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Blanton S, Dunbar S, Clark PC. Content validity and satisfaction with a caregiver-integrated web-based rehabilitation intervention for persons with stroke. Top Stroke Rehabil 2018; 25:168-173. [PMID: 29334344 DOI: 10.1080/10749357.2017.1419618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Family members provide valuable contributions during rehabilitation after stroke, but frequently report higher incidences of burden, depression, and social isolation during caregiving. Thus, effective interventions to reduce stroke impact on the family are needed. Objectives To evaluate the content validity and satisfaction of a caregiver-focused web-based intervention designed to improve stroke survivor physical function while reducing caregiver negative outcomes. Methods Caregivers of individuals with stroke (N = 6) and expert rehabilitation researchers (N = 4) were presented with a novel, web-based intervention (CARE-CITE) designed to foster problem-solving and skill-building while facilitating caregiver involvement during constraint-induced movement therapy. Caregivers rated CARE-CITE for usefulness, ease of use, acceptability, and time to complete. Rehabilitation experts evaluated content for accuracy, feasibility, acceptability, problem relevance and ease of use. Ratings were assessed using a five-point Likert-type response scales (1 = strongly disagree to 5 = strongly agree). Results On average, all caregivers agreed or strongly agreed that the modules were useful (4.42), easy to use (4.60), and acceptable (4.41). Mean total satisfaction score was 4.45, and average review time was 15 min per module. Expert reviewers agreed or strongly agreed that each module was accurate (4.95), feasible (4.8), easy to use (4.86), acceptable (4.96), and had appropriate problem relevance (4.65). Conclusions The CARE-CITE intervention may be a viable program for caregivers of patients with stroke. Currently a pilot study is underway to evaluate the impact of the intervention on caregiver mental health, family conflict around stroke recovery and stroke survivor upper extremity function.
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Affiliation(s)
- Sarah Blanton
- a Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine , Emory University , Atlanta , GA , USA
| | - Sandra Dunbar
- b Nell Hodgson Woodruff School of Nursing , Emory University , Atlanta , GA , USA
| | - Patricia C Clark
- c Byrdine F. Lewis School of Nursing , Georgia State University , Atlanta , GA , USA
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Schulz CH, Godwin KM, Hersch GI, Hyde LK, Irabor JJ, Ostwald SK. Return to work predictors of stroke survivors and their spousal caregivers. Work 2018; 57:111-124. [PMID: 28506018 DOI: 10.3233/wor-172544] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Return to work is an issue of concern for stroke survivors and their spouses. Ramifications may include loss of income and self-efficacy. OBJECTIVE This study describes the return to work patterns of stroke survivors and their spousal caregivers post stroke. METHODS One hundred fifty-nine dyads were examined for their return to work patterns at baseline (post hospital discharge) and then at 3 month intervals for one year. Relationships were determined between work and gender, age, ethnicity, education, type of insurance, type of stroke, location of stroke, motor and cognitive functional status, depression, mutuality, and life satisfaction. RESULTS Low levels of return to work by stroke survivors (7.5%) and a small decrease in the amount of working caregivers (from 45.3% to 40.35%) were found one year post baseline. Variables that predicted return to work changed over the five data points except for younger age for the caregiver, which was consistently significant across all data points. Three case scenarios representative of working patterns are offered. CONCLUSIONS Further research is needed regarding the return to work needs of stroke survivors and their spousal caregivers, particularly what role the occupational therapist may play in facilitating that process.
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Affiliation(s)
- Celia H Schulz
- The University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Kyler M Godwin
- Department of Medicine, Section of Health Sciences Research, Baylor College of Medicine, Houston, TX, USA
| | - Gayle I Hersch
- School of Occupational Therapy, Texas Woman's University, Houston, TX, USA
| | - Leslie K Hyde
- CHI St. Joseph Health Rehabilitation Hospital, Bryan, TX, USA
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Effects of Home-Based Supportive Care on Improvements in Physical Function and Depressive Symptoms in Patients With Stroke: A Meta-Analysis. Arch Phys Med Rehabil 2017; 98:1666-1677.e1. [DOI: 10.1016/j.apmr.2017.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/04/2017] [Accepted: 03/16/2017] [Indexed: 12/29/2022]
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Bakas T, McCarthy M, Miller ET. Update on the State of the Evidence for Stroke Family Caregiver and Dyad Interventions. Stroke 2017; 48:e122-e125. [PMID: 28351961 DOI: 10.1161/strokeaha.117.016052] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/30/2017] [Accepted: 02/16/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Tamilyn Bakas
- From the College of Nursing (T.B., E.T.M.); and School of Social Work, College of Allied Health Sciences (M.M.), University of Cincinnati, OH.
