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van den Broek B, Verrijt L, Rijnen S, van Heugten C, Bus B. Factors Related to the Quality and Stability of Partner Relationships After Stroke: A Systematic Literature Review. Arch Phys Med Rehabil 2024:S0003-9993(24)01005-0. [PMID: 38777292 DOI: 10.1016/j.apmr.2024.05.016] [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: 10/12/2023] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To provide an overview of the current state of knowledge on factors related to relationship quality and relationship stability after stroke. DATA SOURCES Cumulative Index to Nursing and Allied Health (CINAHL), Embase, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycINFO, and PubMed were searched on November 15, 2022, for literature on factors associated with (1) relation quality and (2) relation stability after stroke. STUDY SELECTION English quantitative and qualitative studies investigating factors associated with relation quality and/or stability after stroke were included. Three reviewers independently assessed eligibility. Consensus meetings were held in case of divergent opinions. A total of 44 studies were included. DATA EXTRACTION Information regarding study objectives and characteristics, participant demographics, independent and dependent variables, and main findings was extracted. Study quality was rated using the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies and/or the Critical Appraisal Skills Programme Checklist for Qualitative Research. Both were administered by the lead reviewer and checked by the second reviewer. Identified factors are described and presented according to the domains of the International Classification of Functioning, Disability, and Health model. DATA SYNTHESIS Thirty-seven factors related to relationship quality after stroke were identified, covering the domains of body functions and structures (eg, cognitive problems), activities (eg, decrease in physical intimacy), participation (eg, being socially active), environment (eg, medication side effects), and personal factors (eg, hypervigilance). Eight factors related to relationship stability were identified, covering the domains of participation (agreement on reciprocal roles) and personal factors (eg, quality of prestroke relation). CONCLUSIONS Relationship quality and stability after stroke are related to a multitude of factors. Future research should confirm the relevance of factors found in a few studies of suboptimal quality; explore possible associations between relationship stability and factors falling in the domains of body functions and structure, activity, and environmental factors; and explicitly explore potential positive effects of stroke on relationships.
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Affiliation(s)
- Brenda van den Broek
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel; School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht; Limburg Brain Injury Centre, Maastricht.
| | - Laura Verrijt
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel
| | - Sophie Rijnen
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel; Limburg Brain Injury Centre, Maastricht
| | - Caroline van Heugten
- Limburg Brain Injury Centre, Maastricht; Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Boudewijn Bus
- Multidisciplinary Specialist Centre for Brain Injury and Neuropsychiatry, GGZ Oost Brabant, Boekel; Limburg Brain Injury Centre, Maastricht
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Jírů-Hillmann S, Gabriel KMA, Schuler M, Wiedmann S, Mühler J, Dötter K, Soda H, Rascher A, Benesch S, Kraft P, Pfau M, Stenzel J, von Nippold K, Benghebrid M, Schulte K, Meinck R, Volkmann J, Haeusler KG, Heuschmann PU. Experiences of family caregivers 3-months after stroke: results of the prospective trans-regional network for stroke intervention with telemedicine registry (TRANSIT-Stroke). BMC Geriatr 2022; 22:228. [PMID: 35305580 PMCID: PMC8934512 DOI: 10.1186/s12877-022-02919-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/02/2022] [Indexed: 12/04/2022] Open
Abstract
Background Long-term support of stroke patients living at home is often delivered by family caregivers (FC). We identified characteristics of stroke patients being associated with receiving care by a FC 3-months (3 M) after stroke, assessed positive and negative experiences and individual burden of FC caring for stroke patients and determined factors associated with caregiving experiences and burden of FC 3 M after stroke. Methods Data were collected within TRANSIT-Stroke, a regional telemedical stroke-network comprising 12 hospitals in Germany. Patients with stroke/TIA providing informed consent were followed up 3 M after the index event. The postal patient-questionnaire was accompanied by an anonymous questionnaire for FC comprising information on positive and negative experiences of FC as well as on burden of caregiving operationalized by the Caregiver Reaction Assessment and a self-rated burden-scale, respectively. Multivariable logistic and linear regression analyses were performed. Results Between 01/2016 and 06/2019, 3532 patients provided baseline and 3 M-follow-up- data and 1044 FC responded to questionnaires regarding positive and negative caregiving experiences and caregiving burden. 