Nursing, Boston, MA, USA
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
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15
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Saragih ID, Saragih IS, Tarihoran DETAU, Sharma S, Chou FH. A meta-analysis of studies of the effects of case management intervention for stroke survivors across three countries. J Nurs Scholarsh 2023; 55:345-355. [PMID: 36310396 DOI: 10.1111/jnu.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/05/2022] [Accepted: 09/09/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE A stroke survivor who is discharged to home care faces many challenges during the transition from the hospital to home, including managing their care at home and engaging in rehabilitation and recovery. Case management was developed to ease the transition from hospital to home and help people with stroke cope with their care management challenges. However, the effects of case management intervention remain inconclusive. Case management was designed to direct care and may represent a novel method for reducing the burden of care. This study was designed to evaluate the effects of case management interventions on mental health outcomes, activities of daily living capacity, physical function, and social function among stroke survivors. DESIGN Systematic review and meta-analysis. METHODS This study included studies examining the impacts of case management interventions for stroke survivors that were published in English and identified by searching eight databases, from database inception to February 20, 2022. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used to pool effect sizes using a random-effects model (in Stata 16.0). The revised Cochrane risk-of-bias tool for randomized trials (RoB-2) was used to assess the methodological quality of each study. FINDINGS The inclusion criteria were satisfied by eight studies (including a total of 1119 stroke survivors). Case management had positive effects on mental health (SMD: 0.26; 95% CI: 0.07 to 0.45, p = 0.001) and activities of daily living (SMD: 0.68; 95% CI: 00.37 to 0.99, p < 0.001). However, no significant effects were observed for either physical function or social function. CONCLUSION Case management appears to enhance the mental health and activities of daily living among stroke survivors. CLINICAL RELEVANCE Case management interventions hold promise as efficient, cost-effective, and accessible strategies to positively influence care for stroke survivors. This intervention strategy could be applied to the hospital-to-home transition to guide care among this population.
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Affiliation(s)
| | | | - Dame Elysabeth Tuty Arna Uly Tarihoran
- School of Nursing, Universitas Kristen Krida Wacana Jakarta, Indonesia.,School of Nursing Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sapna Sharma
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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16
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Mou H, Lam SKK, Chien WT. Effects of a family-focused dyadic psychoeducational intervention for stroke survivors and their family caregivers: a pilot study. BMC Nurs 2022; 21:364. [PMID: 36544154 PMCID: PMC9768401 DOI: 10.1186/s12912-022-01145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Stroke is one of the leading causes of disability in China and worldwide, affecting the health and well-being of both stroke survivors and their family caregivers (i.e. stroke dyads). Dyadic interventions targeting both as active participants can be beneficial for the dyads' health and well-being. Psychoeducation is a potentially acceptable approach to developing participants' knowledge about their disease management to promote their recovery. This study aims to explore the feasibility, acceptability, and preliminary effects of a family-focused dyadic psychoeducational intervention for stroke dyads. METHODS This study was a single-blinded, parallel-group randomised controlled trial. Totally, a convenience sample of 40 stroke dyads was recruited. The intervention included three in-hospital face-to-face education sessions and four weekly post-discharge follow-up telephone counselling sessions. Feasibility was assessed by the rates of recruitment, attritions, and adherence to the intervention. Acceptability was evaluated via semi-structured qualitative interviews. Preliminary intervention effects were evaluated on primary (survivors' functioning and caregivers' burden) and secondary (caregivers' competence and dyads' coping, depressive and anxiety symptoms, family functioning, and dyadic relationship) outcomes. RESULTS Intervention feasibility was established with satisfactory recruitment (76.9%), attrition (10%), and intervention completion (75%) rates. Qualitative interviews suggested that the intervention was acceptable and useful to stroke dyads. The intervention effects on survivors' functioning were significant in the memory and thinking (F = 8.39, p = 0.022, η = 0.18) and mobility (F = 5.37, p = 0.026, η = 0.12) domains, but not significant on their overall functioning (F = 2.39, p = 0.131). Caregiver burden in the intervention group was significantly greater reduced at post-test than the control group, with a large effect size (F = 7.55, p = 0.013, η = 0.28). For secondary outcomes, this intervention suggested a significant effect on caregivers' competence (F = 5.20, p = 0.034, η = 0.22), but non-significant effects on other outcomes. CONCLUSIONS The family-focused dyadic psychoeducation programme was feasible and acceptable for stroke dyads and showed preliminary effects for stroke dyads. These findings support a larger-scale controlled trial to further examine its intervention effects over a longer-term follow-up. TRIAL REGISTRATION This study was retrospectively registered as a randomised controlled trial in the ISRCTN Registry. Registration Date: October 10, 2022. REGISTRATION NUMBER ISRCTN18158500.
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Affiliation(s)
- Huanyu Mou
- grid.10784.3a0000 0004 1937 0482The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, New Territories, Hong Kong SAR, China
| | - Stanley Kam Ki Lam
- grid.10784.3a0000 0004 1937 0482The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, New Territories, Hong Kong SAR, China
| | - Wai Tong Chien
- grid.10784.3a0000 0004 1937 0482The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, New Territories, Hong Kong SAR, China
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17
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Wijeratne T, Sales C, Wijeratne C. A Narrative Review on the Non-Pharmacologic Interventions in Post-Stroke Depression. Psychol Res Behav Manag 2022; 15:1689-1706. [PMID: 35832139 PMCID: PMC9273151 DOI: 10.2147/prbm.s310207] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
Stroke is a major cause of death and disability globally. Post-stroke depression (PSD) is a major driver for poor recovery and poor quality of life with extra burden for the patient and the caregiver. We have previously shown the inflammatory basis of PSD with associated bioenergetic failure, disruption of the blood-brain barrier, cell death, and persistent maladapted inflammation, making the PSD a norm rather than the exception, highlighting the unmet need for therapeutic intervention in PSD across the recovery trajectory. In this era, various interventions are focused on pharmacotherapy; however, non-pill-based medication should also be explored as post-stroke patients are likely to suffer from the adverse effects of polypharmacy. This narrated review explores the status of non-pharmacological interventions in managing PSD. We performed a PubMed search using pre-specified keywords looking at various non-pharmacologic approaches for the management of PSD. Worldwide, approaches such as non-invasive brain stimulation, behavioral and psychosocial therapy, as well as exercise, acupuncture, music, literature, and art therapies are available as monotherapy or adjunctive treatment for PSD. While current literature shows convincing results on the benefits of non-pharmacologic interventions, more robust studies are necessary to determine its utility in PSD.
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Affiliation(s)
- Tissa Wijeratne
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans, 3021, Australia.,Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura, Anuradhapura, Sri Lanka
| | - Carmela Sales
- Department of Medicine and Neurology, AIMSS, Melbourne Medical School, Sunshine Hospital, Western Health, St. Albans, Victoria, Australia
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Cruces R, Muñoz-García I, Palmer-Cancel SJ, Salas C. A Neuropsychological Rehabilitation Framework to Address Cognitive and Neurobehavioral Impairments After Strokes to the Anterior Communicating Artery. Front Hum Neurosci 2022; 16:808011. [PMID: 35754764 PMCID: PMC9226309 DOI: 10.3389/fnhum.2022.808011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/12/2022] [Indexed: 11/28/2022] Open
Abstract
Patients with strokes to the Anterior Communicating Artery (ACoA) pose an important challenge to rehabilitation teams due to a particular mix of cognitive and behavioral impairments (anosognosia, anterograde amnesia, prospective memory problems, and executive dysfunction). These deficits often compromise engagement with rehabilitation, learning and generalization. The goal of this article is to describe the long-term presentation of a patient with an ACoA stroke (Mrs. B, a 60-year-old electric engineer) as well as her rehabilitation needs and the many challenges experienced by the rehabilitation team when attempting to facilitate functional, vocational and psychosocial recovery. Based on this case, and the existing literature, a neuropsychological rehabilitation framework to understand and address the specific problems and needs of this population is proposed. This framework demands rehabilitation teams to consider: the slow pattern of recovery of this population, the interaction between cognitive and behavioral impairments, the relevance of physical and social environments, the value of personal projects and the need to include psychological and relational interventions.
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Affiliation(s)
- Ramiro Cruces
- Clinical Neuropsychology Unit, Centre for Human Neuroscience and Neuropsychology, Faculty of Psychology, Diego Portales University, Santiago, Chile
| | - Indhira Muñoz-García
- Clinical Neuropsychology Unit, Centre for Human Neuroscience and Neuropsychology, Faculty of Psychology, Diego Portales University, Santiago, Chile.,Hospital Metropolitano, Santiago, Chile
| | | | - Christian Salas
- Clinical Neuropsychology Unit, Centre for Human Neuroscience and Neuropsychology, Faculty of Psychology, Diego Portales University, Santiago, Chile
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Hinwood M, Ilicic M, Gyawali P, Coupland K, Kluge MG, Smith A, Bowden S, Nilsson M, Walker FR. Psychological Stress Management and Stress Reduction Strategies for Stroke Survivors: A Scoping Review. Ann Behav Med 2022; 57:111-130. [PMID: 35689664 PMCID: PMC9899067 DOI: 10.1093/abm/kaac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Stroke can be a life-changing event, with survivors frequently experiencing some level of disability, reduced independence, and an abrupt lifestyle change. Not surprisingly, many stroke survivors report elevated levels of stress during the recovery process, which has been associated with worse outcomes. PURPOSE Given the multiple roles of stress in the etiology of stroke recovery outcomes, we aimed to scope the existing literature on stress management interventions that have been trialed in stroke survivors. METHODS We performed a database search for intervention studies conducted in stroke survivors which reported the effects on stress, resilience, or coping outcome. Medline (OVID), Embase (OVID), CINAHL (EBSCO), Cochrane Library, and PsycInfo (OVID) were searched from database inception until March 11, 2019, and updated on September 1, 2020. RESULTS Twenty-four studies met the inclusion criteria. There was significant variation in the range of trialed interventions, as well as the outcome measures used to assess stress. Overall, just over half (13/24) of the included studies reported a benefit in terms of stress reduction. Acceptability and feasibility were considered in 71% (17/24) and costs were considered in 17% (4/24) of studies. The management of stress was rarely linked to the prevention of symptoms of stress-related disorders. The overall evidence base of included studies is weak. However, an increase in the number of studies over time suggests a growing interest in this subject. CONCLUSIONS Further research is required to identify optimum stress management interventions in stroke survivors, including whether the management of stress can ameliorate the negative impacts of stress on health.
