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Jaracz K, Grabowska-Fudala B, Jaracz J, Moczko J, Kleka P, Pawlicka A, Górna K. Caregiver burden after stroke: a 10-year follow-up study of Polish caregivers for stroke patients. BMC Nurs 2024; 23:589. [PMID: 39183261 DOI: 10.1186/s12912-024-02251-x] [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: 05/31/2024] [Accepted: 08/09/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND A long-term assessment of stroke outcomes from the perspectives of patients and their caregivers is important for optimising long-term post-stroke care. The extended effects of stroke caregiving, particularly caregiver burden beyond 5 years since stroke, remain to be determined. Hence, this study aimed to determine caregiver burden at 10 years after stroke, compare the burden severity at 10 years with its levels at 5 years and 6 months after stroke, and identify predictors of the burden severity at 10 years post-stroke. METHODS A longitudinal follow-up study including a group of first-ever stroke patients/informal continuous caregivers pairs was followed for 10 years and interviewed face-to face at their home setting. Caregiver burden was evaluated with the Caregiver Burden Scale. Potential predictors were examined using standardised measures and identified by applying the Classification and Regression Tree. RESULTS A total of 40 caregiver/patient pairs participated in the study. At 10 years, 47.5% of the caregivers experienced a considerable burden. This was more than after 5 years (17.5%) and comparable to that after 6 months (37.5%), p < 0.003. Longer time spent caregiving, caregivers' weaker sense of coherence, more severe stroke, and caregivers' anxiety were the independent predictors of considerable burden 10 years after stroke. CONCLUSIONS Caregivers' burden in the late chronic post-stroke phase is a significant problem, as nearly half of the caregivers experience a substantial burden. This problem mainly concerns individuals who spend at least 7 h daily caregiving and have a lower Sense of Coherence. The long-term evaluation of stroke consequences reported by stroke patients and their caregivers can be an important source of information for healthcare professionals in order to optimise the care and support they provide at various stages of life after stroke.
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Affiliation(s)
- Krystyna Jaracz
- Department of Neurological Nursing, Poznan University of Medical Sciences, 2 A, Rokietnicka Str, 60-806, Poznań, Poland.
| | - Barbara Grabowska-Fudala
- Department of Neurological Nursing, Poznan University of Medical Sciences, 2 A, Rokietnicka Str, 60-806, Poznań, Poland.
| | - Jan Jaracz
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznań, Poland
| | - Jerzy Moczko
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznań, Poland
| | - Paweł Kleka
- Faculty of Psychology and Cognitive Sciences, Adam Mickiewicz University, Poznań, Poland
| | | | - Krystyna Górna
- Department of Psychiatric Nursing, Poznan University of Medical Sciences, Poznań, Poland
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Rose D, Newman SD, Mueller M, Magwood GS, Lutz BJ. Working-Age Caregivers of Stroke Survivors: Needs, Concerns, and Quality of Life. Rehabil Nurs 2024; 49:33-43. [PMID: 38345829 DOI: 10.1097/rnj.0000000000000447] [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: 03/01/2024]
Abstract
PURPOSE The purpose of this study was to characterize the unmet needs and concerns of working-age caregivers of stroke survivors and to explore the relationships between these unmet needs and concerns and factors such as stroke survivor functional independence, caregiver strain, caregiver self-efficacy, caregiver perceived social support, and caregiver quality of life (QoL). DESIGN Cross-sectional descriptive design was used in this study. METHODS Participants ( N = 103) completed an online survey. Descriptive statistics, bivariate Pearson correlation, and linear regression analysis was performed. RESULTS Negative correlations were found between caregiver needs and concerns and both stroke survivor functional independence and caregiver self-efficacy. Positive correlations were identified between caregiver needs and concerns and caregiver strain. In multiple regression models, stroke survivor functional independence, caregiver self-efficacy, race, and gender were statistically significantly associated with caregiver QoL. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING Results of this study can inform nurses as they collaborate with informal caregivers and researchers in optimizing the rehabilitation and discharge process and aiding in the support of caregiver QoL. CONCLUSION Working-age caregivers of stroke survivors expressed many needs and concerns. These needs, along with other factors, can affect outcomes including QoL in caregivers and stroke survivors.
