1
|
Marcassoli A, Guastafierro E, Toppo C, Leonardi M, Bersano A, Boncoraglio G, Canavero I, Raggi A. Psychosocial factors as main predictors of quality of life 5 years after stroke: a cross-sectional study from a third-level Italian center. Int J Rehabil Res 2023; 46:151-156. [PMID: 36691780 DOI: 10.1097/mrr.0000000000000570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Stroke causes a significant reduction in health-related quality of life (HRQoL), and studies addressing its predictors often rely on models with few variables. This study aimed to assess the degree to which health status, health habits, and features of the environment predict HRQoL in stroke survivors with stable clinical condition. WHO Quality of Life questionnaire for old-Age subjects (WHOQOL-AGE) was used to assess HRQoL. We ran a multivariable linear regression to predict WHOQOL-AGE variation, entering measures of health state, bad habits, healthy behaviors, physical environment features, and social support. Patients were stroke survivors with a stable clinical condition, distance from acute event of more than 6 months, and National Institutes of Health Stroke Scale (NIHSS) of 10 or less. A total of 122 participants (47 females, 97 with ischemic stroke) were enrolled, the mean age was 64.1, mean NIHSS 2.9, and mean distance from the acute event was 5.1 years. State anxiety (β = -0.202), trait anxiety (β = -0.232), depression (β = -0.255), social support (β = 0.247), and functional independence (β = -0.210) predicted WHOQOL-AGE variation (Adj. R2 = 0.549). Our results show that psychological symptoms, reduced social network, and functional dependence together have a negative impact on HRQoL. These elements, which are partly stroke-specific, should be taken into account in the recovery process to enhance patients' health outcomes.
Collapse
Affiliation(s)
- Alessia Marcassoli
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Erika Guastafierro
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Claudia Toppo
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta
| | - Anna Bersano
- Cerebrovascular Neurological Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giorgio Boncoraglio
- Cerebrovascular Neurological Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Isabella Canavero
- Cerebrovascular Neurological Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta
| |
Collapse
|
2
|
Blanton S, Dunbar S, Caston S, McLaughlin T, Stewart H, Clark PC. Implementing Home-Based Clinical Research for Caregivers and Persons with Stroke: Lessons Learned. Home Healthc Now 2023; 41:149-157. [PMID: 37144930 DOI: 10.1097/nhh.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Conducting research in the home environment presents challenges related to setting, study participants, methods, and researchers. Researchers should be aware of potential challenges to ensure rigor and improve planning for future studies. This paper describes difficulties experienced and lessons learned when conducting a two-group, randomized pilot study (n = 32) of a web-based intervention (Carepartner and Constraint-Induced Therapy [CARE-CITE]) designed to foster positive carepartner engagement in home-based activities to improve upper extremity function in persons with stroke. Challenges and issues included: 1) recruitment and referral, 2) data collection in the home setting, 3) participants' understanding of the rationale for adhering to constraint-induced movement therapy principles (wearing mitt on the less-affected limb), 4) tracking adherence of upper extremity practice time, 5) participant-driven goal setting, 6) potentially unsafe participant practice activities, 7) home visit safety, 8) encouraging versus controlling-using autonomy support, 9) participant needs beyond study scope, and 10) ethical safeguards for addressing depressive symptoms. Researchers can incorporate suggested strategies to support methodological rigor and facilitate interventions engaging carepartners in the rehabilitation process when planning for research in the home environment.
Collapse
|
3
|
Stein MS, Reynolds FA. How is carer strain related to the recovery of stroke survivors with right hemisphere dysfunction? Implications for practice. Disabil Rehabil 2020; 44:693-701. [PMID: 32543914 DOI: 10.1080/09638288.2020.1775311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: Right hemisphere strokes are associated with neuro-behavioural impairments including hemi-inattention, impulsiveness and anosognosia, which can impede stroke recovery and adversely affect carer health. This study explored the impact of associated impairments on carer strain and depression through a mixed methods approach.Method: Fifty-one carer-survivor dyads were recruited from inpatient rehabilitation units and followed-up for 6 months. Validated measures assessed survivors' physical and cognitive function and carers' strain and depression levels. Survey methods captured qualitative experiences of the caring role. Data collection occurred at baseline, discharge, 6 weeks post-discharge and 6 months. Multilevel-modelling and thematic data analysis, were employed.Results: Carer strain median scores were within normal ranges of the Caregiver Strain Index scale. Carer strain was positively linked to carer depression, number of carers' concerns reported and survivors' anosognosia levels. Carer strain was negatively linked to the survivors' functional and cognitive abilities. Carers' experiences differed qualitatively with caring concerns increasing over time.Conclusion: Carer strain worsens with increases in significant concerns about the rehabilitation process and poor survivor functioning skills, which potentially increase risk of depression in carers. Consequently, improving right-hemisphere stroke survivors' recovery and nurturing the carer-survivor relationship are likely to enhance overall outcomes and caring experiences.IMPLICATIONS FOR REHABILITATIONIn the context of right hemisphere stroke: Carer assessment should be comprehensive and include a measure of perceived ability to care.Less strained carers tend to report fewer caring concerns and have lower depression levels.Education, training and practical support should be tailored to carer identified needs, abilities and the caring context.
Collapse
Affiliation(s)
- Maria Stella Stein
- School of Allied Health Professions, Faculty of Health and Well-being, Canterbury Christ Church University, Canterbury, UK
| | | |
Collapse
|
4
|
Lee RY, Engelberg RA, Curtis JR, Hough CL, Kross EK. Novel Risk Factors for Posttraumatic Stress Disorder Symptoms in Family Members of Acute Respiratory Distress Syndrome Survivors. Crit Care Med 2020; 47:934-941. [PMID: 30985448 DOI: 10.1097/ccm.0000000000003774] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Family members of ICU survivors report long-term psychologic symptoms of posttraumatic stress disorder. We describe patient- and family-member risk factors for posttraumatic stress disorder symptoms among family members of survivors of acute respiratory distress syndrome. DESIGN Prospective cohort study of family members of acute respiratory distress syndrome survivors. SETTING Single tertiary care center in Seattle, Washington. SUBJECTS From 2010 to 2015, we assembled an inception cohort of adult acute respiratory distress syndrome survivors who identified family members involved in ICU and post-ICU care. One-hundred sixty-two family members enrolled in the study, corresponding to 120 patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Family members were assessed for self-reported psychologic symptoms 6 months after patient discharge using the Posttraumatic Stress Disorder Checklist-Civilian Version, the Patient Health Questionnaire 9-item depression scale, and the Generalized Anxiety Disorder 7-item scale. The primary outcome was posttraumatic stress disorder symptoms, and secondary outcomes were symptoms of depression and anxiety. We used clustered multivariable logistic regression to identify patient- and family-member risk factors for psychologic symptoms. Posttraumatic stress disorder symptoms were present in 31% (95% CI, 24-39%) of family participants. Family member risk factors for posttraumatic stress disorder symptoms included preexisting mental health disorders (adjusted odds ratio, 3.22; 95% CI, 1.42-7.31), recent personal experience of serious physical illness (adjusted odds ratio, 3.07; 95% CI, 1.40-6.75), and female gender (adjusted odds ratio, 5.18; 95% CI, 1.74-15.4). Family members of previously healthy patients (Charlson index of zero) had higher frequency of posttraumatic stress disorder symptoms (adjusted odds ratio, 2.25; 95% CI, 1.06-4.77). Markers of patient illness severity were not associated with family posttraumatic stress disorder symptoms. CONCLUSIONS The prevalence of long-term posttraumatic stress disorder symptoms among family members of acute respiratory distress syndrome survivors is high. Family members with preexisting mental health disorders, recent experiences of serious physical illness, and family members of previously healthy patients are at increased risk for posttraumatic stress disorder symptoms.