74.4% of FC were older than 55 years, 70.1% were women and 67.5% were spouses. Older age, diabetes and lower Barthel-Index in patients were significantly associated with a higher probability of receiving care by a FC at 3 M. Positive experiences of FC comprised the importance (81.5%) and the privilege (70.0%) of caring for their relative; negative experiences of FC included financial difficulties associated with caregiving (20.4%). Median overall self-rated burden was 30 (IQR: 0–50; range 0–100). Older age of stroke patients was associated with a lower caregiver burden, whereas younger age of FC led to higher burden. More than half of the stroke patients in whom a FC questionnaire was completed did self-report that they are not being cared by a FC. This stroke patient group tended to be younger, more often male with less severe stroke and less comorbidities who lived more often with a partner. Conclusions The majority of caregivers wanted to care for their relatives but experienced burden at the same time. Elderly patients, patients with a lower Barthel Index at discharge and diabetes are at higher risk of needing care by a family caregiver. Trial registration The study was registered at “German Clinical Trial Register”: DRKS00011696. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011696 Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02919-6.
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McCarthy MJ, Lyons KS, Schellinger J, Stapleton K, Bakas T. Interpersonal relationship challenges among stroke survivors and family caregivers. SOCIAL WORK IN HEALTH CARE 2020; 59:91-107. [PMID: 31964295 DOI: 10.1080/00981389.2020.1714827] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 12/10/2019] [Accepted: 01/06/2020] [Indexed: 06/10/2023]
Abstract
A strong interpersonal relationship after stroke is important for the well-being of survivors and family caregivers. However, as many as 54% of families experience relationship problems after stroke and as many as 38% of couples experience overt conflict. The purpose of this study is to enhance understanding about relationship challenges among stroke dyads and to identify implications for direct practice in social work. Semi-structured interviews were conducted with N = 19 care dyads. Qualitative data were analyzed through an interpretive description lens. Seven themes about relationship challenges were identified. Findings highlight areas to consider in promoting strong relationships between survivors and family caregivers. Social workers may have the opportunity to assist dyads with disrupting negative communication cycles, strengthening empathy and collaboration, and achieving a balance so that each person's needs are met.
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Affiliation(s)
- Michael J McCarthy
- Department of Social Work, College of Social and Behavioral Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA
| | - Jeffrey Schellinger
- School of Social Work, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Katie Stapleton
- School of Social Work, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, USA
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Costa-García Á, Ozaki KI, Yamasaki H, Itkonen M, S FA, Okajima S, Tanimoto M, Kondo I, Shimoda S. Model for prompt and effective classification of motion recovery after stroke considering muscle strength and coordination factors. J Neuroeng Rehabil 2019; 16:130. [PMID: 31684980 PMCID: PMC6829968 DOI: 10.1186/s12984-019-0611-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 10/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background Muscle synergies are now widely discussed as a method for evaluating the existence of redundant neural networks that can be activated to enhance stroke rehabilitation. However, this approach was initially conceived to study muscle coordination during learned motions in healthy individuals. After brain damage, there are several neural adaptations that contribute to the recovery of motor strength, with muscle coordination being one of them. In this study, a model is proposed that assesses motion based on surface electromyography (sEMG) according to two main factors closely related to the neural adaptations underlying motor recovery: (1) the correct coordination of the muscles involved in a particular motion and (2) the ability to tune the effective strength of each muscle through muscle fiber contractions. These two factors are hypothesized to be affected differently by brain damage. Therefore, their independent evaluation will play an important role in understanding the origin of stroke-related motor impairments. Results The model proposed was validated by analyzing sEMG data from 18 stroke patients with different paralysis levels and 30 healthy subjects. While the factors necessary to describe motion were stable across heathy subjects, there was an increasing disassociation for stroke patients with severe motor impairment. Conclusions The clear dissociation between the coordination of muscles and the tuning of their strength demonstrates the importance of evaluating these factors in order to choose appropriate rehabilitation therapies. The model described in this research provides an efficient approach to promptly evaluate these factors through the use of two intuitive indexes.