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Affiliation(s)
- Dixie Rose
- The University of Texas at Tyler, Tyler, TX, USA
| | - Susan D Newman
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Barbara J Lutz
- University of North Carolina Wilmington, Wilmington, NC, USA
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Tziaka E, Tsiakiri A, Vlotinou P, Christidi F, Tsiptsios D, Aggelousis N, Vadikolias K, Serdari A. A Holistic Approach to Expressing the Burden of Caregivers for Stroke Survivors: A Systematic Review. Healthcare (Basel) 2024; 12:565. [PMID: 38470676 PMCID: PMC10930970 DOI: 10.3390/healthcare12050565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
This systematic review explores the multifaceted challenges faced by caregivers of stroke survivors, addressing the global impact of strokes and the anticipated rise in survivors over the coming decades. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a thorough literature search identified 34 relevant studies published between 2018 and 2023. The review categorizes caregiver burden into four domains: physical health, social functioning, financial issues, and psychological health. Caregivers often experience a decline in physical health, marked by chronic fatigue, sleep disturbances, and pain. Emotional distress is prevalent, leading to anxiety and depression, especially in cases of high burden. Financial strains arise from medical expenses and employment changes, exacerbating the overall burden. Contextual factors, such as cultural norms and resource availability, influence the caregiver experience. The Newcastle-Ottawa scale assessed the methodological quality of studies. The conclusion emphasizes tailored interventions and support systems for caregivers, with practical recommendations for healthcare professionals, therapists, mental health professionals, financial counselors, and policymakers. This comprehensive review enhances the understanding of caregiver experiences and provides actionable insights to improve stroke care and rehabilitation The study's novelty lies in its holistic examination of caregiver burden in stroke care, its focus on the recent literature, and its emphasis on forecasting caregiver outcomes, contributing valuable insights for proactive intervention strategies.
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Affiliation(s)
- Eftychia Tziaka
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.T.); (F.C.); (K.V.)
| | - Anna Tsiakiri
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.T.); (F.C.); (K.V.)
| | - Pinelopi Vlotinou
- Department of Occupational Therapy, University of West Attica, 12243 Athens, Greece;
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.T.); (F.C.); (K.V.)
| | - Dimitrios Tsiptsios
- 3rd Department of Neurology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece;
| | - Konstantinos Vadikolias
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.T.); (F.C.); (K.V.)
| | - Aspasia Serdari
- Department of Child & Adolescent Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
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Sahbaz T, Medin-Ceylan C. Stroke severity to determine musculoskeletal symptoms in family caregivers. Rev Lat Am Enfermagem 2023; 31:e4004. [PMID: 37820216 PMCID: PMC10561800 DOI: 10.1590/1518-8345.6725.4004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/12/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE the objective of this study is to examine the relationship between the musculoskeletal problems experienced by the family members who care for stroke patients, physical health and disability levels. METHOD the subjects included in the study were patients and family caregivers admitted to the Kanuni Sultan Suleyman Training and Research Hospital Physical Medicine and Rehabilitation outpatient clinic with a stroke diagnosis between May 30 th, 2019, and May 30 th, 2021. The caregivers were assessed using the Extended Nordic Musculoskeletal Questionnaire. Validated scales were employed to evaluate stroke patients' physical health and disability level. RESULTS a total of 104 stroke patients and 104 caregivers who met our inclusion criteria took part in this study. Low back complaints in the last month were associated with the patients' Functional Ambulation Score (FAS), Functional Independence Measure (FIM), Stroke Impact Scale (SIS) and Brunnstrom scores. Neck pain was the second musculoskeletal complaint, but was not statistically associated with patient-related factors. Upper limb problems were associated with FAS, FIM, SIS, Brunnstrom and the Modified Ashworth Scale scores. CONCLUSION according to our findings, the low back is the body area most affected by musculoskeletal complaints in family caregivers of stroke patients, closely related to the patients' functional capacity and disability levels. CLINICAL TRIALS NUMBER NCT04901637 (1) Stroke survivors highly depend on informal caregivers for daily living. (2) Family caregivers are at an increased risk of experiencing musculoskeletal problems. (3) The caregivers' musculoskeletal symptoms are related to the level of the patient disability. (4) Preventive medicine should become a part of nursing education for family caregivers.