Collapse
Affiliation(s)
- Robert Y Lee
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
| | - Ruth A Engelberg
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
| | - Catherine L Hough
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
| | - Erin K Kross
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
| |
Collapse
|
5
|
Persson J, Levin LÅ, Holmegaard L, Redfors P, Jood K, Jern C, Blomstrand C, Forsberg-Wärleby G. Stroke survivors' long-term QALY-weights in relation to their spouses' QALY-weights and informal support: a cross-sectional study. Health Qual Life Outcomes 2017; 15:150. [PMID: 28743277 PMCID: PMC5526309 DOI: 10.1186/s12955-017-0724-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/17/2017] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare interventions that have positive effects on the stroke survivors’ health-related quality of life (HRQoL) and quality-adjusted life-years (QALYs) might also have positive effects for their spouses in terms of improved HRQoL and/or reduced spousal informal support. However, knowledge about stroke survivors’ HRQoL and QALY and the consequences for their spouses’ HRQoL and QALY is limited. Therefore, the aim of this study was to describe the HRQoL and QALY-weights in dyads of stroke survivors in comparison with dyads of healthy controls, and to study the relationship between the stroke survivors’ QALY-weights and consequences for spouses in terms of QALY-weight and annual cost of informal support, using a long-term perspective. Methods Data on stroke survivors, controls, and spouses were collected from the seven-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). HRQoL was assessed by the SF-36, and the preference-based health state values were assessed with the SF-6D. The magnitude of the support was assessed with a study specific time-diary. An ordinary least squares (OLS) regression was used to estimate the association between stroke survivors’ and spouses’ QALY-weights. A two-part econometric model was used to estimate the association between stroke survivors’ QALY-weights and the time spent and cost of spouses’ informal support. Results Cohabitant dyads of 248 stroke survivors’ aged <70 at stroke onset and 245 controls were included in the study. Stroke survivors had lower HRQoL in the SF-36 domains physical functioning, physical role, general health, vitality (P < 0.001), and social functioning (P = 0.005) in comparison with their cohabitant spouses. There was no significant difference in HRQoL for the dyads of controls. The results from the regression analyses showed that lower QALY-weights of the stroke survivors were associated with lower QALY-weights of their spouses and increased annual cost of spousal informal support. Conclusion Our results show that the QALY-weights for stroke survivors had consequences for their spouses in terms of annual cost of spousal informal support and QALY-weights. Hence, economic evaluation of interventions that improve the HRQoL of the stroke survivors but ignore the consequences for their spouses may underestimate the value of the intervention.
Collapse
Affiliation(s)
- Josefine Persson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. .,Health Metrics, the Sahlgrenska Academy at University of Gothenburg & Centre for Health Economics (CHEGU), University of Gothenburg, Box 414, 405 30, Gothenburg, Sweden.
| | - Lars-Åke Levin
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Medical and Health Science, Linköping University, Linköping, Sweden
| | - Lukas Holmegaard
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Christina Jern
- Department of Clinical Pathology and Genetics, Institute of Biomedicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Christian Blomstrand
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Stroke Centre West the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Gunilla Forsberg-Wärleby
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
6
|
Jellema S, van Hees S, Zajec J, van der Sande R, Nijhuis-van der Sanden MW, Steultjens EM. What environmental factors influence resumption of valued activities post stroke: a systematic review of qualitative and quantitative findings. Clin Rehabil 2016; 31:936-947. [PMID: 27681480 PMCID: PMC5482381 DOI: 10.1177/0269215516671013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Identify the environmental factors that influence stroke-survivors' reengagement in personally valued activities and determine what specific environmental factors are related to specific valued activity types. DATA SOURCES PubMed, CINAHL and PsycINFO were searched until June 2016 using multiple search-terms for stroke, activities, disability, and home and community environments. REVIEW METHODS An integrated mixed-method systematic review of qualitative, quantitative and mixed-design studies was conducted. Two researchers independently identified relevant studies, assessed their methodological quality and extracted relevant findings. To validly compare and combine the various findings, all findings were classified and grouped by environmental category and level of evidence. RESULTS The search yielded 4024 records; 69 studies were included. Most findings came from low-evidence-level studies such as single qualitative studies. All findings were consistent in that the following factors facilitated reengagement post-stroke: personal adapted equipment; accessible environments; transport; services; education and information. Barriers were: others' negative attitudes and behaviour; long distances and inconvenient environmental conditions (such as bad weather). Each type of valued activity, such as mobility or work, had its own pattern of environmental influences, social support was a facilitator to all types of activities. Although in many qualitative studies others' attitudes, behaviour and stroke-related knowledge were seen as important for reengagement, these factors were hardly studied quantitatively. CONCLUSION A diversity of environmental factors was related to stroke-survivors' reengagement. Most findings came from low-evidence-level studies so that evidence on causal relationships was scarce. In future, more higher-level-evidence studies, for example on the attitudes of significant others, should be conducted.