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Affiliation(s)
| | - Marina Ilicic
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia,School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia,Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia
| | - Prajwal Gyawali
- School of Health and Wellbeing, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Darling Heights, QLD, Australia
| | - Kirsten Coupland
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia,School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia,Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia
| | - Murielle G Kluge
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia,Centre for Advanced Training Systems, The University of Newcastle, Callaghan, NSW, Australia
| | - Angela Smith
- HNE Health Libraries, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Sue Bowden
- Consumer Investigator, Moon River Turkey, Bathurst, NSW, Australia
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20
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Bakas T, McCarthy MJ, Miller EL. Systematic Review of the Evidence for Stroke Family Caregiver and Dyad Interventions. Stroke 2022; 53:2093-2102. [PMID: 35264010 PMCID: PMC9133104 DOI: 10.1161/strokeaha.121.034090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke family caregiver and dyad literature has expanded over the past few years. The purpose of this review was to build upon 2 prior systematic reviews to critique, analyze, and synthesize the evidence pertaining to the impact of family caregiver and dyad interventions on stroke survivor and family caregiver outcomes. CINAHL, PsychINFO, PubMed, and reference lists were searched from December 1, 2016 through March 31, 2021. Using PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), articles were identified that tested outcomes from stroke family caregiver or dyad interventions that targeted the health or well-being of family caregivers. Data from the articles were abstracted into tables for analysis, then compared with recommendations from the 2 prior systematic reviews. A total of 18 articles met inclusion criteria (10 caregiver interventions; 8 dyad interventions) representing sample sizes ranging from 7 to 349 caregivers or dyads. Most were randomized controlled trials (n=13); 2 were cluster randomized trials; and 3 were single-group quasi-experimental designs. Of the 18 studies, 8 had <50 caregivers or dyads and 5 were small feasibility studies that reported data trends rather than testing for significance. Only 6 studies reported significant survivor outcomes. Eleven studies reported significant caregiver outcomes, the most common being burden. A number of survivor and caregiver outcomes were not significant, or only significant for certain subgroups. The limited number of studies, small sample sizes, and conflicting results, made it difficult to draw firm conclusions regarding the impact of these interventions on outcomes. Based on the available evidence from these 18 studies, recommendations from the 2 prior reviews were generally supported. Well-designed and well-powered randomized controlled clinical trials are still needed to confirm efficacy of stroke family caregiver and dyad interventions.
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Affiliation(s)
- Tamilyn Bakas
- University of Cincinnati College of Nursing, Cincinnati, OH
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21
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Mack A, Hildebrand M. Education and Support Interventions for Caregivers of Persons With Stroke (January 1, 1999-December 31, 2019). Am J Occup Ther 2022; 76:23261. [PMID: 35302595 DOI: 10.5014/ajot.2022.763003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from a systematic review on stroke and education and support interventions for caregivers of people with stroke.
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Affiliation(s)
- Amanda Mack
- Amanda Mack, OT, OTD, MS, OTR, is Instructor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, MA;
| | - Mary Hildebrand
- Mary Hildebrand, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, MA
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22
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Qureshi A, Hargest C, Swain N, Aldabe D, Hale L. Psychosocial interventions for building resilience of informal carers of people living with stroke: a systematic review. Disabil Rehabil 2022; 45:1419-1432. [PMID: 35468030 DOI: 10.1080/09638288.2022.2063419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To identify and synthesise the evidence of interventions purported to build resilience among informal carers of stroke survivors. METHODS A systematic review of randomised controlled trials of psychosocial interventions to build resilience for carers of people post-stroke was planned. A systematic search was conducted in seven online databases from inception to March 2021. Outcomes measured were resilience and its proxy constructs including copying, adaptation, adjustment, problem-solving, self-efficacy, locus of control, competence and strength. RESULTS Twelve studies were included in the review and were grouped into four intervention categories (i) Education and social support, (ii) problem-solving skills, (iii) problem-solving skills, and psychoeducation and (iv) information provision, problem-solving skills and psychoeducation. Level of evidence A exists for interventions that combine information provision, problem-solving skills and psychoeducation over the interventions that only use problem-solving skills intervention or problem-solving skills with psychoeducation strategies. All interventions apart from one reported significant within and/or between group changes in outcomes. CONCLUSION Interventions comprising of information provision, problem-solving skills and psychoeducation appear to be beneficial to improve resilience of carers. However, because of the heterogeneity of the interventions and outcome measures reported across the twelve studies no particular intervention could be definitively supported. CLINICAL TRIAL REGISTRATION Systematic review registration: CRD 42020172824 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172824 IMPLICATIONS FOR REHABILITATIONProviding care for stroke survivors is particularly demanding due to the lack of preparation for managing the unexpected and complex nature of stroke, resulting in negative physical, social, behavioral, emotional, and financial outcomes.The long-term nature of stroke and its many residual problems can negatively affect the physical and psychological well-being of the individual and their carers, which may subsequently affect the recovery of the stroke survivor.Evidence suggests that resilience is the protective shield for carers' stress and burnout.Integrating interventions focusing on carers' resilience as part of the stroke rehabilitation process is imperative to ensure the well-being of carers and the sustainability of the care provided to the stroke survivor.
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Affiliation(s)
- Ayesha Qureshi
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy - University of Otago, Dunedin, New Zealand
| | - Claire Hargest
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicola Swain
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Daniela Aldabe
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Leigh Hale
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Lamson AL, Hodgson JL, Pratt KJ, Mendenhall TJ, Wong AG, Sesemann EM, Brown BJ, Taylor ES, Williams-Reade JM, Blocker DJ, Harsh Caspari J, Zubatsky M, Martin MP. Couple and family interventions for high mortality health conditions: A strategic review (2010-2019). JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:307-345. [PMID: 34741539 DOI: 10.1111/jmft.12564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
The earliest publications in the field of marriage and family therapy introduced interventions conducted with families experiencing complex health conditions. This strategic review captures an evaluation of efficacy for 87 couple and family interventions published between 2010 and 2019 with a focus on the leading causes of mortality in the United States. These health conditions include chromosomal anomalies and accidents with infants aged 0-4 years; accidents and cancer among children aged 5-14; accidents among adolescents aged 15-24; and heart disease, cancer, accidents, chronic lower respiratory diseases, stroke, Alzheimer's disease, diabetes, influenza/pneumonia, and nephritis/nephrosis among adults 25 and older. Results support the need for greater inclusion of couples and families in assessments and interventions. The greatest chasm in efficacy research was with minoritized couples and families. Implications include ways to initiate couple and family interventions in the context of health conditions with attention given to accessibility, recruitment, retention, and evaluation.
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Affiliation(s)
- Angela L Lamson
- Department of Human Development & Family Science, College of Health and Human Performance, Greenville, North Carolina, USA
| | - Jennifer L Hodgson
- Department of Human Development & Family Science, College of Health and Human Performance, Greenville, North Carolina, USA
| | - Keeley J Pratt
- Department of Human Services, Human Development and Family Science Program, Couple and Family Therapy Specialization, College of Education & Human Ecology, Columbus, Ohio, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Tai J Mendenhall
- Department of Family Social Science, University of Minnesota, Saint Paul, Minnesota, USA
| | - Alison G Wong
- Department of Marriage and Family Therapy, Fuller School of Psychology and Marriage and Family Therapy, Pasadena, California, USA
| | | | - Braden J Brown
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Athletics Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Erika S Taylor
- Department of Family Medicine, Behavioral Medicine Section, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Daniel J Blocker
- Pomona Valley Family Medicine Residency, Pomona Valley Hospital Medical Center, Pomona, California, USA
| | - Jennifer Harsh Caspari
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Max Zubatsky
- Department of Family and Community Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Matthew P Martin
- Doctor of Behavioral Health Program, College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
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24
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Crocker TF, Brown L, Lam N, Wray F, Knapp P, Forster A. Information provision for stroke survivors and their carers. Cochrane Database Syst Rev 2021; 11:CD001919. [PMID: 34813082 PMCID: PMC8610078 DOI: 10.1002/14651858.cd001919.pub4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A stroke is a sudden loss of brain function caused by lack of blood supply. Stroke can lead to death or physical and cognitive impairment and can have long lasting psychological and social implications. Research shows that stroke survivors and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues. OBJECTIVES The primary objective is to assess the effects of active or passive information provision for stroke survivors (people with a clinical diagnosis of stroke or transient ischaemic attack (TIA)) or their identified carers. The primary outcomes are knowledge about stroke and stroke services, and anxiety. SEARCH METHODS We updated our searches of the Cochrane Stroke Group Specialised Register on 28 September 2020 and for the following databases to May/June 2019: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5) and the Cochrane Database of Systematic Reviews (CDSR; 2019, Issue 5) in the Cochrane Library (searched 31 May 2019), MEDLINE Ovid (searched 2005 to May week 4, 2019), Embase Ovid (searched 2005 to 29 May 2019), CINAHL EBSCO (searched 2005 to 6 June 2019), and five others. We searched seven study registers and checked reference lists of reviews. SELECTION CRITERIA Randomised trials involving stroke survivors, their identified carers or both, where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone, or where the comparison was between active and passive information provision without other differences in treatment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We categorised interventions as either active information provision or passive information provision: active information provision included active participation with subsequent opportunities for clarification and reinforcement; passive information provision provided no systematic follow-up or reinforcement procedure. We stratified analyses by this categorisation. We used GRADE methods to assess the overall certainty