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Affiliation(s)
- Tugba Sahbaz
- Beykent University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Cansın Medin-Ceylan
- University of Health Sciences, Istanbul Physical Therapy Rehabilitation Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
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Liu CH, Chen YJ, Chen JS, Fan CW, Hsieh MT, Lin CY, Pakpour AH. Burdens on caregivers of patients with stroke during a pandemic: relationships with support satisfaction, psychological distress, and fear of COVID-19. BMC Geriatr 2022; 22:958. [PMID: 36514006 PMCID: PMC9745281 DOI: 10.1186/s12877-022-03675-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Caregivers have faced unprecedented circumstances throughout the COVID-19 pandemic, but previous research only minimally addresses the caregivers' burden. Therefore, this study aimed to investigate the relationship between caregiver burden, psychological stress, satisfaction with support, and fear of COVID-19 in caregivers of patients with stroke during the pandemic. METHODS A cross-sectional survey study with total of 171 caregivers of patients with stroke in a community hospital in Taiwan. All participants completed the Zarit Burden Interview, Depression, Anxiety, Stress Scale (DASS-21), satisfaction of support survey, and Fear of COVID-19 Scale. Pearson correlations were used to examine the bivariate correlations between study variables. Then, with the control of demographic confounders, a multiple linear regression model was applied with significant variables to construct and explain caregiver burden. RESULTS The proposed model significantly explained the caregiver burden of caregivers of patients with stroke. Specifically, the caregiver burden was negatively correlated with satisfaction with family support, but positively with psychological distress and the fear of COVID-19. CONCLUSIONS Caregivers of patients with stroke will suffer a greater burden if they have lower satisfaction with family support, experienced higher psychological distress, and perceived more fear of the COVID-19 pandemic. Health professionals must address these concerns, support caregivers, and enhance available resources.
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Affiliation(s)
- Chieh-hsiu Liu
- grid.416911.a0000 0004 0639 1727Department of Family Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yi-Jung Chen
- grid.64523.360000 0004 0532 3255Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Rd, Tainan, 701 Taiwan
| | - Jung-Sheng Chen
- grid.414686.90000 0004 1797 2180Department of Medical Research, E-Da Hospital, Kaohsiung, 82445 Taiwan
| | - Chia-Wei Fan
- Department of Occupational Therapy, AdventHealth University, Orlando, Florida USA
| | - Meng-Tsang Hsieh
- grid.414686.90000 0004 1797 2180Stroke Center and Department of Neurology, E-Da Hospital, Kaohsiung, 82445 Taiwan ,grid.411447.30000 0004 0637 1806School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 82445 Taiwan ,grid.64523.360000 0004 0532 3255Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, 70101 Taiwan
| | - Chung-Ying Lin
- grid.64523.360000 0004 0532 3255Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Rd, Tainan, 701 Taiwan ,grid.64523.360000 0004 0532 3255Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan ,grid.64523.360000 0004 0532 3255Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan ,grid.64523.360000 0004 0532 3255Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Amir H. Pakpour
- grid.118888.00000 0004 0414 7587Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Factors Associated With Depression Among Family Caregivers of Patients With Stroke in Indonesia: A Cross-Sectional Study. THE JOURNAL OF NURSING RESEARCH : JNR 2022; 30:e231. [PMID: 36018723 DOI: 10.1097/jnr.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Strokes may lead to increased dependency, which may impact the daily lives of patients with stroke and their family caregivers. Caring for a poststroke family member in Indonesia may differ from other countries in terms of extending beyond the provision of hands-on care. Contradictions and gaps in the factors affecting caregiver depression have been highlighted in a review of the relevant literature. Few studies have examined comprehensively the contradictory factors, uncovered factors, and cultural and spiritual values affecting this phenomenon. PURPOSE This study was designed to identify the factors associated with depression in