Collapse
Affiliation(s)
- Sandra Jellema
- 1 Radboud university medical center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands
| | - Suzanne van Hees
- 3 Radboud university medical center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Jana Zajec
- 3 Radboud university medical center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Rob van der Sande
- 2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands.,4 Radboud university medical center, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Maria Wg Nijhuis-van der Sanden
- 1 Radboud university medical center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands.,3 Radboud university medical center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Esther Mj Steultjens
- 2 HAN University of Applied Sciences, Institute of Health Studies, Nijmegen, The Netherlands
| |
Collapse
|
7
|
Conductive Education as a Method of Stroke Rehabilitation: A Single Blinded Randomised Controlled Feasibility Study. Stroke Res Treat 2016; 2016:5391598. [PMID: 27418997 PMCID: PMC4935920 DOI: 10.1155/2016/5391598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/29/2016] [Indexed: 11/22/2022] Open
Abstract
Background. Conductive Education for stroke survivors has shown promise but randomised evidence is unavailable. This study assessed the feasibility of a definitive randomised controlled trial to evaluate efficacy. Methods. Adult stroke survivors were recruited through local community notices. Those completing the baseline assessment were randomised using an online program and group allocation was independent. Intervention group participants received 10 weekly 1.5-hour sessions of Conductive Education at the National Institute of Conductive Education in Birmingham, UK. The control group participants attended two group meetings. The study evaluated the feasibility of recruitment procedures, delivery of the intervention, retention of participants, and appropriateness of outcome measures and data collection methods. Independent assessments included the Barthel Index, the Stroke Impact Scale, the Timed Up and Go test, and the Hospital Anxiety and Depression Scale. Results. Eighty-two patients were enrolled; 77 completed the baseline assessment (46 men, mean age 62.1 yrs.) and were randomised. 70 commenced the intervention (n = 37) or an equivalent waiting period (n = 33). 32/37 completed the 10-week training and 32/33 the waiting period. There were no missing items from completed questionnaires and no adverse events. Discussion. Recruitment, intervention, and assessment methods worked well. Transport issues for intervention and assessment appointments require review. Conclusion. A definitive trial is feasible. This trial is registered with ISRCTN84064492.
Collapse
|
8
|
Bakas T, Jessup NM, McLennon SM, Habermann B, Weaver MT, Morrison G. Tracking patterns of needs during a telephone follow-up programme for family caregivers of persons with stroke. Disabil Rehabil 2015; 38:1780-90. [PMID: 26680007 DOI: 10.3109/09638288.2015.1107767] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Programmes that address stroke family caregiver needs and skill-building are recommended based on the literature and patient care guidelines for stroke rehabilitation. The purpose of this study was to explore patterns of perceived needs and skill-building during a stroke caregiver intervention programme. METHOD Descriptive statistics were used to analyse data from 123 stroke caregivers enrolled in the intervention group of a randomised controlled clinical trial. Caregivers received eight weekly telephone sessions, with a booster session a month later. At each session, the Caregiver Needs and Concerns Checklist (CNCC) was used to identify and prioritise current needs that were then addressed through skill-building strategies. RESULTS Perceived needs changed over time. Information about stroke was the highest priority need during Session 1. Managing survivor emotions and behaviours was the highest priority for Sessions 2 through 4. Caregivers generally waited until Sessions 5 through 9 to address their own emotional and physical health needs. Physical and instrumental care needs were relatively low but stable across all nine sessions. Skill-building was consistently high, though it peaked during Sessions 2 and 3. CONCLUSIONS Tracking patterns of needs and skill-building suggest appropriate timing for targeting different types of family caregiver support during stroke rehabilitation. Implications for Rehabilitation Family caregivers of stroke survivors play an essential role in the rehabilitation process of the stroke survivor. Identifying and addressing the priority needs and concerns of stroke caregivers during the early discharge period enables caregivers to provide sustained support for the stroke survivor. Rehabilitation professionals are in a key position to address evolving caregiver needs and concerns as they transition to home settings with follow-up care.
Collapse
Affiliation(s)
- Tamilyn Bakas
- a School of Nursing , Indiana University , Indianapolis , IN , USA ;,b College of Nursing , University of Cincinnati , Cincinnati , OH , USA
| | - Nenette M Jessup
- c Clinical Trials Office , Indiana University Simon Cancer Center , Indianapolis , IN , USA
| | - Susan M McLennon
- a School of Nursing , Indiana University , Indianapolis , IN , USA
| | - Barbara Habermann
- d School of Nursing , University of Delaware College of Health Sciences , Newark , DE , USA
| | - Michael T Weaver
- e College of Nursing , University of Florida , Gainesville , FL , USA
| | - Gwendolyn Morrison
- f Department of Economics , Indiana University Purdue University at Indianapolis , IN , USA
| |
Collapse
|
9
|
Bakas T, Austin JK, Habermann B, Jessup NM, McLennon SM, Mitchell PH, Morrison G, Yang Z, Stump TE, Weaver MT. Telephone Assessment and Skill-Building Kit for Stroke Caregivers: A Randomized Controlled Clinical Trial. Stroke 2015; 46:3478-87. [PMID: 26549488 DOI: 10.1161/strokeaha.115.011099] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/13/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE There are few evidence-based programs for stroke family caregivers postdischarge. The purpose of this study was to evaluate efficacy of the Telephone Assessment and Skill-Building Kit (TASK II), a nurse-led intervention enabling caregivers to build skills based on assessment of their own needs. METHODS A total of 254 stroke caregivers (primarily female TASK II/information, support, and referral 78.0%/78.6%; white 70.7%/72.1%; about half spouses 48.4%/46.6%) were randomized to the TASK II intervention (n=123) or to an information, support, and referral group (n=131). Both groups received 8 weekly telephone sessions, with a booster at 12 weeks. General linear models with repeated measures tested efficacy, controlling for patient hospital days and call minutes. Prespecified 8-week primary outcomes were depressive symptoms (with Patient Health Questionnaire Depressive Symptom Scale PHQ-9 ≥5), life changes, and unhealthy days. RESULTS Among caregivers with baseline PHQ-9 ≥5, those randomized to the TASK II intervention had a greater reduction in depressive symptoms from baseline to 8, 24, and 52 weeks and greater improvement in life changes from baseline to 12 weeks compared with the information, support, and referral group (P<0.05); but not found for the total sample. Although not sustained at 12, 24, or 52 weeks, caregivers randomized to the TASK II intervention had a relatively greater reduction in unhealthy days from baseline to 8 weeks (P<0.05). CONCLUSIONS The TASK II intervention reduced depressive symptoms and improved life changes for caregivers with mild to severe depressive symptoms. The TASK II intervention reduced unhealthy days for the total sample, although not sustained over the long term. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01275495.
Collapse
Affiliation(s)
- Tamilyn Bakas
- From the Indiana University School of Nursing, Indianapolis (T.B., J.K.A., S.M.M.); University of Cincinnati College of Nursing, OH (T.B.); College of Health Sciences, University of Delaware, Newark (B.H.); Indiana University Melvin and Bren Simon Cancer Center, Indianapolis (N.M.J.); School of Nursing, University of Washington, Seattle (P.H.M.); Indianapolis Economics Department, Indiana University Purdue University (G.M.); Richard M. Fairbanks School of Public Health, Indianapolis, IN (Z.Y., T.E.S.); and College of Nursing, University of Florida, Gainesville (M.T.W.).
| | - Joan K Austin
- From the Indiana University School of Nursing, Indianapolis (T.B., J.K.A., S.M.M.); University of Cincinnati College of Nursing, OH (T.B.); College of Health Sciences, University of Delaware, Newark (B.H.); Indiana University Melvin and Bren Simon Cancer Center, Indianapolis (N.M.J.); School of Nursing, University of Washington, Seattle (P.H.M.); Indianapolis Economics Department, Indiana University Purdue University (G.M.); Richard M. Fairbanks School of Public Health, Indianapolis, IN (Z.Y., T.E.S.); and College of Nursing, University of Florida, Gainesville (M.T.W.)