of the evidence. MAIN RESULTS We have added 12 new studies in this update. This review now includes 33 studies involving 5255 stroke-survivor and 3134 carer participants. Twenty-two trials evaluated active information provision interventions and 11 trials evaluated passive information provision interventions. Most trials were at high risk of bias due to lack of blinding of participants, personnel, and outcome assessors where outcomes were self-reported. Fewer than half of studies were at low risk of bias regarding random sequence generation, concealment of allocation, incomplete outcome data or selective reporting. The following estimates have low certainty, based on the quality of evidence, unless stated otherwise. Accounting for certainty and size of effect, analyses suggested that for stroke survivors, active information provision may improve stroke-related knowledge (standardised mean difference (SMD) 0.41, 95% confidence interval (CI) 0.17 to 0.65; 3 studies, 275 participants), may reduce cases of anxiety and depression slightly (anxiety risk ratio (RR) 0.85, 95% CI 0.68 to 1.06; 5 studies, 1132 participants; depression RR 0.83, 95% CI 0.68 to 1.01; 6 studies, 1315 participants), may reduce Hospital Anxiety and Depression Scale (HADS) anxiety score slightly, (mean difference (MD) -0.73, 95% CI -1.10 to -0.36; 6 studies, 1171 participants), probably reduces HADS depression score slightly (MD (rescaled from SMD) -0.8, 95% CI -1.27 to -0.34; 8 studies, 1405 participants; moderate-certainty evidence), and may improve each domain of the World Health Organization Quality of Life assessment short-form (WHOQOL-BREF) (physical, MD 11.5, 95% CI 7.81 to 15.27; psychological, MD 11.8, 95% CI 7.29 to 16.29; social, MD 5.8, 95% CI 0.84 to 10.84; environment, MD 7.0, 95% CI 3.00 to 10.94; 1 study, 60 participants). No studies evaluated positive mental well-being. For carers, active information provision may reduce HADS anxiety and depression scores slightly (MD for anxiety -0.40, 95% CI -1.51 to 0.70; 3 studies, 921 participants; MD for depression -0.30, 95% CI -1.53 to 0.92; 3 studies, 924 participants), may result in little to no difference in positive mental well-being assessed with Bradley's well-being questionnaire (MD -0.18, 95% CI -1.34 to 0.98; 1 study, 91 participants) and may result in little to no difference in quality of life assessed with a 0 to 100 visual analogue scale (MD 1.22, 95% CI -7.65 to 10.09; 1 study, 91 participants). The evidence is very uncertain (very low certainty) for the effects of active information provision on carers' stroke-related knowledge, and cases of anxiety and depression. For stroke survivors, passive information provision may slightly increase HADS anxiety and depression scores (MD for anxiety 0.67, 95% CI -0.37 to 1.71; MD for depression 0.39, 95% CI -0.61 to 1.38; 3 studies, 227 participants) and the evidence is very uncertain for the effects on stroke-related knowledge, quality of life, and cases of anxiety and depression. For carers, the evidence is very uncertain for the effects of passive information provision on stroke-related knowledge, and HADS anxiety and depression scores. No studies of passive information provision measured carer quality of life, or stroke-survivor or carer positive mental well-being. AUTHORS' CONCLUSIONS Active information provision may improve stroke-survivor knowledge and quality of life, and may reduce anxiety and depression. However, the reductions in anxiety and depression scores were small and may not be important. In contrast, providing information passively may slightly worsen stroke-survivor anxiety and depression scores, although again the importance of this is unclear. Evidence relating to carers and to other outcomes of passive information provision is generally very uncertain. Although the best way to provide information is still unclear, the evidence is better for strategies that actively involve stroke survivors and carers and include planned follow-up for clarification and reinforcement.
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Affiliation(s)
- Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Natalie Lam
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Faye Wray
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford, UK
| | - Peter Knapp
- Department of Health Sciences, University of York and the Hull York Medical School, York, UK
| | - Anne Forster
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford, UK
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25
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Pucciarelli G, Lyons KS, Petrizzo A, Ambrosca R, Simeone S, Alvaro R, Lee CS, Vellone E. Protective Role of Caregiver Preparedness on the Relationship Between Depression and Quality of Life in Stroke Dyads. Stroke 2021; 53:145-153. [PMID: 34496626 DOI: 10.1161/strokeaha.120.034029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Depression and quality of life (QOL) have an interdependent and transactional nature in stroke survivor-caregiver dyads. While the strong relationship between depression and physical and emotional QOL in stroke survivor-caregiver dyads is well known, it is less clear if this relationship is moderated by caregiver preparedness, which could easily be targeted with interventions. In this study, we examined the moderating role of caregiver preparedness on the association between depression and QOL in stroke survivor-caregiver dyads. METHODS We used a longitudinal design with follow-ups every 3 months over a 1-year period. Considering the nonindependent nature of the data (survivors and their caregivers), we used multilevel modeling to analyze data at the dyad level. We implemented 4 longitudinal dyadic moderation models (one for each QOL domain: physical, psychological, social, and environmental) using hierarchical linear modeling. RESULTS A sample of 222 stroke survivor-caregiver dyads was analyzed. Stroke survivors were older (M=70.8, SD=11.9) than their caregivers (M=52.4, SD=13.1). Stroke survivors predominantly had an ischemic stroke, equally distributed by site. Caregivers were primarily female (66%), with a medium to high educational level (57%). Caregiver preparedness significantly moderated the association between survivor depression and survivor psychological (B=0.56, P<0.01) and environmental (B=0.58, P<0.01) QOL at baseline and social QOL over time (B=0.24, P<0.05). Similarly, caregiver preparedness significantly moderated the association between caregiver depression and caregiver physical (B=0.25, P<0.01) and environmental (B=0.18, P<0.05) QOL over time. CONCLUSIONS Caregiver preparedness has a positive influence on both members of the dyad. Assessment of stroke-caregiver preparedness could be helpful to motivate clinicians to develop and implement interventions for stroke survivor-caregiver dyads.
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Affiliation(s)
- Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (G.P.)
| | - Karen S Lyons
- Boston College, William F. Connell School of Nursing (K.S.L., C.S.L.)
| | - Antonello Petrizzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (A.P.)
| | - Rossella Ambrosca
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (R. Ambrosca)
| | - Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (S.S.)
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (R. Alvaro)
| | - Christopher S Lee
- Boston College, William F. Connell School of Nursing (K.S.L., C.S.L.)
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (E.V.)
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26
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Mohammadi E, Hassandoost F, Mozhdehipanah H. Evaluation of the "partnership care model" on quality of life and activity of daily living in stroke patients: A randomized clinical trial. Jpn J Nurs Sci 2021; 19:e12448. [PMID: 34448546 DOI: 10.1111/jjns.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Stroke is a widespread chronic disease which remains a serious problem for public health and is the cause of major disability and death in adults. Despite valuable efforts, these patients still need new care programs for recovery and rehabilitation. AIM The aim of this study is to determine the effect of the partnership care model (PCM) on quality of life (QOL) and activities of daily living (ADL) in stroke participants. METHOD The study is a randomized clinical trial carried out in an educational and therapeutic center in 2019. Sixty-seven participants (allocated randomly in intervention and control groups) with cerebrovascular accident who had hospitalization histories were selected. Data collection instruments were the Stroke-Specific QOL scale and Lawton questionnaires. The care plan was developed and implemented for the intervention group after evaluating and recording basic information including demographic variables, care needs, and problems identified in the first PCM-based stage. Ethics approval was obtained from the University / Regional Research Ethics Committee (IR.NIMAD.REC.1397.236). RESULTS The results show that the mean scores of the QOL significantly increased after the intervention in the intervention group (before = 130.80; 3 months = 172.19; 6 months = 205.29) compared to the control group (before = 150; 3 months = 144.86; 6 months = 160.66). Also, the mean scores of the ADL significantly increased after the intervention in the intervention group (before = 1.96; 3 months = 3.64; 6 months = 4.87) compared to the control group (p < .05). The effect size is equal to 0.501 and 0.245 for QOL and ADL, respectively. CONCLUSION The findings show that the care program based on a PCM recovered the QOL and ADL of stroke participants more than other interventions.
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Affiliation(s)
- Eesa Mohammadi
- Faculty of Medical Sciences, Nursing Department, Tarbiat Modares University, Tehran, Iran
| | - Fateme Hassandoost
- Faculty of Medical Sciences, Nursing Department, Tarbiat Modares University, Tehran, Iran
| | - Hossein Mozhdehipanah
- Clinical Research Development Unit, Bouali Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
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27
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Mavaddat N, Sadler E, Lim L, Williams K, Warburton E, Kinmonth AL, Mckevitt C, Mant J. What underlies the difference between self-reported health and disability after stroke? A qualitative study in the UK. BMC Neurol 2021; 21:315. [PMID: 34388983 PMCID: PMC8362227 DOI: 10.1186/s12883-021-02338-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Levels of self-reported health do not always correlate with levels of physical disability in stroke survivors. We aimed to explore what underlies the difference between subjective self-reported health and objectively measured disability among stroke survivors. Methods Face to face semi-structured interviews were conducted with stroke survivors recruited from a stroke clinic or rehabilitation ward in the UK. Fifteen stroke survivors purposively sampled from the clinic who had discordant self-rated health and levels of disability i.e. reported health as ‘excellent’ or ‘good’ despite significant physical disability (eight), or as ‘fair’ or ‘poor’ despite minimal disability (seven) were compared to each other, and to a control group of 13 stroke survivors with concordant self-rated health and disability levels. Interviews were conducted 4 to 6 months after stroke and data analysed using the constant comparative method informed by Albrecht and Devlieger’s concept of ‘disability paradox’. Results Individuals with ‘excellent’ or ‘good’ self-rated health reported a sense of self-reliance and control over their bodies, focussed on their physical rehabilitation and lifestyle changes and reported few bodily and post-stroke symptoms regardless of level of disability. They also frequently described a positive affect and optimism towards recovery. Some, especially those with ‘good’ self-rated health and significant disability also found meaning from their stroke, reporting a spiritual outlook including practicing daily gratitude and acceptance of limitations. Individuals with minimal disability reporting ‘fair’ or ‘poor’ self-rated health on the other hand frequently referred to their post-stroke physical symptoms and comorbidities and indicated anxiety about future recovery. These differences in psychological outlook clustered with differences in perception of relational and social context including support offered by family and healthcare professionals. Conclusions The disability paradox may be illuminated by patterns of individual attributes and relational dynamics observed among stroke survivors. Harnessing these wider understandings can inform new models of post-stroke care for evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02338-x.