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Affiliation(s)
- Álvaro Costa-García
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan.
| | - Ken-Ichi Ozaki
- National Center for Geriatrics and Gerontology, 7-430, Morioka cho, Aichi-ken, Ohbu, 474-8511, Japan
| | - Hiroshi Yamasaki
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan
| | - Matti Itkonen
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan
| | - Fady Alnajjar S
- Intelligent Robot Interaction Lab, College of Information Technology, United Arab Emirates University, Abu Dhabi, 15551, United Arab Emirates
| | - Shotaro Okajima
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan
| | - Masanori Tanimoto
- National Center for Geriatrics and Gerontology, 7-430, Morioka cho, Aichi-ken, Ohbu, 474-8511, Japan
| | - Izumi Kondo
- National Center for Geriatrics and Gerontology, 7-430, Morioka cho, Aichi-ken, Ohbu, 474-8511, Japan
| | - Shingo Shimoda
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan
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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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Eriksson E, Wejåker M, Danhard A, Nilsson A, Kristofferzon ML. Living with a spouse with chronic illness - the challenge of balancing demands and resources. BMC Public Health 2019; 19:422. [PMID: 31014309 PMCID: PMC6480606 DOI: 10.1186/s12889-019-6800-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/11/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The number of partners providing informal care for their chronically ill spouse is rising, and they describe their daily life as demanding. The aim of this paper was to describe the partners' experiences of living with a person with chronic illness and how they manage everyday life. METHODS A descriptive design with a qualitative approach was used. A purposive sample of 16 Swedish partners with a chronically ill spouse were interviewed. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. RESULTS Four main themes were identified: 'Managing challenges in daily life,' 'Seeking support and use own capabilities to manage life,' 'Appreciating the good parts of life' and 'Adapting to constant changes and an uncertain future'. Their experiences of support from formal care providers varied; they expressed the need for more assistance from the health care sector. CONCLUSIONS The partners experienced many challenges in everyday life when providing informal care for their chronically ill spouse. This affected both their physical and psychological health, as they had limited time for themselves. The partners seemed to receive more support from their informal network than from formal care providers. In handling daily life, the partners balanced demands and resources to identify possibilities to move forward and find meaning in life. This is congruent with theories by Antonovsky, and Folkman and Lazarus that describes meaningfulness and how to handle challenges in everyday life.