| | - Barbara Habermann
- From the Indiana University School of Nursing, Indianapolis (T.B., J.K.A., S.M.M.); University of Cincinnati College of Nursing, OH (T.B.); College of Health Sciences, University of Delaware, Newark (B.H.); Indiana University Melvin and Bren Simon Cancer Center, Indianapolis (N.M.J.); School of Nursing, University of Washington, Seattle (P.H.M.); Indianapolis Economics Department, Indiana University Purdue University (G.M.); Richard M. Fairbanks School of Public Health, Indianapolis, IN (Z.Y., T.E.S.); and College of Nursing, University of Florida, Gainesville (M.T.W.)
| | - Nenette M Jessup
- From the Indiana University School of Nursing, Indianapolis (T.B., J.K.A., S.M.M.); University of Cincinnati College of Nursing, OH (T.B.); College of Health Sciences, University of Delaware, Newark (B.H.); Indiana University Melvin and Bren Simon Cancer Center, Indianapolis (N.M.J.); School of Nursing, University of Washington, Seattle (P.H.M.); Indianapolis Economics Department, Indiana University Purdue University (G.M.); Richard M. Fairbanks School of Public Health, Indianapolis, IN (Z.Y., T.E.S.); and College of Nursing, University of Florida, Gainesville (M.T.W.)
| | - Susan M McLennon
- From the Indiana University School of Nursing, Indianapolis (T.B., J.K.A., S.M.M.); University of Cincinnati College of Nursing, OH (T.B.); College of Health Sciences, University of Delaware, Newark (B.H.); Indiana University Melvin and Bren Simon Cancer Center, Indianapolis (N.M.J.); School of Nursing, University of Washington, Seattle (P.H.M.); Indianapolis Economics Department, Indiana University Purdue University (G.M.); Richard M. Fairbanks School of Public Health, Indianapolis, IN (Z.Y., T.E.S.); and College of Nursing, University of Florida, Gainesville (M.T.W.)
| | - Pamela H Mitchell
- From the Indiana University School of Nursing, Indianapolis (T.B., J.K.A., S.M.M.); University of Cincinnati College of Nursing, OH (T.B.); College of Health Sciences, University of Delaware, Newark (B.H.); Indiana University Melvin and Bren Simon Cancer Center, Indianapolis (N.M.J.); School of Nursing, University of Washington, Seattle (P.H.M.); Indianapolis Economics Department, Indiana University Purdue University (G.M.); Richard M. Fairbanks School of Public Health, Indianapolis, IN (Z.Y., T.E.S.); and College of Nursing, University of Florida, Gainesville (M.T.W.)
| | - Gwendolyn Morrison
- From the Indiana University School of Nursing, Indianapolis (T.B., J.K.A., S.M.M.); University of Cincinnati College of Nursing, OH (T.B.); College of Health Sciences, University of Delaware, Newark (B.H.); Indiana University Melvin and Bren Simon Cancer Center, Indianapolis (N.M.J.); School of Nursing, University of Washington, Seattle (P.H.M.); Indianapolis Economics Department, Indiana University Purdue University (G.M.); Richard M. Fairbanks School of Public Health, Indianapolis, IN (Z.Y., T.E.S.); and College of Nursing, University of Florida, Gainesville (M.T.W.)
| | - Ziyi Yang
- From the Indiana University School of Nursing, Indianapolis (T.B., J.K.A., S.M.M.); University of Cincinnati College of Nursing, OH (T.B.); College of Health Sciences, University of Delaware, Newark (B.H.); Indiana University Melvin and Bren Simon Cancer Center, Indianapolis (N.M.J.); School of Nursing, University of Washington, Seattle (P.H.M.); Indianapolis Economics Department, Indiana University Purdue University (G.M.); Richard M. Fairbanks School of Public Health, Indianapolis, IN (Z.Y., T.E.S.); and College of Nursing, University of Florida, Gainesville (M.T.W.)
| | - Timothy E Stump
- From the Indiana University School of Nursing, Indianapolis (T.B., J.K.A., S.M.M.); University of Cincinnati College of Nursing, OH (T.B.); College of Health Sciences, University of Delaware, Newark (B.H.); Indiana University Melvin and Bren Simon Cancer Center, Indianapolis (N.M.J.); School of Nursing, University of Washington, Seattle (P.H.M.); Indianapolis Economics Department, Indiana University Purdue University (G.M.); Richard M. Fairbanks School of Public Health, Indianapolis, IN (Z.Y., T.E.S.); and College of Nursing, University of Florida, Gainesville (M.T.W.)
| | - Michael T Weaver
- From the Indiana University School of Nursing, Indianapolis (T.B., J.K.A., S.M.M.); University of Cincinnati College of Nursing, OH (T.B.); College of Health Sciences, University of Delaware, Newark (B.H.); Indiana University Melvin and Bren Simon Cancer Center, Indianapolis (N.M.J.); School of Nursing, University of Washington, Seattle (P.H.M.); Indianapolis Economics Department, Indiana University Purdue University (G.M.); Richard M. Fairbanks School of Public Health, Indianapolis, IN (Z.Y., T.E.S.); and College of Nursing, University of Florida, Gainesville (M.T.W.)
| |
Collapse
|
10
|
Short-Term Trajectories of Depressive Symptoms in Stroke Survivors and Their Family Caregivers. J Stroke Cerebrovasc Dis 2015; 25:172-81. [PMID: 26476585 DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/04/2015] [Accepted: 09/15/2015] [Indexed: 11/22/2022] Open
Abstract
GOAL We utilize group-based trajectory modeling (GBTM) to delineate depressive symptom trajectories among stroke survivor-caregiver dyads, to identify predictors of the delineated trajectories, and to assess the influence of time-varying covariates (stroke survivor depressive symptoms and functional disability, caregiver depressive symptoms, and foreign domestic worker [FDW] assistance) on the level of the depressive symptom trajectories. METHODS Data on 172 stroke survivor-caregiver dyads in Singapore, for whom depressive symptoms were assessed thrice (baseline/3 months/6 months), were utilized. GBTM was applied to delineate depressive symptom trajectories, and to identify their predictors and time-varying covariates. FINDINGS Three stroke survivor depressive symptom trajectories (low and decreasing [47.6%], low and increasing [43.1%], and high and increasing [9.3%]) and 2 caregiver depressive symptom trajectories (low and stable [71.5%] and high and decreasing [28.5%]) were delineated. Caregivers with chronic diseases were more likely (odds ratio [95% confidence interval]: 8.09[2.04-32.07]) and those caring for older stroke survivors (0.94[0.90-0.98]) were less likely to follow the high and decreasing than the low and stable depressive symptom trajectory. An increase in stroke survivor functional disability and caregiver depressive symptoms led to a rise (~worsening) in stroke survivor depressive symptom trajectories. Whereas an increase in stroke survivor depressive symptoms led to a rise in caregiver depressive symptom trajectories, FDW assistance led to a decline (~improvement). CONCLUSION Care professionals should be mindful of heterogeneity in depressive symptom patterns over time among stroke survivor-caregiver dyads. Reciprocal association of depressive symptoms in the stroke survivor-caregiver dyad suggests that addressing mood problems in 1 member may benefit the other member, and calls for dyadic mental health interventions.