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Affiliation(s)
- Nahal Mavaddat
- School of Medicine, Division of General Practice, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia.
| | - Euan Sadler
- Department of Nursing, Midwifery and Health, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Lisa Lim
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - Kate Williams
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - Elizabeth Warburton
- Department of Clinical Neurosciences, Neurology Unit, University of Cambridge, R3, Box 83, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Ann Louise Kinmonth
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
| | - Chris Mckevitt
- School of Population Health and Environmental Sciences, King's College London, Addison House, London, SE1 1UL, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Laboratory, 2 Worts Causeway, Cambridge, CB1 8RN, UK
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Mou H, Wong MS, Chien WT. Effectiveness of dyadic psychoeducational intervention for stroke survivors and family caregivers on functional and psychosocial health: A systematic review and meta-analysis. Int J Nurs Stud 2021; 120:103969. [PMID: 34052538 DOI: 10.1016/j.ijnurstu.2021.103969] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/25/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Stroke is the third leading cause of disability worldwide, influencing the whole family's health and well-being. Dyadic (i.e., stroke survivor and family caregiver) psychoeducational intervention is a potential alternative to disease management and support, targeting at the dyads of stroke survivors and their caregivers as active participants in partnership. This review aimed to evaluate the current evidence on supporting the dyadic psychoeducational intervention for the functional and psychosocial health of stroke survivors' and their family caregivers. DESIGN Systematic review and meta-analysis DATA SOURCES: Nine English databases (Cochrane Library, Medline, CINAHL, PsycINFO, EMBASE, British Nursing Index, PubMed, Web of Science and Digital Dissertation Consortium) and two Chinese databases (CNKI and Wanfang) were searched to identify eligible studies published from their inception to April 2020. Additional relevant studies were identified from the reference lists and bibliographies of the identified articles and a manual search of relevant journals. REVIEW METHODS Studies were searched using keywords based on the 'PICOS' framework. The eligibility of individual full-text articles was independently assessed by two reviewers in accordance with the selection criteria. The risk of bias of the included studies was assessed using Cochrane RoB 2.0. The main outcomes were subjected to meta-analysis whenever possible; otherwise, narrative syntheses were conducted. RESULTS Eleven studies with 1769 stroke survivors and 1578 family caregivers were identified. The meta-analysis of pooled data suggested that the dyadic psychoeducational intervention had a significant immediate (<1 month) effect on family caregivers' burden (SMD = -0.25, 95% CI: -0.50 to -0.01, p = 0.04) and a long-term (≥6 months) effect on survivors' quality of life (SMD = -0.30, 95% CI: -0.53 to -0.07, p = 0.01). Subgroup pooled analyses indicated that the interventions initiated in hospitals could significantly improve the survivors' functional independence immediately after intervention (SMD = 0.40, 95% CI: 0.08 to 0.72, p = 0.01). Conversely, the interventions initiated at home did not significantly affect this functional outcome. CONCLUSIONS This review supports the notion that the dyadic psychoeducational intervention can be effective in improving the stroke survivors' functional independence and their family caregivers' burden for a short period and the survivors' quality of life in the long run. However, its effectiveness is not conclusive because other psychosocial health outcomes for the stroke survivors and their family caregivers have not yet been found to significantly improve after intervention. Therefore, further large-scale randomised controlled trials with a high-quality design are warranted to evaluate their effectiveness in diverse functional and psychosocial health outcomes for stroke survivors and their family caregivers.
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Affiliation(s)
- Huanyu Mou
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 7/F, 733, Esther Lee Building, Shatin, N.T., Hong Kong.
| | - Mei Sze Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 7/F, 733, Esther Lee Building, Shatin, N.T., Hong Kong.
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 7/F, 733, Esther Lee Building, Shatin, N.T., Hong Kong.
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Interventions for Informal Caregivers of Stroke Survivors: Is There Racial and Ethnic Representation in Stroke Caregiver Studies? Rehabil Nurs 2021; 47:3-11. [PMID: 33560779 DOI: 10.1097/rnj.0000000000000315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The specific aims of this scoping review of the literature are to (1) map the current scope of literature regarding nonpharmacological interventions for informal stroke caregivers and (2) explore the degree to which racial/ethnic minority groups were represented in nonpharmacological interventions for stroke caregivers in the United States. DESIGN AND METHODS Arksey and O'Malley's methodological framework was used to conduct this scoping review. The framework entails formulating research questions, developing criteria for selecting relevant studies, charting the data, and synthesizing results. FINDINGS The scoping review yielded 11 studies that varied in intervention design, methods of implementation, and outcome measurements. The review indicated that racial and ethnic minorities were less likely to be represented in nonpharmacological intervention studies for stroke caregivers. CONCLUSION Currently, there is sparse research that focuses on interventions with family caregivers of varying racial/ethnic groups in the United States.
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Brief Psychosocial Intervention to Address Poststroke Depression May Also Benefit Fatigue and Sleep-Wake Disturbance. Rehabil Nurs 2021; 46:222-231. [PMID: 33443981 DOI: 10.1097/rnj.0000000000000304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to determine if brief psychosocial/behavioral therapy directed to reduce poststroke depression would decrease fatigue and improve sleep-wake disturbance. DESIGN A preplanned secondary data analysis from a completed clinical trial was conducted. METHODS One hundred participants received usual care, in-person intervention, or telephone intervention. Depression, fatigue, and sleep-wake disturbance were measured at entry, 8 weeks, 21 weeks, and 12 months following the intervention. FINDINGS Fatigue (within: p = .042, between: p = .394), sleep disturbance (within: p = .024, between: p = .102), and wake disturbance (within: p = .004, between: p = .508) decreased over the 12 months in the intervention groups, but not in the control group. This difference was clinically meaningful for wake disturbance and approached the clinically important difference for fatigue. CONCLUSIONS/CLINICAL RELEVANCE Reduction in wake disturbance was consistent with clinically meaningful difference standards for patient-reported outcomes, warranting further research in larger samples.
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Elsheikh MA, Moriyama M, Rahman MM, Kako M, El-Monshed AH, Zoromba M, Zehry H, Khalil MH, Amr M. Effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e041637. [PMID: 33323445 PMCID: PMC7745514 DOI: 10.1136/bmjopen-2020-041637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Caring 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 effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors. Based on the perceived needs of family caregivers, this intervention takes into account scientific recommendations to combine three different approaches: skill-building, psychoeducation and peer support. METHODS AND ANALYSIS Using a prospective, randomised, open-label, parallel-group design, 110 family caregivers will be enrolled from Dakahlia Governorate, Egypt between December 2019 and May 2020, and randomly assigned to either the intervention group or the control group. The tailored multidimensional intervention will be administered for 6 months, including three home visits, six home-based telephone calls and one peer support session. The primary outcome is the care burden as measured using the Zarit Burden Interview. Secondary outcomes include changes in the family caregivers' perceived needs (Family Needs Questionnaire-Revised), coping strategies (Brief-Coping Orientation to Problems Experienced) and quality of life (WHO Quality of Life-BREF). Outcomes evaluation will be conducted at baseline (T0), month 3 (T1) and month 6 (T2). Independent t-test will be performed to compare the mean values of study variables between the two groups at both T1 and T2. After adjusting for confounding variables, analysis of covariance will be used to assess the effect of the intervention. In addition, repeated measures analysis of variance will be conducted to assess changes in effect over time. ETHICS AND DISSEMINATION This study was approved by the Research Ethics Committee of the Faculty of Nursing, Mansoura University, Mansoura, Egypt (P.0195). The results will be published in a scientific peer-reviewed journal, and findings will be disseminated at the local and international levels. TRIAL REGISTRATION NUMBER NCT04211662.
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Affiliation(s)
- Mahmoud Ahmed Elsheikh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Community Health Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mayumi Kako
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ahmed Hashem El-Monshed
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Mohamed Zoromba
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Hamada Zehry
- New Mansoura General Hospital, Neurology, Ministry of Health and Population, Mansoura, Egypt
| | | | - Mostafa Amr
- Psychiatry, Mansoura University Faculty of Medicine, Mansoura, Egypt
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Lin S, Xiao LD, Chamberlain D, Newman P, Xie S, Tan JY. The effect of transition care interventions incorporating health coaching strategies for stroke survivors: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2020; 103:2039-2060. [PMID: 32532632 DOI: 10.1016/j.pec.2020.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To systematically analyse health coaching strategies in transition care and synthesise the effect of these strategies on health care outcomes for stroke survivors. METHODS A systematic search of nine databases in two languages was conducted. Meta-analysis was conducted when data were available. RESULTS Twenty-five randomised controlled trials met the inclusion criteria. The meta-analysis revealed that health coaching strategies in transition care interventions significantly improve quality of life (QoL) (p < 0.001), activities of daily living (ADL) (p = 0.002) and reduce depression (p = 0.001) for stroke survivors at 3 months. Further subgroup analysis demonstrated that transition care interventions with a greater number of health coaching strategies are associated with a larger effect size on QoL (SMD=1.15) and ADL (SMD=1.177) at 3 months, and a medium effect size (SMD=0.674) on depression reduction. However, the effects of health coaching strategies on readmission, mortality and falls in stroke survivors remain inconclusive. CONCLUSIONS This review provides evidence that incorporating health coaching strategies in transitional care improves health outcomes of stroke survivors. PRACTICE IMPLICATION More trials of health coaching interventions to improve transition care with a rigorous study design are much needed to address the lack of support for stroke survivors and their caregivers in this crucial care period.