| | - Michael McCarthy
- From the College of Nursing (T.B., E.T.M.); and School of Social Work, College of Allied Health Sciences (M.M.), University of Cincinnati, OH
| | - Elaine T Miller
- From the College of Nursing (T.B., E.T.M.); and School of Social Work, College of Allied Health Sciences (M.M.), University of Cincinnati, OH
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55
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Canadian Stroke Best Practice Recommendations: Managing transitions of care following Stroke, Guidelines Update 2016. Int J Stroke 2016; 11:807-22. [DOI: 10.1177/1747493016660102] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/06/2016] [Indexed: 11/15/2022]
Abstract
Every year, approximately 62,000 people with stroke and transient ischemic attack are treated in Canadian hospitals. For patients, families and caregivers, this can be a difficult time of adjustment. The 2016 update of the Canadian Managing Transitions of Care following Stroke guideline is a comprehensive summary of current evidence-based and consensus-based recommendations appropriate for use by clinicians who provide care to patients following stroke across a broad range of settings. The focus of these recommendations is on support, education and skills training for patients, families and caregivers; effective discharge planning; interprofessional communication; adaptation in resuming activities of daily living; and transition to long-term care for patients who are unable to return to or remain at home. Unlike other modules contained in the Canadian Stroke Best Practice Recommendations (such as acute inpatient care), many of these recommendations are based on consensus opinion, or evidence level C, highlighting the absence of conventional evidence (i.e. randomized controlled trials) in this area of stroke care. The quality of care transitions between stages and settings may have a direct impact on patient and family outcomes such as coping, readmissions and functional recovery. While many qualitative and non-controlled studies were reviewed, this gap in evidence combined with the fact that mortality from stoke is decreasing and more people are living with the effects of stroke, underscores the need to channel a portion of available research funds to recovery and adaptation following the acute phase of stroke.
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Krieger T, Feron F, Dorant E. Developing a complex intervention programme for informal caregivers of stroke survivors: The Caregivers’ Guide. Scand J Caring Sci 2016; 31:146-156. [DOI: 10.1111/scs.12344] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/16/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Theresia Krieger
- Institute for Health Research and Social Psychiatry; Catholic University of Applied Sciences North-Rhine Westphalia; Aachen Germany
| | - Frans Feron
- Department of Social Medicine; Faculty of Health Medicine and Life Sciences; Maastricht University; Maastricht The Netherlands
| | - Elisabeth Dorant
- Department of Social Medicine; Faculty of Health Medicine and Life Sciences; Maastricht University; Maastricht The Netherlands
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Aldehaim AY, Alotaibi FF, Uphold CR, Dang S. The Impact of Technology-Based Interventions on Informal Caregivers of Stroke Survivors: A Systematic Review. Telemed J E Health 2015; 22:223-31. [PMID: 26274910 DOI: 10.1089/tmj.2015.0062] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE This article is a systematic review of the impact of technology-based intervention on outcomes related to care providers for those who survived a stroke. MATERIALS AND METHODS Literature was identified in the PubMed, PsycINFO, Scopus, and Cochrane databases for evidence on technology-based interventions for stroke survivors' caregivers. The search was restricted for all English-language articles from 1970 to February 2015 that implied technology-based interventions. This review included studies that measured the impact of these types of approaches on one or more of the following: depression and any of the following-problem-solving ability, burden, health status, social support, preparedness, and healthcare utilization by care recipient-as secondary outcomes. Telephone or face-to-face counseling sessions were not of interest for this review. The search strategy yielded five studies that met inclusion criteria: two randomized clinical trials and three pilot/preliminary studies, with diverse approaches and designs. RESULTS Four studies have assessed the primary outcome, two of which reported significant decreases in caregivers' depressive symptoms. Two studies had measured each of the following outcomes-burden, problem-solving ability, health status, and social support-and they revealed no significant differences following the intervention. Only one study assessed caregivers' preparedness and showed improved posttest scores. Healthcare services use by the care recipient was assessed by one study, and the results indicated significant reduction in emergency department visits and hospital re-admissions. CONCLUSIONS Despite various study designs and small sample sizes, available data suggest that an intervention that incorporates a theoretical-based model and is designed to target caregivers as early as possible is a promising strategy. Furthermore, there is a need to incorporate a cost-benefit analysis in future studies.