Collapse
|
11
|
Bidwell JT, Vellone E, Lyons KS, D'Agostino F, Riegel B, Juárez-Vela R, Hiatt SO, Alvaro R, Lee CS. Determinants of Heart Failure Self-Care Maintenance and Management in Patients and Caregivers: A Dyadic Analysis. Res Nurs Health 2015; 38:392-402. [PMID: 26355702 DOI: 10.1002/nur.21675] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 12/20/2022]
Abstract
Disease self-management is a critical component of maintaining clinical stability for patients with chronic illness. This is particularly evident in the context of heart failure (HF), which is the leading cause of hospitalization for older adults. HF self-management, commonly known as HF self-care, is often performed with the support of informal caregivers. However, little is known about how a HF dyad manages the patient's care together. The purpose of this study was to identify determinants of patient and caregiver contributions to HF self-care maintenance (daily adherence and symptom monitoring) and management (appropriate recognition and response to symptoms), utilizing an approach that controls for dyadic interdependence. This was a secondary analysis of cross-sectional data from 364 dyads of Italian HF patients and caregivers. Multilevel modeling was used to identify determinants of HF self-care within patient-caregiver dyads. Patients averaged 76.2 (SD = 10.7) years old, and a slight majority (56.9%) was male, whereas caregivers averaged 57.4 (SD = 14.6) years old, and about half (48.1%) were male. Most caregivers were adult children (48.4%) or spouses (32.7%) of patients. Both patients and caregivers reported low levels of HF maintenance and management behaviors. Significant individual and dyadic determinants of self-care maintenance and self-care management included gender, quality of life, comorbid burden, impaired ADLs, cognition, hospitalizations, HF duration, relationship type, relationship quality, and social support. These comprehensive dyadic models assist in elucidating the complex nature of patient-caregiver relationships and their influence on HF self-care, leading to more effective ways to intervene and optimize outcomes.
Collapse
Affiliation(s)
- Julie T Bidwell
- PhD Student, School of Nursing, Oregon Health & Science University, Mail code: SN-2N, 3455 SW US Veterans Hospital Road, Portland, OR, 97239-2941, USA
| | - Ercole Vellone
- Research Fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Karen S Lyons
- Associate Professor, School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Fabio D'Agostino
- Research Fellow, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Riegel
- Professor, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Raúl Juárez-Vela
- Research Fellow, Faculty of Health Science, University of San Jorge, Zaragoza, Spain
| | - Shirin O Hiatt
- Research Associate, School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Rosaria Alvaro
- Research Associate, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Christopher S Lee
- Associate Professor, School of Nursing, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
12
|
Buijck BI, Zuidema SU, Spruit-van Eijk M, Bor H, Gerritsen DL, Koopmans RTCM. Determinants of geriatric patients' quality of life after stroke rehabilitation. Aging Ment Health 2015; 18:980-5. [PMID: 24679003 DOI: 10.1080/13607863.2014.899969] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Geriatric patients' physical disabilities, dependency on care, and possible psychological ill-being may negatively affect both the patient's quality of life and the informal caregiver burden. Focusing on this interrelationship which can be particularly prominent in geriatric patients with stroke, the objective of this study was to identify determinants of patients' quality of life and informal caregiver burden. METHOD This is a prospective, multicentre, cohort study. Data were collected in 84 geriatric home-dwelling patients with stroke three months after their rehabilitation period in skilled nursing facilities (SNFs). We assessed patients' quality of life, depressive complaints, neuropsychiatric symptoms, balance, (instrumental) activities of daily living, and informal caregiver burden. Linear regression models were constructed to study the association between the variables. RESULTS For several domains, high quality of life of these geriatric patients was associated with high functional independence, less neuropsychiatric symptoms, and less depressive complaints. Informal caregiver burden was not associated with patients' quality of life, but patients' neuropsychiatric symptoms were a significant determinant of high informal caregiver burden. CONCLUSION The presence of neuropsychiatric symptoms (more specifically depressive complaints) negatively affects the quality of life of geriatric patients. Their neuropsychiatric symptoms also affect caregiver burden. Health care professionals in SNFs can play an important role in providing the necessary psychosocial support and aftercare.
Collapse
Affiliation(s)
- Bianca I Buijck
- a Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health , Radboud University Nijmegen Medical Centre , Nijmegen , The Netherlands
| | | | | | | | | | | |
Collapse
|
13
|
Staccini L, Tomba E, Grandi S, Keitner GI. The evaluation of family functioning by the family assessment device: a systematic review of studies in adult clinical populations. FAMILY PROCESS 2015; 54:94-115. [PMID: 25154959 DOI: 10.1111/famp.12098] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A large body of research, documenting the impact of a family's functioning on health outcomes, highlights the importance of introducing the evaluation of patients' family dynamics into clinical judgment. The Family Assessment Device (FAD) is a self-report questionnaire designed to assess specific dimensions of family functioning. This qualitative systematic review, which follows PRISMA guidelines, aimed to identify the FAD's clinimetric properties and to report the incremental utility of its inclusion in clinical settings. A thorough literature search was performed, using both computerized and manual searches, yielding a total of 148 studies that were included in this review. The FAD has been extensively used in a variety of research contexts. In the majority of studies it was able to discriminate between clinical populations and controls and among groups of patients with different illnesses. The FAD also showed good test-retest and concurrent reliability, and modest sensitivity to change after treatment. FAD-dysfunctional family functioning was related to several patient clinical outcomes, including lower recovery rates and adherence to treatment, longer recovery time, poorer quality of life, and increased risk of relapse and drop-out. The present review demonstrates that the FAD is a suitable instrument for the evaluation of family functioning both in clinical and research settings.
Collapse
Affiliation(s)
- Laura Staccini
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | | | | | | |
Collapse
|
14
|
McCarthy MJ, Lyons KS. Incongruence between stroke survivor and spouse perceptions of survivor functioning and effects on spouse mental health: a mixed-methods pilot study. Aging Ment Health 2015; 19:46-54. [PMID: 24831861 DOI: 10.1080/13607863.2014.913551] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES This pilot study investigated stroke survivors' and caregiving spouses' individual perspectives on survivor cognitive and physical functioning and the extent to which incongruence between partners' perceptions affects spouse depressive symptoms and overall mental health. METHOD Mixed-methods, with quantitative survey data from 35 couples and qualitative interview data from a subsample of 13 couples being collected and analyzed using paired t-tests, multiple regression with survivor-spouse discrepancy scores as predictors of spouse depressive symptoms, and interpretive-description techniques. RESULTS Quantitative data indicated that spouses rated survivor cognitive functioning as significantly worse than survivors rated their own and that survivor-spouse discrepancy scores for physical functioning were significantly associated with spouse depressive symptoms. Qualitative data enhanced understanding about the nuances of partner incongruence and the ramifications of partner incongruence for spouse mental health. CONCLUSION Partner incongruence has an impact on spouse depressive symptoms and overall mental health. Interventions targeted at survivor-spouse dyads and focused on improving communication between partners about survivor abilities may be effective for improving the mental health of spousal caregivers.