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Affiliation(s)
- Shuanglan Lin
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Peter Newman
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Shiqi Xie
- Nursing College of Chongqing Medical University, Chongqing, China
| | - Jing-Yu Tan
- College of Nursing and Midwifery, Charles Darwin University, Darwin, NT, Australia
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Kontou E, Kettlewell J, Condon L, Thomas S, Lee AR, Sprigg N, Watkins DC, Walker MF, Shokraneh F. A scoping review of psychoeducational interventions for people after transient ischemic attack and minor stroke. Top Stroke Rehabil 2020; 28:390-400. [PMID: 32996432 DOI: 10.1080/10749357.2020.1818473] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Psychoeducation can provide information and support to cope with the physical and emotional effects of a health condition. This scoping review aimed to identify the evidence regarding psychoeducational interventions for people after a Transient Ischemic Attack (TIA) and minor stroke. METHODS This review was conducted in accordance with the PRISMA Extension for Scoping Reviews. Three electronic databases (MEDLINE, Embase, PsycINFO) were searched for articles on interventions related to psychoeducational support post-TIA and minor/mild stroke. Search retrieved 3722 articles. Three reviewers independently screened titles, abstracts, full-texts, and extracted data for included studies. Study quality was assessed using the JADAD scale. TIDieR checklist was used to describe interventions. RESULTS Fifteen RCTs were included. Twelve studies were of high quality (JADAD score ≥2), two were of low quality. A total of 1500 participants were recruited across studies. Definition of TIA and minor stroke was unclear, leading to the exclusion of several studies. Various interventions were included, including education/psychoeducation (n = 4); exercise and lifestyle advice (n = 3); telephone-based education/counseling (n = 3); secondary prevention education (n = 1); motivational interviewing (n = 2); self-management (n = 2). Interventions were inconsistently described, with information missing about who delivered it and tailoring. CONCLUSIONS Definitions of stroke severity are not adequately reported. There are a variety of interventions including education about a range of stroke-specific topics. Many interventions are not adequately described, thus making it difficult to determine if the aim was to provide information or support post-TIA/minor stroke. There is a need for an in-depth systematic review to develop a clear definition of psychoeducation.
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Affiliation(s)
- Eirini Kontou
- Division of Rehabilitation, Ageing & Wellbeing, B Floor, The Medical School, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Jade Kettlewell
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Laura Condon
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Shirley Thomas
- Division of Rehabilitation, Ageing & Wellbeing, B Floor, The Medical School, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Abigail R Lee
- Division of Rehabilitation, Ageing & Wellbeing, B Floor, The Medical School, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Nikola Sprigg
- Division of Clinical Neuroscience, Clinical Sciences Building, City Hospital Campus, Nottingham, UK
| | | | - Marion F Walker
- Division of Rehabilitation, Ageing & Wellbeing, B Floor, The Medical School, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Farhad Shokraneh
- King's Technology Evaluation Centre, London Institute of Healthcare Engineering, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Pucciarelli G, Lommi M, Magwood GS, Simeone S, Colaceci S, Vellone E, Alvaro R. Effectiveness of dyadic interventions to improve stroke patient-caregiver dyads' outcomes after discharge: A systematic review and meta-analysis study. Eur J Cardiovasc Nurs 2020; 20:14-33. [PMID: 33570593 DOI: 10.1177/1474515120926069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 04/23/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Because of the importance of a dyadic approach, it is necessary to conduct a systematic review to identify which dyadic intervention could be implemented for stroke survivor-caregiver dyads after discharge from the rehabilitation hospital to improve outcomes. AIMS The aims were to systematically review the evidence to identify which dyadic interventions have been implemented in stroke survivor-caregiver dyads to improve stroke survivor-caregiver dyads' outcomes and to analyse, through a meta-analysis, which intervention was found to be the most effective. METHODS A systematic review and meta-analysis were conducted using the following electronic databases: PubMed, CINAHL and PsycInfo. Randomized controlled trials (RCTs) and quasi-RCT studies published within the last 10 years were included. Quantitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. Pooled effects were analysed between the experimental and control groups for each outcome. RESULTS Sixteen studies involving 2997 stroke survivors (male gender=58%) and 2187 caregivers (male gender=25%) were included in this review. In 16 studies, which were subdivided into three quasi-RCTs and 13 RCTs, the application of dyadic interventions for stroke survivors and caregivers was systematically reviewed, but only a few of these identified a significant improvement in the stroke survivors' and caregivers' outcomes of its intervention group. Dyadic interventions showed a significant effect on stroke survivors' physical functioning (p=0.05), memory (p<0.01) and quality of life (p=0.01) and on caregivers' depression (p=0.05). CONCLUSIONS This study provides moderate support for the use of a dyadic intervention to improve stroke survivors' physical functioning, memory and quality of life and caregiver depression.
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Affiliation(s)
| | - Marzia Lommi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | | | - Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Sofia Colaceci
- Saint Camillus International University of Health and Medical Sciences, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
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Two-level multi-methodological evaluation of a new complex primary support programme for stroke care-givers in Germany. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20000665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Allida S, Cox KL, Hsieh CF, House A, Hackett ML. Pharmacological, psychological and non-invasive brain stimulation interventions for preventing depression after stroke. Cochrane Database Syst Rev 2020; 5:CD003689. [PMID: 32390167 PMCID: PMC7211517 DOI: 10.1002/14651858.cd003689.pub4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Depression is an important consequence of stroke that influences recovery yet often is not detected, or is inadequately treated. This is an update and expansion of a Cochrane Review first published in 2004 and previously updated in 2008. OBJECTIVES The primary objective is to test the hypothesis that pharmacological, psychological therapy, non-invasive brain stimulation, or combinations of these interventions reduce the incidence of diagnosable depression after stroke. Secondary objectives are to test the hypothesis that pharmacological, psychological therapy, non-invasive brain stimulation or combinations of these interventions reduce levels of depressive symptoms and dependency, and improve physical functioning after stroke. We also aim to determine the safety of, and adherence to, the interventions. SEARCH METHODS We searched the Specialised Register of Cochrane Stroke and the Cochrane Depression Anxiety and Neurosis (last searched August 2018). In addition, we searched the following databases; Cochrane Central Register of Controlled Trials, CENTRAL (the Cochrane Library, 2018, Issue 8), MEDLINE (1966 to August 2018), Embase (1980 to August 2018), PsycINFO (1967 to August 2018), CINAHL (1982 to August 2018) and three Web of Science indexes (2002 to August 2018). We also searched reference lists, clinical trial registers (World Health Organization International Clinical Trials Registry Platform (WHO ICTRP); to August 2018 and ClinicalTrials.gov; to August 2018), conference proceedings; we also contacted study authors. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing: 1) pharmacological interventions with placebo; 2) one of various forms of psychological therapy with usual care and/or attention control; 3) one of various forms of non-invasive brain stimulation with sham stimulation or usual care; 4) a pharmacological intervention and one of various forms of psychological therapy with a pharmacological intervention and usual care and/or attention control; 5) non-invasive brain stimulation and pharmacological intervention with a pharmacological intervention and sham stimulation or usual care; 6) pharmacological intervention and one of various forms of psychological therapy with placebo and psychological therapy; 7) pharmacological intervention and non-invasive brain stimulation with placebo plus non-invasive brain stimulation; 8) non-invasive brain stimulation and one of various forms of psychological therapy versus non-invasive brain stimulation plus usual care and/or attention control; and 9) non-invasive brain stimulation and one of various forms of psychological therapy versus sham brain stimulation or usual care plus psychological therapy, with the intention of preventing depression after stroke. DATA COLLECTION AND ANALYSIS Review authors independently selected studies, assessed risk of bias, and extracted data from all included studies. We calculated mean difference (MD) or standardised mean difference (SMD) for continuous data and risk ratio (RR) for dichotomous data with 95% confidence intervals (CIs). We assessed heterogeneity using the I2 statistic and assessed the certainty of evidence using GRADE. MAIN RESULTS We included 19 RCTs (21 interventions), with 1771 participants in the review. Data were available for 12 pharmacological trials (14 interventions) and seven psychological trials. There were no trials of non-invasive brain stimulation compared with sham stimulation or usual care, a combination of pharmacological intervention and one of various forms of psychological therapy with placebo and psychological therapy, or a combination of non-invasive brain stimulation and a pharmacological intervention with a pharmacological intervention and sham stimulation or usual care to prevent depression after stroke. Treatment effects were observed on the primary outcome of meeting the study criteria for depression at the end of treatment: there is very low-certainty evidence from eight trials (nine interventions) that pharmacological interventions decrease the number of people meeting the study criteria for depression (RR 0.50, 95% CI 0.37 to 0.68; 734 participants) compared to placebo. There is very low-certainty evidence from two trials that psychological interventions reduce the proportion of people meeting the study criteria for depression (RR 0.68, 95% CI 0.49 to 0.94, 607 participants) compared to usual care and/or attention control. Eight trials (nine interventions) found no difference in death and other adverse events between pharmacological intervention and placebo groups (RR 1.25, 95% CI 0.32 to 4.91; 496 participants) based on very low-certainty evidence. Five trials found no difference in psychological intervention and usual care and/or attention control groups for death and other adverse events (RR 1.18, 95% CI 0.73 to 1.91; 975 participants) based on very low-certainty evidence. AUTHORS' CONCLUSIONS The available evidence suggests that pharmacological interventions and psychological therapy may prevent depression and improve mood after stroke. However, there is very low certainty in these conclusions because of the very low-certainty evidence. More trials are required before reliable recommendations can be made about the routine use of such treatments after stroke.
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Affiliation(s)
- Sabine Allida
- Mental Health, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Katherine Laura Cox
- Mental Health, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Cheng-Fang Hsieh
- Division of Geriatrics and Gerontology, Department of Internal Medicine and Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Allan House
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Maree L Hackett
- Professor, Program Head, Mental Health, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, Lancashire, UK
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Fakolade A, Walters AJ, Cameron J, Latimer-Cheung AE, Pilutti LA. Healthy together: A systematic review of theory and techniques used in health interventions for persons with chronic neurological conditions and their caregivers. PATIENT EDUCATION AND COUNSELING 2020; 103:788-803. [PMID: 31767245 DOI: 10.1016/j.pec.2019.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/03/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the level of theory application and use of behaviour change techniques (BCTs) in dyadic health interventions for persons with chronic neurological conditions (CNCs) and their caregivers. METHODS A systematic review of five databases was conducted to locate articles published before January 2019. Methodological quality was assessed, study characteristics, theory application and BCTs were narratively summarized. RESULTS More than half of the studies identified (59% [16/27]) did not mention theory, and only 22% (6/27) were explicitly theory-based. Across the 27 studies, two to 17 BCTs (mean = 6.8 ± 4.02) were used. Common BCTs were related to intervention implementation (e.g., credible source), knowledge (e.g., instruction on how to perform behaviour) and skill development (e.g., behavioural practice/rehearsal). CONCLUSIONS Researchers need to incorporate theory-based dyadic techniques that target both people with CNCs and their caregivers into the design and implementation of future health interventions. PRACTICE IMPLICATIONS Health professionals require explicitly theory-based interventions to provide dyads with CNCs techniques that they can apply in their daily life to the benefit of each individual and the partnership.