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Affiliation(s)
- Abdulkarim Yousef Aldehaim
- 1 Department of Public Health, University of Miami Miller School of Medicine , Miami, Florida.,2 Department of Medicine, King Saud University , Riyadh, Saudi Arabia
| | - Faisal F Alotaibi
- 1 Department of Public Health, University of Miami Miller School of Medicine , Miami, Florida.,3 Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam Bin Abdulaziz University , Alkharj, Saudi Arabia
| | - Constance R Uphold
- 4 Department of Aging, University of Florida , Gainesville, Florida.,5 Geriatric Research, Education, and Clinical Center and Extended Care and Research Services , North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Stuti Dang
- 6 Geriatric Research, Education, and Clinical Center and Extended Care and Research Services, Bruce W. Carter Department of Veterans Affairs Medical Center , Miami, Florida.,7 The Geriatrics Institute, Department of Medicine, University of Miami Miller School of Medicine , Miami, Florida
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Obembe AO, Eng JJ. Rehabilitation Interventions for Improving Social Participation After Stroke: A Systematic Review and Meta-analysis. Neurorehabil Neural Repair 2015. [PMID: 26223681 DOI: 10.1177/1545968315597072] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite the fact that social participation is considered a pivotal outcome of a successful recovery after stroke, there has been little attention on the impact of activities and services on this important domain. OBJECTIVE To present a systematic review and meta-analysis from randomized controlled trials (RCTs) on the effects of rehabilitation interventions on social participation after stroke. METHODS A total of 8 electronic databases were searched for relevant RCTs that evaluated the effects of an intervention on the outcome of social participation after stroke. Reference lists of selected articles were hand searched to identify further relevant studies. The methodological quality of the studies was assessed using the Physiotherapy Evidence Database Scale. Standardized mean differences (SMDs) and confidence intervals (CIs) were estimated using fixed- and random-effect models. RESULTS In all, 24 RCTs involving 2042 stroke survivors were identified and reviewed, and 21 were included in the meta-analysis. There was a small beneficial effect of interventions that utilized exercise on social participation (10 studies; SMD = 0.43; 95% CI = 0.09, 0.78;P= .01) immediately after the program ended. Exercise in combination with other interventions (13 studies; SMD = 0.34; 95% CI = 0.10, 0.58;P= .006) also resulted in beneficial effects. No significant effect was observed for interventions that involved support services over 9 studies (SMD = 0.09 [95% CI = -0.04, 0.21];I(2)= 0%;P= .16). CONCLUSIONS The included studies provide evidence that rehabilitation interventions may be effective in improving social participation after stroke, especially if exercise is one of the components.
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Affiliation(s)
| | - Janice J Eng
- University of British Columbia, Vancouver, BC, Canada
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Vallury KDB, Jones M, Gray R. Do family-oriented interventions reduce poststroke depression? A systematic review and recommendations for practice. Top Stroke Rehabil 2015; 22:453-9. [PMID: 25816867 DOI: 10.1179/1074935715z.00000000061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Up to half of all stroke survivors become depressed. Poststroke depression (PSD) negatively impacts on quality of life and rehabilitation outcomes and increases risk of mortality. Depression is also common in carers, leading to poorer outcomes in survivors. Few stroke patients receive adequate care to support prevention and management of PSD. We aimed to systematically review the evidence regarding the effectiveness of family-oriented interventions to prevent and manage depression after stroke and identify components of effective interventions. METHODS A systematic review was conducted, adhering to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eight databases were searched, and relevant journals and reference lists were hand searched. Abstracts were screened for relevance and two authors independently assessed selected full texts against inclusion criteria. Studies were included if they (1) engaged stroke patients and their informal/family caregivers; (2) measured changes in depression due to an intervention; and (3) were available in English. RESULTS Twenty-five of 2741 identified citations met the inclusion criteria. Five studies demonstrated significant reductions in depression. Commonalities across effective studies included the delivery of interventions that were structured and multicomponent, actively engaged patients and families, coordinated care, and were initiated soon after a stroke. CONCLUSION Family-oriented stroke rehabilitation may reduce depression in stroke survivors and their family caregivers. More research is required to clarify the effectiveness, feasibility, and acceptability of working with families and patients living with or who may be at risk of PSD.
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Affiliation(s)
- Kari D B Vallury
- University Department of Rural Health (UDRH), University of South Australia , Whyalla, Australia
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Community Stroke Rehabilitation Teams: Providing Home-Based Stroke Rehabilitation in Ontario, Canada. Can J Neurol Sci 2014; 41:697-703. [DOI: 10.1017/cjn.2014.31] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTBackground: Community stroke rehabilitation teams (CSRTs) provide a community-based, interdisciplinary approach to stroke rehabilitation. Our objective was to assess the effectiveness of these teams with respect to client outcomes. Methods: Functional, psychosocial, and caregiver outcome data. were available at intake, discharge from the program, and six-month follow-up. Repeated measures analysis of covariance was performed to assess patient changes between time points for each outcome measure. Results: A total of 794 clients met the inclusion criteria for analysis (54.4% male, mean age 68.5±13.0 years). Significant changes were found between intake and discharge on the Hospital Anxiety and Depression Scale total score (p=0.017), Hospital Anxiety and Depression Scale Anxiety subscale (p<0.001), Functional Independence Measure (p<0.001), Reintegration to Normal Living Index (p=0.01), Bakas Caregiver Outcomes Scale (p<0.001), and Caregiver Assistance and Confidence Scale assistance subscale (p=0.005). Significant gains were observed on the strength, communication, activities of daily living, social participation, memory, and physical domains of the Stroke Impact Scale (all p<0.001). These improvements were maintained at the 6-month follow-up. No significant improvements were observed upon discharge on the memory and thinking domain of the Stroke Impact Scale; however, there was a significant improvement between admission and follow-up (p=0.002). All significant improvements were maintained at the 6-month follow-up. Conclusions: Results indicate that the community stroke rehabilitation teams were effective at improving the functional and psychosocial recovery of patients after stroke. Importantly, these gains were maintained at 6 months postdischarge from the program. A home-based, stroke-specific multidisciplinary rehabilitation program should be considered when accessibility to outpatient services is limited.
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