Collapse
Affiliation(s)
- Michael J McCarthy
- a School of Social Work, College of Allied Health Sciences , University of Cincinnati , Cincinnati , OH , USA
| | | |
Collapse
|
15
|
White CL, Brady TL, Saucedo LL, Motz D, Sharp J, Birnbaum LA. Towards a better understanding of readmissions after stroke: partnering with stroke survivors and caregivers. J Clin Nurs 2014; 24:1091-100. [PMID: 25441776 DOI: 10.1111/jocn.12739] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2014] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To describe the experience of readmission from the perspective of the stroke survivor and family caregiver. BACKGROUND Older stroke survivors are at an increased risk for readmission with approximately 40% being readmitted in the first year after stroke. Patients and their families are best positioned to provide information about factors associated with readmission, yet their perspectives have rarely been elicited. DESIGN Descriptive qualitative study. METHODS This study included older stroke survivors who were readmitted to acute care from home in the six months following stroke, and their family caregivers. Participants were interviewed by telephone at approximately two weeks after discharge and a sub-set was also interviewed in person during the readmission. Interviews were audio-taped and content analysis was used to identify themes. RESULTS From the 29 semi-structured interviews conducted with 20 stroke survivors and/or their caregivers, the following themes were identified: preparing to go home after the stroke, what to expect at home, complexity of medication management, support for self-care in the community and the influence of social factors. CONCLUSIONS This study provides the critical perspective of the stroke survivor and family caregiver into furthering our understanding of readmissions after stroke. Participants identified several areas for intervention including better discharge preparation and the need for support in the community for medication management and self-care. The findings suggest that interventions designed to reduce readmissions after stroke should be multifaceted in approach and extend across the continuum of care. RELEVANCE TO CLINICAL PRACTICE The hospital level has been the focus of interventions to reduce preventable readmissions, but the results of this study suggest the importance of community-level care. The individual nature of each situation must be taken into account, including the postdischarge environment and the availability of social support.
Collapse
Affiliation(s)
- Carole L White
- School of Nursing, University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA
| | | | | | | | | | | |
Collapse
|
16
|
Savini S, Buck HG, Dickson VV, Simeone S, Pucciarelli G, Fida R, Matarese M, Alvaro R, Vellone E. Quality of life in stroke survivor-caregiver dyads: a new conceptual framework and longitudinal study protocol. J Adv Nurs 2014; 71:676-87. [PMID: 25186274 DOI: 10.1111/jan.12524] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2014] [Indexed: 11/30/2022]
Abstract
AIM To describe a new conceptual framework and the research protocol of a study designed to examine the quality of life in stroke survivor-caregiver dyads. BACKGROUND Stroke has a significant impact on the patient-caregiver dyad. Few studies have been guided by a specific conceptual framework which considers the interactions among pre-existing situations prior to stroke, the new situation caused by the stroke and the moderating effects of environmental and caregiver-related variables. DESIGN Longitudinal study. METHODS A sample of stroke survivor-caregiver dyads will be enrolled at patient discharge from rehabilitation hospitals and will be surveyed every 3 months for 1-year. Hypotheses generated from the conceptual framework will test predictors, mediators and moderators of stroke survivor and caregiver quality of life from the pre-existing situation prior to the stroke, the new situation mediation poststroke and situation moderators. The study is supported by a grant from the Centre of Excellence for Nursing Scholarship, Rome, December 2013. DISCUSSION This study seeks to identify variables in the pre-existing situation prior to the stroke (e.g. living condition), the new situation mediation poststroke (e.g. type of stroke and caregiver burden) as well as situation moderators (e.g. social support) that influence stroke survivor-caregiver dyad's quality of life across the stroke trajectory. Also, the study will inform clinical practice and research by identifying variables that are potentially modifiable and therefore amenable to intervention. The proposed framework will also be helpful for future research focused on stroke survivor-caregiver dyads.
Collapse
|
17
|
Jessup NM, Bakas T, McLennon SM, Weaver MT. Are there gender, racial or relationship differences in caregiver task difficulty, depressive symptoms and life changes among stroke family caregivers? Brain Inj 2014; 29:17-24. [PMID: 25141098 PMCID: PMC4860205 DOI: 10.3109/02699052.2014.947631] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/25/2014] [Accepted: 07/20/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine differences in caregiver perceptions of task difficulty, depressive symptoms and life changes based on caregiver characteristics of gender, race and type of relationship to the person with stroke. METHODS A sample of 243 stroke caregivers (females n = 191; males n = 52; non-African Americans n = 184; African Americans n = 59; non-spouses n = 127; spouses n = 116) were interviewed by telephone within 8 weeks of the survivor's discharge to home. Measures included the Oberst Caregiving Burden Scale (OCBS) for task difficulty, Patient Health Questionnaire (PHQ-9) for depressive symptoms and Bakas Caregiving Outcomes Scale (BCOS) for life changes. Three general linear models computed differences in OCBS, PHQ9 and OCBS scores. RESULTS Significant differences were found on the OCBS for females (p < 0.001) and African American spouses (p < 0.048); on the PHQ9 for females (p < 0.001), non-African Americans (p = 0.047), spouses (p = 0.003) and African-American spouses (p = 0.010); and on the BCOS for females (p = 0.008) and non-African Americans (p = 0.033). CONCLUSIONS Findings suggest that female and non-African American stroke caregivers are relatively more likely to experience task difficulty, depressive symptoms and negative life changes as a result of providing care. African American spouses were also at risk. Tailoring interventions based on caregivers' characteristics may improve outcomes.