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Affiliation(s)
- Afolasade Fakolade
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - Alexandra J Walters
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada
| | - Julie Cameron
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | | | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada.
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Minshall C, Castle DJ, Thompson DR, Pascoe M, Cameron J, McCabe M, Apputhurai P, Knowles SR, Jenkins Z, Ski CF. A psychosocial intervention for stroke survivors and carers: 12-month outcomes of a randomized controlled trial. Top Stroke Rehabil 2020; 27:563-576. [PMID: 32191569 DOI: 10.1080/10749357.2020.1738677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background and Purpose: Stroke can have a devastating impact on the mental and physical health of stroke survivors and their carers. We aimed to evaluate the effectiveness of a novel psychosocial intervention designed to improve health outcomes in both groups.Methods: We conducted a randomized controlled trial of a personalized psychosocial intervention (eight 1-hour weekly sessions plus one booster) compared to usual care for adult stroke survivors and carers. Participants recruited from hospital services and community referrals completed questionnaires at baseline, 3, 6, and 12 months. Primary outcomes were quality of life and self-efficacy; secondary outcomes were depressive and anxiety symptoms, coping, illness perception, work and social adjustment, carer strain, and carer satisfaction. Mixed-effect model repeated measures analysis between groups and across time was conducted.Results: Of the 173 participants recruited (89 stroke survivors; 84 carers), a total of 137 participants - 73 stroke survivors (intervention n = 42; usual care n = 31) and 64 carers (intervention n = 35; usual care n = 29) - underwent analysis up to 12 months. No statistically significant differences were found in the primary outcomes between groups over time, though a significant improvement in carer satisfaction was found at 6 months in the intervention group compared to the usual care group.Conclusion: A personalized psychosocial intervention resulted in a significant improvement in carer satisfaction at 6 months but in no other outcomes. A lack of available services and barriers to social engagement may have impeded the effectiveness of this intervention.
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Affiliation(s)
- Catherine Minshall
- Centre for Mental Health, University of Melbourne, Melbourne, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, Australia
| | - David J Castle
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - David R Thompson
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Michaela Pascoe
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia
| | - Jan Cameron
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Marita McCabe
- Faculty of Health Sciences, Swinburne University, Melbourne, Australia
| | | | - Simon R Knowles
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Faculty of Health Sciences, Swinburne University, Melbourne, Australia
| | - Zoe Jenkins
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia
| | - Chantal F Ski
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Allida S, Cox KL, Hsieh C, Lang H, House A, Hackett ML. Pharmacological, psychological, and non-invasive brain stimulation interventions for treating depression after stroke. Cochrane Database Syst Rev 2020; 1:CD003437. [PMID: 31989584 PMCID: PMC6999797 DOI: 10.1002/14651858.cd003437.pub4] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Depression is an important morbidity associated with stroke that impacts on recovery yet often undetected or inadequately treated. This is an update and expansion of a Cochrane Review first published in 2004 and updated in 2008. OBJECTIVES Primary objective • To determine whether pharmacological therapy, non-invasive brain stimulation, psychological therapy, or combinations of these interventions reduce the prevalence of diagnosable depression after stroke Secondary objectives • To determine whether pharmacological therapy, non-invasive brain stimulation, psychological therapy, or combinations of these interventions reduce levels of depressive symptoms, improve physical and neurological function and health-related quality of life, and reduce dependency after stroke • To assess the safety of and adherence to such treatments SEARCH METHODS: We searched the Specialised Registers of Cochrane Stroke and Cochrane Depression Anxiety and Neurosis (last searched August 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1), in the Cochrane Library, MEDLINE (1966 to August 2018), Embase (1980 to August 2018), the Cumulative Index to Nursing and Alllied Health Literature (CINAHL) (1982 to August 2018), PsycINFO (1967 to August 2018), and Web of Science (2002 to August 2018). We also searched reference lists, clinical trial registers (World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) to August 2018; ClinicalTrials.gov to August 2018), and conference proceedings, and we contacted study authors. SELECTION CRITERIA Randomised controlled trials comparing (1) pharmacological interventions with placebo; (2) one of various forms of non-invasive brain stimulation with sham stimulation or usual care; (3) one of various forms of psychological therapy with usual care and/or attention control; (4) pharmacological intervention and various forms of psychological therapy with pharmacological intervention and usual care and/or attention control; (5) non-invasive brain stimulation and pharmacological intervention with pharmacological intervention and sham stimulation or usual care; (6) pharmacological intervention and one of various forms of psychological therapy with placebo and psychological therapy; (7) pharmacological intervention and non-invasive brain stimulation with placebo plus non-invasive brain stimulation; (8) non-invasive brain stimulation and one of various forms of psychological therapy versus non-invasive brain stimulation plus usual care and/or attention control; and (9) non-invasive brain stimulation and one of various forms of psychological therapy versus sham brain stimulation or usual care plus psychological therapy, with the intention of treating depression after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed risk of bias, and extracted data from all included studies. We calculated mean difference (MD) or standardised mean difference (SMD) for continuous data, and risk ratio (RR) for dichotomous data, with 95% confidence intervals (CIs). We assessed heterogeneity using the I² statistic and certainty of the evidence according to GRADE. MAIN RESULTS We included 49 trials (56 comparisons) with 3342 participants. Data were available for: (1) pharmacological interventions with placebo (with 20 pharmacological comparisons); (2) one of various forms of non-invasive brain stimulation with sham stimulation or usual care (with eight non-invasive brain stimulation comparisons); (3) one of various forms of psychological therapy with usual care and/or attention control (with 16 psychological therapy comparisons); (4) pharmacological intervention and various forms of psychological therapy with pharmacological intervention and usual care and/or attention control (with two comparisons); and (5) non-invasive brain stimulation and pharmacological intervention with pharmacological intervention and sham stimulation or usual care (with 10 comparisons). We found no trials for the following comparisons: (6) pharmacological intervention and various forms of psychological therapy interventions versus placebo and psychological therapy; (7) pharmacological intervention and non-invasive brain stimulation versus placebo plus non-invasive brain stimulation; (8) non-invasive brain stimulation and one of various forms of psychological therapy versus non-invasive brain stimulation plus usual care and/or attention control; and (9) non-invasive brain stimulation and one of various forms of psychological therapy versus sham brain stimulation or usual care plus psychological therapy. Treatment effects observed: very low-certainty evidence from eight trials suggests that pharmacological interventions decreased the number of people meeting study criteria for depression (RR 0.70, 95% CI 0.55 to 0.88; 1025 participants) at end of treatment, and very low-certainty evidence from six trials suggests that pharmacological interventions decreased the number of people with less than 50% reduction in depression scale scores at end of treatment (RR 0.47, 95% CI 0.32 to 0.69; 511 participants) compared to placebo. No trials of non-invasive brain stimulation reported on meeting study criteria for depression at end of treatment. Only one trial of non-invasive brain stimulation reported on the outcome <50% reduction in depression scale scores; thus, we were unable to perform a meta-analysis for this outcome. Very low-certainty evidence from six trials suggests that psychological therapy decreased the number of people meeting the study criteria for depression at end of treatment (RR 0.77, 95% CI 0.62 to 0.95; 521 participants) compared to usual care/attention control. No trials of combination therapies reported on the number of people meeting the study criteria for depression at end of treatment. Only one trial of combination (non-invasive brain stimulation and pharmacological intervention) therapy reported <50% reduction in depression scale scores at end of treatment. Thus, we were unable to perform a meta-analysis for this outcome. Five trials reported adverse events related to the central nervous system (CNS) and noted significant harm in the pharmacological interventions group (RR 1.55, 95% CI 1.12 to 2.15; 488 participants; very low-certainty evidence). Four trials found significant gastrointestinal adverse events in the pharmacological interventions group (RR 1.62, 95% CI 1.19 to 2.19; 473 participants; very low-certainty evidence) compared to the placebo group. No significant deaths or adverse events were found in the psychological therapy group compared to the usual care/attention control group. Non-invasive brain stimulation interventions and combination therapies resulted in no deaths. AUTHORS' CONCLUSIONS Very low-certainty evidence suggests that pharmacological or psychological therapies can reduce the prevalence of depression. This very low-certainty evidence suggests that pharmacological therapy, psychological therapy, non-invasive brain stimulation, and combined interventions can reduce depressive symptoms. Pharmacological intervention was associated with adverse events related to the CNS and the gastrointestinal tract. More research is required before recommendations can be made about the routine use of such treatments.
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Affiliation(s)
- Sabine Allida
- The George Institute for Global Health, Faculty of Medicine, University of New South WalesMental HealthSydneyNSWAustralia2050
| | - Katherine Laura Cox
- The George Institute for Global Health, Faculty of Medicine, University of New South WalesMental HealthSydneyNSWAustralia2050
| | - Cheng‐Fang Hsieh
- Kaohsiung Medical UniversityDivision of Geriatrics and Gerontology, Department of Internal Medicine and Department of Neurology, Kaohsiung Medical University HospitalKaohsiungTaiwan
| | | | - Allan House
- Leeds Institute of Health Sciences, University of LeedsDivision of Psychological and Social MedicineRoom 1090c, Worsley BuildingClarendon WayLeedsUKLS2 9LJ
| | - Maree L Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South WalesMental HealthSydneyNSWAustralia2050
- University of Central LancashireFaculty of Health and WellbeingPreston, LancashireUK
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McCarthy MJ, Garcia YE, Dunn DJ, Lyons KS, Bakas T. Development and validation of a quality of relationship intervention for stroke survivor-family caregiver dyads. Top Stroke Rehabil 2019; 27:305-315. [PMID: 31782683 DOI: 10.1080/10749357.2019.1690823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: The relationship between stroke survivors and family caregivers is critical for the well-being of both dyad members. Currently, there are few interventions targeted at dyads and focused on strengthening the relationship between survivors and family caregivers.Objectives: This study reports on the development of a customizable, strengths-based, relationship-focused intervention driven by the real-world experience and advice of stroke dyads. It also describes the "tips" that survivors and family caregivers offered for dealing with relationship challenges after stroke.Methods: Content of the intervention, including relationship tips, was derived from semi-structured interviews with N= 19 stroke dyads. A modified Delphi process with a national panel of 10 subject matter experts was used to evaluate and refine the content of the intervention and the associated screening tool.Results: Seventeen domains of relationship challenges and tips were identified. Consensus was reached among experts that the intervention content was relevant to the goal of helping survivors and family caregivers maintain a strong relationship after stroke; (2) clear from the perspective of stroke survivors and family caregivers who would be using it; (3) accurate with respect to the advice being offered, and; (4) useful for helping stroke survivors and family caregivers improve the quality of their relationship.Conclusions: This study extends the limited body of research about dyadic interventions after stroke. The next steps in this line of research include feasibility testing the intervention and evaluating its efficacy in a larger trial.