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Affiliation(s)
- Elisabet Eriksson
- Department of Health and Caring Sciences, University of Gävle, Kungsbäcksvägen 47, 801 76 Gävle, Sweden
| | - Maria Wejåker
- Department of Health and Caring Sciences, University of Gävle, Kungsbäcksvägen 47, 801 76 Gävle, Sweden
| | - Anna Danhard
- Department of Health and Caring Sciences, University of Gävle, Kungsbäcksvägen 47, 801 76 Gävle, Sweden
| | - Annika Nilsson
- Department of Health and Caring Sciences, University of Gävle, Kungsbäcksvägen 47, 801 76 Gävle, Sweden
- Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Marja-Leena Kristofferzon
- Department of Health and Caring Sciences, University of Gävle, Kungsbäcksvägen 47, 801 76 Gävle, Sweden
- Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden
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Bucki B, Spitz E, Baumann M. Emotional and social repercussions of stroke on patient-family caregiver dyads: Analysis of diverging attitudes and profiles of the differing dyads. PLoS One 2019; 14:e0215425. [PMID: 31013289 PMCID: PMC6478282 DOI: 10.1371/journal.pone.0215425] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/02/2019] [Indexed: 12/18/2022] Open
Abstract
For patients, the social and emotional repercussions of stroke include shame, personality changes, and upheavals experienced by the couple (i.e. patient and main family caregiver). These impacts on the couple 'patient/family caregiver' are scarcely documented. Focusing on the perceptions of the patients and the family caregivers living at home, two years after a stroke occurrence, the aims of the study were to analyse the concordance of attitudes towards the emotional and social repercussions of stroke and to determine the profiles of the differing dyads. Two researchers conducted separate face-to-face structured interviews with stroke survivors and their family caregivers. Eleven items, identified through a content analysis of interviews and after a qualitative process of generating questionnaire items, assessed the commonly experienced impact of stroke on the family, the social repercussions of stroke, and its emotional effects on the stroke survivors. The kappa concordance coefficient was used to determine the response convergence between patients and family caregivers. Four items, selected by a panel of experts, were included in logistic regressions (i.e., demographic characteristics and patients' impaired functions) to identify the differing dyadic profiles. Family caregivers' and patients' attitudes towards the social repercussions of stroke were similar. Patients with motor deficiencies tended to underestimate the upheaval brought to their couple by stroke, whereas caregivers of language-impaired patients tended to underestimate their feelings of shame and demeaning. Communication disturbances, but also residual physical disabilities in stroke survivors, may affect the understanding of each other's attitudes within dyads. In order to avoid dysfunctional relationships between family caregivers and patients, healthcare professionals need to pay special attention to this issue, especially in cases of aphasia and motor deficiencies.
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Affiliation(s)
- Barbara Bucki
- Institute for Research on Socio-Economy and health Inequalities (IRSEI), Unit INSIDE, University of Luxembourg, Luxembourg city, Grand-Duchy of Luxembourg
- Department of Psychology, EA4360 APEMAC, University of Lorraine, Paris Descartes University, Metz, France
| | - Elisabeth Spitz
- Department of Psychology, EA4360 APEMAC, University of Lorraine, Paris Descartes University, Metz, France
| | - Michèle Baumann
- Institute for Research on Socio-Economy and health Inequalities (IRSEI), Unit INSIDE, University of Luxembourg, Luxembourg city, Grand-Duchy of Luxembourg
- * E-mail:
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Zale EL, Heinhuis TJ, Tehan T, Salgueiro D, Rosand J, Vranceanu AM. Resiliency is independently associated with greater quality of life among informal caregivers to neuroscience intensive care unit patients. Gen Hosp Psychiatry 2018; 52:27-33. [PMID: 29549820 DOI: 10.1016/j.genhosppsych.2018.02.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Every year, millions of Americans become informal caregivers to loved ones admitted to Neuroscience Intensive Care Units (Neuro-ICU), and face challenges to Quality of Life (QoL). This study sought to identify associations between resiliency, distress, and caregiver QoL at time of Neuro-ICU admission. METHODS Informal caregivers (N = 79, Mage = 53, 64% female) of Neuro-ICU patients were recruited and completed self-report questionnaires during the hospitalization. We used hierarchical regression to test relative contributions of caregiver mindfulness, perceived coping abilities, and preparedness for caregiving to caregiver QoL, above-and-beyond non-modifiable patient and caregiver factors (e.g., gender) and caregiver psychological distress (i.e., anxiety, depression, history of mental health conditions). RESULTS Preparedness for caregiving was uniquely and positively associated with Physical Health QoL (sr2 = 0.07, p = 0.001), Social QoL (sr2 = 0.05, p = 0.021), and Environmental QoL (sr2 = 0.14, p < 0.001), even after accounting for psychological distress. Mindfulness was uniquely and positively associated with Physical Health QoL (sr2 = 0.12, p < 0.001) and Psychological QoL (sr2 = 0.07, p = 0.004), above-and-beyond variance accounted for by psychological distress. CONCLUSIONS Mindfulness and preparedness for caregiving emerged as consistent, unique resiliency factors associated with greater caregiver QoL across QoL dimensions. Results highlight the importance of resiliency factors in QoL among Neuro-ICU caregivers and the need for early interventions to support resiliency.