Collapse
Affiliation(s)
- Nenette M. Jessup
- Research Associate and Project Manager, Indiana University School of Nursing, 1111 Middle Drive, NU 235, Indianapolis, IN, 46202, 317-274-7549,
| | - Tamilyn Bakas
- Professor and Chair, Department of Science of Nursing Care, Indiana University School of Nursing, 1111 Middle Drive, NU 413, Indianapolis, IN, 46202, 317-274-4695,
| | - Susan M. McLennon
- Assistant Professor, Indiana University School of Nursing, 1111 Middle Drive, NU W437, Indianapolis, IN, 46202, 317-278-0459,
| | - Michael T. Weaver
- Interim Associate Dean for Research and Professor, Indiana University School of Nursing, 1111 Middle Drive, NU 340D, Indianapolis, IN, 46202, 317-274-0385,
| |
Collapse
|
18
|
Steultjens E, Jellema S. Early applied stroke carers training programme was not more effective than usual care. Aust Occup Ther J 2014; 61:210-1. [DOI: 10.1111/1440-1630.12127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Esther Steultjens
- CAPs Advisory Board Member; University of Applied Sciences HAN; Nijmegen The Netherlands
- Faculty of Health and Social Studies; University of Applied Sciences HAN; Nijmegen The Netherlands
| | - Sandra Jellema
- School of Allied Health; University of Applied Sciences HAN; Nijmegen The Netherlands
| |
Collapse
|
19
|
Task difficulty and life changes among stroke family caregivers: relationship to depressive symptoms. Arch Phys Med Rehabil 2014; 95:2484-90. [PMID: 24858447 DOI: 10.1016/j.apmr.2014.04.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/22/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate differences in stroke caregiver task difficulty and life changes based on level of caregiver depressive symptoms, and to estimate probabilities among task difficulty and life change items. DESIGN Descriptive analysis of baseline data from an ongoing stroke caregiver intervention trial. SETTING Hospitals and rehabilitation facilities. PARTICIPANTS Caregivers (N=242; 78.6% women; 47.7% spouses; 71.8% white; mean age, 54.2±12.1y) caring for stroke survivors within 8 weeks of discharge to home. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Baseline measures for task difficulty (Oberst Caregiving Burden Scale) and life changes (Bakas Caregiving Outcomes Scale) were compared based on level of depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores <5 means no depressive symptoms; n=126; PHQ-9 scores ≥5 means mild to severe depressive symptoms, n=116). Mean scores were analyzed using general linear modeling, with item analyses using logistic regression and the Benjamini-Hochberg method to control type I error inflation. RESULTS Caregivers with mild to severe depressive symptoms have greater difficulty with tasks and worse life changes than those with no depressive symptoms (P<.001). Odds ratios were highest for the task of arranging care while away and for negative life changes (eg, addressing self-esteem, coping with stress, physical health). CONCLUSIONS Findings underscore the importance of depressive symptom screening for stroke caregivers during or shortly after discharge. Assisting caregivers with depressive symptoms to arrange for respite care and addressing negative physical and psychological changes may be priority areas for future interventions.
Collapse
|
20
|
Quality of life after intra-arterial therapy for acute ischemic stroke. J Stroke Cerebrovasc Dis 2014; 23:1890-6. [PMID: 24813258 DOI: 10.1016/j.jstrokecerebrovasdis.2014.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/04/2014] [Accepted: 02/14/2014] [Indexed: 11/20/2022] Open
Abstract
Few data exist about health-related quality of life outcomes after intra-arterial therapy (IAT) for acute ischemic stroke (AIS). We assessed stroke-specific quality of life (SS-QOL) in survivors of stroke after IAT. Consecutive patients undergoing IAT for AIS from 2005 to 2010 were retrospectively identified via an institutional database. SS-QOL (using the SS-QOL score) and disability status (modified Rankin Scale [mRS]) were prospectively assessed via mailed questionnaire. We analyzed quality of life (QOL) scores by domain and summary score, with a summary score of 4 or more defined as a good outcome. Analysis of variance (ANOVA) was used to model the effect of final recanalization status, stroke severity, and mRS on total QOL score. ANOVA and Pearson correlations were used to test the association between stroke severity/mRS and QOL/time since stroke, respectively. Of 99 patients with AIS, 61 responded, yielding 11 interim deaths, 7 incomplete surveys, and 43 complete surveys for analysis. Among responding survivors, overall QOL score was 3.9 (standard deviation 0.7); 77% of these reported good QOL. Scores were higher in recanalized patients in 11 of 12 domains but was significant only for mood. Although mRS was associated with stroke severity, QOL was independent of both. Seventy-seven percent of survivors of AIS who received IAT reported good QOL. Furthermore, these data suggest that SS-QOL is an independent outcome from stroke severity and disability status.
Collapse
|
21
|
Clark PC, Aycock DM, Reiss A, Tanner D, Shenvi NV, Easley KA, Wolf SL. Potential benefits for caregivers of stroke survivors receiving BTX-A and exercise for upper extremity spasticity. Rehabil Nurs 2014; 40:188-96. [PMID: 24633739 DOI: 10.1002/rnj.147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2013] [Indexed: 11/06/2022]
Abstract
PURPOSE To explore possible extended benefits to caregivers of stroke survivors receiving a treatment of onabotulinumtoxinA (BTX-A) or saline with a structured exercise program. DESIGN A comparative, prospective, companion study using a nonrandom sample of 16 caregivers of stroke survivors enrolled in a pilot clinical trial comparing BTX-A or saline and exercise for upper extremity spasticity. METHODS The caregiver measures were depressive symptoms, care demands, family conflict surrounding stroke recovery, and mental and physical health status. FINDINGS There were no statistically significant differences between caregiver groups. Caregivers of stroke survivors who received BTX-A had a greater change in depressive symptoms that may reflect a clinically important change. Estimates of effect sizes between the groups, controlling for baseline values, indicate a trend for moderate to large effects (last evaluation) for fewer depressive symptoms (d = 0.52) and less caregiver burden (d = 0.77 time, 0.85 difficulty) for caregivers of the BTX-A group. CONCLUSIONS AND CLINICAL RELEVANCE Receiving BTX-A did not alter caregiving demands or depressive symptoms compared to those receiving saline. Further research with larger sample sizes is needed to better understand the interdependence of stroke survivors and caregivers on the health of each.
Collapse
Affiliation(s)
- Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA, USA
| | - Dawn M Aycock
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA, USA
| | - Aimee Reiss
- Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Dee Tanner
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA, USA
| | - Neeta V Shenvi
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Kirk A Easley
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Steven L Wolf
- Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
22
|
Klinedinst NJ, Clark PC, Dunbar SB. Older adult stroke survivors discussing poststroke depressive symptoms with a healthcare provider: a preliminary analysis. Rehabil Psychol 2013; 58:263-71. [PMID: 23855380 DOI: 10.1037/a0033005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE The purposes of this study were to examine the relationship between the poststroke depressive symptoms, older adult stroke survivors' perceptions of the depressive symptoms, and the congruence with an informal caregiver about the presence of depressive symptoms, and comfort talking to the health care provider with whether or not older stroke survivors discussed their depressive symptoms with a health care provider. METHOD A cross-sectional study where 44 caregiver/older adult stroke survivor dyads completed questionnaires including the Center for Epidemiologic Studies Depression Scale, Symptom Perception Questionnaire, and reporting of depressive symptoms to the health care provider via one time interview. RESULTS Thirty-seven percent (n = 16) of all older stroke survivors reported depressive symptoms to their health care provider. Of the stroke survivors who had high levels of depressive symptoms (CESD ≥ 16; n = 11), seven reported the depressive symptoms to their health care provider. Identifying the symptoms as possible depression and attributing the cause of the depressive symptoms to the stroke were related to stroke survivors reporting the depressive symptoms to a health care provider. CONCLUSIONS High functioning, older stroke survivors may benefit from strategies to help them identify when they experience depressive symptoms, in order to be able to play an active role in their recovery by appropriately discussing their symptoms with a health care provider.