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Affiliation(s)
- Michael J McCarthy
- Department of Social Work, College of Social and Behavioral Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Y Evie Garcia
- Department of Educational Psychology, College of Education, Northern Arizona University, Flagstaff, AZ, USA
| | - Dorothy J Dunn
- School of Nursing, College of Health & Human Services, Northern Arizona University, Flagstaff, AZ, USA
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, MA, USA
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
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de Goumoëns V, Rio LM, Jaques C, Ramelet AS. Family-oriented interventions for adults with acquired brain injury and their families: a scoping review. ACTA ACUST UNITED AC 2019; 16:2330-2367. [PMID: 30531483 DOI: 10.11124/jbisrir-2017-003846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This scoping review sought to describe the literature on the different types of interventions to support families of patients with acquired brain injuries (ABIs) and their outcomes. INTRODUCTION Acquired brain injuries are among the leading causes of disability in adults worldwide and have physical, cognitive or/and behavioral consequences not only for the patient, but also for the family. Several support interventions have been proposed in different contexts at different phases of recovery with various levels of evidence, yet no synthesis is available to date. INCLUSION CRITERIA We included studies that focused on family members of patients suffering from ABI. The concept under review included any type of intervention or action oriented to support families of patients with ABI, in any care setting. We included all published qualitative and quantitative designs, including those in the gray literature. METHODS A three-step search strategy was performed. Searches were conducted in eight major databases, MEDLINE, PubMed, Embase, CINAHL, PsycINFO, Cochrane, JBI Database of Systematic Reviews and Implementation Reports, Web of Science in April 2017, and seven databases for unpublished studies in November 2017. This review was limited to studies published in English and French since January 2007. Additional studies were searched amongst reference lists of all included articles. RESULTS We included 89 studies, 19 secondary studies (systematic reviews n = 13, other type of reviews n = 6) and 70 primary studies (experimental studies n = 20, quasi-experimental studies n = 33, other designs n = 17). Even if heterogeneity was found in the characteristics of the 64 selected interventions, emotional support and education were highlighted as the main core components for family-oriented interventions. Mental health and burden were the two most prevalent outcomes found in this scoping review. Interventions targeted families and patients together in 56% of the cases or families alone. CONCLUSION This scoping review provides an actual state of the current evidence available for families of patients with ABI. Extended and heterogeneous literature was found, showing the growing interest for considering ABI as a family issue in recent years. However, the overall level of evidence found indicates that more research is still needed to determine key components to intervene within this specific population.
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Affiliation(s)
- Véronique de Goumoëns
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Nursing, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence
| | - Laura Marques Rio
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence
| | - Cécile Jaques
- Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence.,Medical Library, Research and Education Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence
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Lee D, Heffron JL, Mirza M. Content and Effectiveness of Interventions Focusing on Community Participation Poststroke: A Systematic Review. Arch Phys Med Rehabil 2019; 100:2179-2192.e1. [DOI: 10.1016/j.apmr.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 05/01/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
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Araújo ÉDF, Viana RT, Teixeira-Salmela LF, Lima LAO, Faria CDCDM. Self-rated health after stroke: a systematic review of the literature. BMC Neurol 2019; 19:221. [PMID: 31493791 PMCID: PMC6731602 DOI: 10.1186/s12883-019-1448-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Self-rated health (SRH) allows for comparison and identification of the health status of various populations. The aim of this study was to conduct a systematic review of the literature to expand the understanding of SRH after stroke. METHODS This systematic review was registered with PROSPERO (CRD42017056194) and conducted according to PRISMA guidelines. Studies published until December 2018 that evaluated the SRH of adults with stroke were included. RESULTS Of the 2132 identified studies, 51 were included. Only four studies had experimental designs (7.8%). In 60.7% of the studies, SRH was assessed by variations on direct questions (i.e., general and comparative SRH). Analog visual scales and quality of life instruments were also used to evaluate SRH, but there is no consensus regarding whether they are appropriate for this purpose. The results of cross-sectional and longitudinal studies revealed significant associations between poor SRH and stroke as well as between SRH, function, and disability. The power of SRH to predict stroke mortality is still uncertain. Two interventions (a home-based psychoeducational program concerning stroke health care and family involvement in functional rehabilitation) effectively improved SRH. CONCLUSIONS Direct questions are the most common method of evaluating SRH after stroke. Studies reported significant associations between the SRH of individuals with stroke and several relevant health outcomes. However, few experimental studies have evaluated SRH after stroke. Interventions involving health education and family involvement had a significant impact on SRH.
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Affiliation(s)
- Érika de Freitas Araújo
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, MG Brazil
| | - Ramon Távora Viana
- Graduate Program in Rehabilitation Sciences of the Universidade Federal de Minas Gerais, (UFMG), Belo Horizonte, MG Brazil
- Department of Physical Therapy, Universidade Federal do Ceará (UFC), Fortaleza, Ceará Brazil
| | - Luci Fuscaldi Teixeira-Salmela
- Department of Physical Therapy, Universidade Federal de Minas Gerais, (UFMG), Av. Antonio Carlos, 6627, Campus Pampulha, Belo Horizonte, MG ZIP code 31270-901 Brazil
| | | | - Christina Danielli Coelho de Morais Faria
- Department of Physical Therapy, Universidade Federal de Minas Gerais, (UFMG), Av. Antonio Carlos, 6627, Campus Pampulha, Belo Horizonte, MG ZIP code 31270-901 Brazil
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Panzeri A, Rossi Ferrario S, Vidotto G. Interventions for Psychological Health of Stroke Caregivers: A Systematic Review. Front Psychol 2019; 10:2045. [PMID: 31551881 PMCID: PMC6743500 DOI: 10.3389/fpsyg.2019.02045] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/21/2019] [Indexed: 02/03/2023] Open
Abstract
Background: The increasing number of stroke patients (SPs) requires informal caregivers to bear a high burden of responsibilities and heavy (di)stress. Moreover, these issues could lead to the development of serious psychological problems (e.g., depressive and/or anxious) that in turn could give rise to poor health-related quality of life outcomes. However, although the value of psychological interventions has been widely recognized for SPs, the scientific literature lacks an updated synthesis of interventions addressing the psychological health of their caregivers. Aim: The aim of this review is to summarize the interventions for the psychological health of stroke caregivers and provide a resume of literature-based evidence of their efficacy. Method: A literature review from 2005 to date was conducted in three online databases: PubMed, Scopus, and Google Scholar. Eligibility criteria for studies were (A) English language, (B) caregivers and patients aged 18 years or above, (C) SP's caregiver beneficiating of a specific intervention, and (D) outcome measures addressing depressive and/or anxiety symptomology, quality of life, well-being, or burden. Results: Across the selected 45 studies, substantial differences are observable in three main categories: (a) type of intervention (b) techniques, and (c) operators. Interventions' advantages and results are discussed. Overall, studies using psychological techniques, such as cognitive-behavioral therapy, coping skill-training, and problem-solving therapy, showed their usefulness and efficacy in reducing the caregivers' depressive and anxious symptoms, and burden. Interventions led by psychologists and tailored to meet caregivers' specific needs showed more positive outcomes. Conclusion: This review underlines the usefulness of psychological interventions aimed at reducing the psychological burden, such as anxious and depressive symptomatology, of SPs' informal caregivers. Hence, psychological interventions for caregivers should be integrated as part of the stroke rehabilitation process to improve informal caregivers' and patients' quality of life and well-being.
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Affiliation(s)
- Anna Panzeri
- Psychology and Neuropsychology Unit, Istituti Clinici Scientifici Maugeri, Veruno, Italy
- General Psychology Department, Università degli Studi di Padova, Padova, Italy
| | - Silvia Rossi Ferrario
- Psychology and Neuropsychology Unit, Istituti Clinici Scientifici Maugeri, Veruno, Italy
| | - Giulio Vidotto
- General Psychology Department, Università degli Studi di Padova, Padova, Italy
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Scholten EWM, Hillebregt CF, Ketelaar M, Visser-Meily JMA, Post MWM. Measures used to assess impact of providing care among informal caregivers of persons with stroke, spinal cord injury, or amputation: a systematic review. Disabil Rehabil 2019; 43:746-772. [PMID: 31366259 DOI: 10.1080/09638288.2019.1641847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE (1) To identify measures used to evaluate the impact of caregiving among caregivers of persons with stroke, spinal cord injury, and amputation; and (2) to systematically evaluate their clinimetric properties reported in validation studies. MATERIALS AND METHODS Two separate systematic reviews (Embase, PsycINFO, CINAHL, Pubmed/Medline) were conducted. COSMIN guidelines were used to assess clinimetric properties and methodological quality of studies. RESULTS (1) 154 studies published between 2008 and May 2019 were included, in which 48 measures were used, mostly describing negative impact. Thirty measures were used only once and not further described. (2) In general, structural validity, internal consistency, and hypothesis testing were often investigated. Reliability, cross-cultural and criterion validity to a lesser extent, and scale development and content validity were rarely described. Tests of measurement error and responsiveness were exceptional. Most supporting evidence was found for the Zarit Burden Interview Short Form, Caregiver Burden Scale and Positive Aspects of Caregiving Questionnaire. CONCLUSIONS There is a wide variety of impact of caregiving measures. The present study provided a detailed overview of what is known about clinimetric characteristics of 18 different measures repeatedly used in research. The overview provides clinicians a guidance of appropriate measure selection. PROSPERO REGISTRATION CRD42018094796IMPLICATIONS FOR REHABILITATIONClinicians should be aware that information about measure development and clinimetric properties for most measures used to assess impact of informal caregiving is incomplete.Most supporting evidence was found for the Zarit Burden Interview Short Form, Caregiver Burden Scale and Positive Aspects of Caregiving Questionnaire.This overview of clinimetric properties provides clinicians guidance for selection of an appropriate measure.