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Affiliation(s)
- Emily L Zale
- Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tessa J Heinhuis
- Psychology Department, University of Amsterdam, Amsterdam, Netherlands
| | - Tara Tehan
- Neuroscience Intensive Care Unit, Institute for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Danielle Salgueiro
- Neuroscience Intensive Care Unit, Institute for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Neuroscience Intensive Care Unit, Institute for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1571] [Impact Index Per Article: 196.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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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.
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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
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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.
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Baumann M, Couffignal S, Le Bihan E, Chau N. Life satisfaction two-years after stroke onset: the effects of gender, sex occupational status, memory function and quality of life among stroke patients (Newsqol) and their family caregivers (Whoqol-bref) in Luxembourg. BMC Neurol 2012; 12:105. [PMID: 23009364 PMCID: PMC3551740 DOI: 10.1186/1471-2377-12-105] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 09/05/2012] [Indexed: 11/10/2022] Open
Abstract
Background Life satisfaction (LS) of cerebrovascular disease survivors and their family caregivers may relate to socioeconomic factors, impaired functions, health-related quality of life (QoL), but their respective influences remain unclear. This study assessed, two years post-stroke onset, the effects of these factors on patients’ LS and family caregivers’ LS in Luxembourg. Methods All stroke patients admitted to all hospitals in Luxembourg were identified by the ‘Inspection Général de la Sécurité Sociale’ using the only national system database for care expenditure reimbursement. Their diagnosis was confirmed by medical investigator. The sample included ninety four patients living at home having given consent (mean age 65.5 years) and sixty two main caregivers (mean age 59.3 years). Questionnaires were completed during face-to-face interviews. LS was assessed via European single question (range 1–10), survivors’ QoL via Newsqol (11 dimensions), and caregivers’ QoL via Whoqol-bref (4 domains) (range 0–100). Data were analysed using multiple regression models. Results Two years after stroke onset, 44.7% of patients suffered from impaired sensory function, 35.1% from impaired motor function, and 31.9% from impaired memory function. Mean patient’ LS was 7.1/10 (SD 1.9). It was higher in women (+12.4) and lower among unemployed socioeconomically active patients (−13.1, vs. retired people). Adjusted for sex, occupation, impaired motor and memory functions, LS positively correlated with scores of Newsqol feelings, sleep, emotion, cognition and pain dimensions (slopes 0.20 to 0.31), but did not correlate with those of caregivers’ Whoqol-bref domains. Family caregiver’ LS was 7.2 (SD 1.7). It was lower in those with patients suffering from impaired memory function (−12.8) as well as from feelings and emotion issues (slopes 0.22). It was associated with all caregivers’ Whoqol-bref domains (physical health, psychological health, environment, and social relationships) (slopes 0.53 to 0.68). Conclusions Two-year post-cerebrovascular disease patient’ LS was associated with gender, occupation, and impaired memory function. It correlated with feelings, sleep, emotion, cognition, and pain issues. Family caregivers of patients with impaired memory function had lower LS. Family caregiver’ LS correlated with dimensions of patients’ feelings (less independent, yourself, life changed, depressed, useless, less control because of stroke) and emotion (get more emotional, fear of another stroke or to become dependent on others), and with their own QoL. LS, Newsqol, and Whoqol appeared to be appropriate tools. Our findings may be useful for policy makers in relation to family and medical-social issues of stroke home-based rehabilitation.
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Affiliation(s)
- Michèle Baumann
- Medical Sociology, INSIDE Research Unit, University of Luxembourg, Walferdange, Luxembourg.
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