Collapse
|
23
|
Grant JS, Clay OJ, Keltner NL, Haley WE, Wadley VG, Perkins MM, Roth DL. Does caregiver well-being predict stroke survivor depressive symptoms? A mediation analysis. Top Stroke Rehabil 2013; 20:44-51. [PMID: 23340070 PMCID: PMC3824614 DOI: 10.1310/tsr2001-44] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE Studies suggest that family caregiver well-being (ie, depressive symptoms and life satisfaction) may affect stroke survivor depressive symptoms. We used mediation analysis to assess whether caregiver well-being might be a factor explaining stroke survivor depressive symptoms, after controlling for demographic factors and stroke survivor impairments and problems. METHODS Caregiver/stroke participant dyads (N = 146) completed measures of stroke survivor impairments and problems and depressive symptoms and caregiver depressive symptoms and life satisfaction. Mediation analysis was used to examine whether caregiver well-being mediated the relationship between stroke survivor impairments and problems and stroke survivor depressive symptoms. RESULTS As expected, more stroke survivor problems and impairments were associated with higher levels of stroke survivor depressive symptoms (P < .0001). After controlling for demographic factors, we found that this relationship was partially mediated by caregiver life satisfaction (29.29%) and caregiver depressive symptoms (32.95%). Although these measures combined to account for 40.50% of the relationship between survivor problems and impairments and depressive symptoms, the direct effect remained significant. CONCLUSIONS Findings indicate that stroke survivor impairments and problems may affect family caregivers and stroke survivors and a high level of caregiver distress may result in poorer outcomes for stroke survivors. Results highlight the likely importance of intervening with both stroke survivors and family caregivers to optimize recovery after stroke.
Collapse
|
24
|
Tse T, Douglas J, Lentin P, Carey L. Measuring participation after stroke: a review of frequently used tools. Arch Phys Med Rehabil 2012; 94:177-92. [PMID: 22982555 DOI: 10.1016/j.apmr.2012.09.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/29/2012] [Accepted: 09/02/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify and critique the measures currently used to assess participation in clinical stroke studies. DATA SOURCES Relevant articles published between January 2001 and April 2012 identified through Medline, CINAHL, and ProQuest Central databases. STUDY SELECTION Published articles involving poststroke assessment of participation. Case studies, cohort studies, and randomized controlled trials were included. DATA EXTRACTION The most frequently used measures were identified and the psychometric properties evaluated. Three raters independently evaluated each measure relative to the first and second coding levels of the International Classification of Functioning, Disability and Health (ICF) Activities and Participation domain categories. DATA SYNTHESIS Thirty-six measures were identified. The Stroke Impact Scale (SIS), London Handicap Scale, Assessment of Life Habits (LIFE-H), Frenchay Activities Index, and Activity Card Sort (ACS) were used most frequently. No single measure met criteria across all psychometric indices, and not one covered all 9 of the ICF Activities and Participation domains. The SIS, LIFE-H, and ACS covered the widest range. The domains covered most frequently were Community, Social and Civic Life, Domestic Life, and Mobility. Learning and Applying Knowledge, General Tasks and Demands, and Communication were the domains less frequently covered. CONCLUSIONS This review identified and evaluated the most frequently used participation measures in clinical stroke studies. The SIS, LIFE-H, and ACS covered the ICF Activities and Participation domain categories most comprehensively. However, none of the measures covered all the ICF Activities and Participation domain categories. The information provided in this systematic review can be used to guide the selection of participation measures to meet specific clinical and research purposes.
Collapse
Affiliation(s)
- Tamara Tse
- The Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, Stroke Division, Heidelberg, Victoria, Australia.
| | | | | | | |
Collapse
|
25
|
Cameron JI, Cheung AM, Streiner DL, Coyte PC, Stewart DE. Stroke Survivor Depressive Symptoms Are Associated With Family Caregiver Depression During the First 2 Years Poststroke. Stroke 2011; 42:302-6. [PMID: 21164124 DOI: 10.1161/strokeaha.110.597963] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jill I. Cameron
- From the Department of Occupational Science and Occupational Therapy (J.I.C.), University of Toronto, Toronto Rehabilitation Institute, Toronto, Ontario, Canada; University Health Network and University of Toronto, Departments of Medicine, Health Policy Management and Evaluation, and Public Health Sciences (A.M.C.), Toronto, Ontario, Canada; Department of Psychiatry (D.L.S.), University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry & Behavioural Neurosciences (D.L.S.), McMaster
| | - Angela M. Cheung
- From the Department of Occupational Science and Occupational Therapy (J.I.C.), University of Toronto, Toronto Rehabilitation Institute, Toronto, Ontario, Canada; University Health Network and University of Toronto, Departments of Medicine, Health Policy Management and Evaluation, and Public Health Sciences (A.M.C.), Toronto, Ontario, Canada; Department of Psychiatry (D.L.S.), University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry & Behavioural Neurosciences (D.L.S.), McMaster
| | - David L. Streiner
- From the Department of Occupational Science and Occupational Therapy (J.I.C.), University of Toronto, Toronto Rehabilitation Institute, Toronto, Ontario, Canada; University Health Network and University of Toronto, Departments of Medicine, Health Policy Management and Evaluation, and Public Health Sciences (A.M.C.), Toronto, Ontario, Canada; Department of Psychiatry (D.L.S.), University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry & Behavioural Neurosciences (D.L.S.), McMaster
| | - Peter C. Coyte
- From the Department of Occupational Science and Occupational Therapy (J.I.C.), University of Toronto, Toronto Rehabilitation Institute, Toronto, Ontario, Canada; University Health Network and University of Toronto, Departments of Medicine, Health Policy Management and Evaluation, and Public Health Sciences (A.M.C.), Toronto, Ontario, Canada; Department of Psychiatry (D.L.S.), University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry & Behavioural Neurosciences (D.L.S.), McMaster
| | - Donna E. Stewart
- From the Department of Occupational Science and Occupational Therapy (J.I.C.), University of Toronto, Toronto Rehabilitation Institute, Toronto, Ontario, Canada; University Health Network and University of Toronto, Departments of Medicine, Health Policy Management and Evaluation, and Public Health Sciences (A.M.C.), Toronto, Ontario, Canada; Department of Psychiatry (D.L.S.), University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry & Behavioural Neurosciences (D.L.S.), McMaster
| |
Collapse
|