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Affiliation(s)
- Eline W M Scholten
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Chantal F Hillebregt
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMCU Utrecht Brain Center, University Medical Center, Utrecht, The Netherlands
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, The Netherlands
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Smith TO, Pearson M, Pfeiffer K, Crotty M, Lamb SE. Caregiver Interventions for Adults Discharged from the Hospital: Systematic Review and Meta-Analysis. J Am Geriatr Soc 2019; 67:1960-1969. [PMID: 31350918 DOI: 10.1111/jgs.16048] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/30/2019] [Accepted: 05/31/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To review the evidence evaluating the effectiveness of informal caregiver interventions to facilitate the recovery of older people discharged from the hospital. DESIGN Systematic review and meta-analysis. SETTING Hospital and community. METHODS Published and unpublished randomized and nonrandomized controlled trials assessing the effectiveness of informal caregiver interventions to support the recovery of older people discharged from the hospital were identified (to March 2019). The primary outcome was patient health-related quality of life (HRQOL). Secondary outcomes included patient function, caregiver burden, caregiver HRQOL, psychological distress, adverse events, and health resource use. Studies were critically appraised and meta-analyzed. PARTICIPANTS Adults who had been admitted to the hospital. RESULTS A total of 23 studies were eligible (4695 participants). The indication for hospital admission was stroke in 21 trials (91%). Interventions consisted of training and/or skills-based programs, with or without home visits/telephone follow-up. Caregiver interventions for patients following stroke may provide no benefit for patient HRQOL at 12 months (standardized mean difference = .29; 95% confidence interval = -.12 to .69; low-quality evidence). Caregiver interventions demonstrated benefit for caregiver burden and both patient and caregiver anxiety at 12 months. No consistent effect was found on functional outcomes, depression, HRQOL, adverse events, or health resource use measures. CONCLUSIONS Informal caregivers who receive training to facilitate the recovery of older people discharged from the hospital following stroke may have a lower burden and reduced anxiety at 12 months compared with those who do not. However, the evidence was moderate to low quality. Further study is warranted to explore whether caregiver interventions can be modified for nonstroke populations such as those with hip fracture. J Am Geriatr Soc 67:1960-1969, 2019.
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Affiliation(s)
- Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Matthew Pearson
- Physiotherapy Outpatients Department, Dynamic Health, Cambridgeshire Community Services NHS Trust, Huntingdon, United Kingdom
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Maria Crotty
- Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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Minshall C, Pascoe MC, Thompson DR, Castle DJ, McCabe M, Chau JPC, Jenkins Z, Cameron J, Ski CF. Psychosocial interventions for stroke survivors, carers and survivor-carer dyads: a systematic review and meta-analysis. Top Stroke Rehabil 2019; 26:554-564. [PMID: 31258017 DOI: 10.1080/10749357.2019.1625173] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: To evaluate the effectiveness of psychosocial interventions on depressive symptoms, anxiety symptoms, quality of life, self-efficacy, coping, carer strain and carer satisfaction among stroke survivors, carers and survivor-carer dyads. Data sources: MEDLINE, CINAHL, PsycINFO, SocINDEX, Cochrane Library, Web of Science and Scopus databases and the grey literature were searched up to September 2018. Methods: A systematic review and meta-analysis of randomized controlled trials of psychosocial interventions for stroke survivors, carers and survivor-carer dyads, compared to usual care. Outcomes measured were depressive symptoms, anxiety symptoms, quality of life, coping, self-efficacy, carer strain, and carer satisfaction. Results: Thirty-one randomized controlled trials (n = 5715) were included in the systematic review which found improvements in depressive symptoms, anxiety symptoms, quality of life and coping, though the number of trials assessing each outcome varied. A meta-analysis (11 trials; n = 1280) on depressive symptoms found that in seven trials psychosocial interventions reduced depressive symptoms in stroke survivors (SMD: -0.36, 95% CI -0.73 to 0.00; p = .05) and in six trials reduced depressive symptoms in carers (SMD: -0.20, 95% CI -.40 to 0.00; p = .05). Conclusion: Psychosocial interventions reduced depressive symptoms in stroke survivors and their carers. There was limited evidence that such interventions reduced anxiety symptoms, or improved quality of life and coping for stroke survivors and carers and no evidence that they improved self-efficacy, carer strain or carer satisfaction.
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Affiliation(s)
- Catherine Minshall
- Faculty of Health Sciences, Australian Catholic University , Melbourne , Australia.,Mental Health Service, St. Vincent's Hospital , Melbourne , Australia
| | - Michaela C Pascoe
- Institute of Sport, Exercise and Active Living, Victoria University , Melbourne , Australia.,Department of Cancer Experiences, Peter MacCallum Cancer Centre , Melbourne , Australia
| | - David R Thompson
- Department of Psychiatry, University of Melbourne , Melbourne , Australia.,School of Nursing and Midwifery, Queen's University , Belfast , UK
| | - David J Castle
- Mental Health Service, St. Vincent's Hospital , Melbourne , Australia.,Department of Psychiatry, University of Melbourne , Melbourne , Australia
| | - Marita McCabe
- Faculty of Health Sciences, Swinburne University of Technology , Melbourne , Australia
| | - Janita P C Chau
- Nethersole School of Nursing, Chinese University of Hong Kong , Shatin , Hong Kong
| | - Zoe Jenkins
- Mental Health Service, St. Vincent's Hospital , Melbourne , Australia
| | - Jan Cameron
- School of Nursing and Midwifery, Monash University , Melbourne , Australia
| | - Chantal F Ski
- Department of Psychiatry, University of Melbourne , Melbourne , Australia.,School of Nursing and Midwifery, Queen's University , Belfast , UK
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Pan Y, Chen R, Yang D. The Role of Mutuality and Coping in a Nurse-Led Cognitive Behavioral Intervention on Depressive Symptoms Among Dementia Caregivers. Res Gerontol Nurs 2019; 12:44-55. [PMID: 30653651 DOI: 10.3928/19404921-20181212-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/09/2018] [Indexed: 11/20/2022]
Abstract
The current study explored whether mutuality and coping predicted and/or mediated the effect of a nurse-led cognitive behavioral intervention (NLCBI) on depressive symptoms of caregivers of persons with dementia. The intervention group (n = 56) received five monthly in-home nurse-led cognitive behavioral sessions and consultation calls after each session. The control group (n = 56) received five monthly short general conversations with the nurse interventionist. Questionnaires on study variables and demographics were collected at baseline, end of intervention, and 2-month follow up. Improved mutuality (β = -0.75, p = 0.049) and active coping (β = -2.06, p = 0.0001) and decreased passive coping (β = 1.43, p = 0.001) were found to predict the reduction of depressive symptoms among caregivers in the NLCBI. However, none of these variables mediated the interventional effect. Regular mental health nursing interventions are suggested to focus on enhancing mutuality and active coping and decreasing passive coping to maintain caregivers' mental health. TARGETS Caregivers of persons with dementia. INTERVENTION DESCRIPTION Nurse-led cognitive behavioral sessions and subsequent consultation calls. MECHANISMS OF ACTION Impacted caregivers' reappraisals, thus improving their active coping skills and mutuality and decreasing their passive coping, which directly reduced their depressive symptoms. OUTCOMES Mutuality, active coping, and passive coping played a predicting, but not mediating, role in the effect of the NLCBI. [Res Gerontol Nurs. 2019; 12(1):44-55.].
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Küçükdeveci AA, Stibrant Sunnerhagen K, Golyk V, Delarque A, Ivanova G, Zampolini M, Kiekens C, Varela Donoso E, Christodoulou N. Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for persons with stroke. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2019; 54:957-970. [DOI: 10.23736/s1973-9087.18.05501-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Herron K, Farquharson L, Wroe A, Sterr A. Development and Evaluation of a Cognitive Behavioural Intervention for Chronic Post-Stroke Insomnia. Behav Cogn Psychother 2018; 46:641-660. [PMID: 29478417 DOI: 10.1017/s1352465818000061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive behavioural therapy for insomnia (CBTI) has been successfully applied to those with chronic illness. However, despite the high prevalence of post-stroke insomnia, the applicability of CBTI for this population has not been substantially researched or routinely used in clinical practice. AIMS The present study developed a 'CBTI+' protocol for those with post-stroke insomnia and tested its efficacy. The protocol also incorporated additional management strategies that considered the consequences of stroke. METHOD A single-case experimental design was used with five community-dwelling individuals with post-stroke insomnia. Daily sleep diaries were collected over 11 weeks, including a 2-week baseline, 7-week intervention and 2-week follow-up. The Insomnia Severity Index, Dysfunctional Attitudes and Beliefs About Sleep Scale, Epworth Sleepiness Scale, Fatigue Severity Scale and Stroke Impact Scale were administered pre- and post-treatment, as well as at 2-week follow-up. RESULTS At post-treatment, three participants no longer met diagnostic criteria for insomnia and all participants showed improvements on two or more sleep parameters, including sleep duration and sleep onset latency. Three participants showed a reduction in daytime sleepiness, increased quality of life and reduction in unhelpful beliefs about sleep. CONCLUSIONS This study provides initial evidence that CBTI+ is a feasible and acceptable intervention for post-stroke insomnia. Furthermore, it indicates that sleep difficulties in community-dwelling stroke populations are at least partly maintained by unhelpful beliefs and behaviours. The development and delivery of the CBTI+ protocol has important clinical implications for managing post-stroke insomnia and highlights directions for future research.
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Affiliation(s)
- Katie Herron
- Pain Management Centre,National Hospital For Neurology and Neurosurgery,University College London Hospitals,London,UK
| | - Lorna Farquharson
- Department of Psychology,Royal Holloway,University of London,Surrey,UK
| | - Abigail Wroe
- Clinical Health Psychology Service,Berkshire Healthcare NHS Foundation Trust,Reading,UK
| | - Annette Sterr
- School of Psychology,University of Surrey,Guildford,Surrey,UK
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