family caregivers of patients with stroke in Indonesia. We examined the following factors related to caregiver depression: demographic characteristics of the caregiver and care recipient, functional ability of the patient, caregiver self-efficacy, knowledge regarding stroke care, and spiritual values. METHODS In this cross-sectional study, 157 primary caregivers completed questionnaires involving depression factors during face-to-face interviews. The data were analyzed using multiple logistic regression. RESULTS The prevalence of depression among the participants was 56.7%. The overall mean ages of the participants and their care recipients were 43.6 and 57.1 years, respectively. In this study, 65.6% of the participants were female, and 70.1% lacked knowledge regarding stroke care. In the early caregiving phase, caregiver depression was more likely to occur in female caregivers with back pain and long care hours. Self-efficacy in achieving respite time was found to be associated with a lower risk of depression. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Caregivers' gender, presence of back pain, sufficient respite time, and time since stroke occurrence should be considered when providing knowledge, skills, and coping strategies to caregivers to help them adapt to their caregiving role, maintain their quality of life, and prevent the onset of depression. Understanding the factors influencing caregiver depression may help nursing professionals identify individuals at a higher risk of depression early on and provide critical follow-up and early access to supportive counseling.
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Cheng HY, Li Y, Chau JPC, Chair SY. Influence of psychological responses of caregiving on the perceived health of family caregivers to acute stroke survivors. Medicine (Baltimore) 2022; 101:e30778. [PMID: 36197251 PMCID: PMC9509108 DOI: 10.1097/md.0000000000030778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Family caregivers provide round-the-clock care to their family members who had a stroke. The detrimental effects of caregiving on caregiver's health would lead to the abandonment of caregiver role and institutionalization of stroke survivors. This study aims to determine the factors associated with the perceived health status of family caregivers to stroke survivors. This study conducted a secondary analysis of the baseline data of 142 family caregivers of stroke survivors nested within a longitudinal randomized controlled trial. Potential factors were identified according to the Pittsburgh Mind-Body Center model and were analyzed with hierarchical multiple regression models. The results indicated that stroke caregivers exhibited comparable perceived physical health with general population but poorer perceived mental health. Severity of depressive symptoms (β = -0.37, P < .001) remained the strongest and most significant factor associated with perceived mental health, followed by confidence in problem-solving (β = -0.21, P < .05). Moreover, caregiving competence (β = 0.29, P < .001) was the sole significant psychological factor associated with perceived physical health. Caregiving competence, problem-solving abilities, and severity of depressive symptoms are significant modifiable correlates of the perceived health of caregivers. Intervention for improving these psychological responses of caregivers is suggested incorporated in stroke rehabilitation programs.
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Affiliation(s)
- Ho Yu Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- *Correspondence: Ho Yu Cheng, The Nethersole School of Nursing, 8/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, N. T., Hong Kong SAR, China (e-mail: )
| | - Yating Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Janita Pak-Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Wang S, You J, Lin J, Fu X, Ning M, Mo Y, Yang S. Effects of the nurse-led program on disabilities improvement in patients with ischemic stroke. Medicine (Baltimore) 2022; 101:e30652. [PMID: 36123853 PMCID: PMC9478287 DOI: 10.1097/md.0000000000030652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
To evaluate whether the nurse-led program can improve disabilities in patients with ischemic stroke for more than 6 months. This is a randomized, open-label study. Participants in the usual-care group received the usual care that included verbal stroke-related education and secondary prevention. Participants in the active group received the usual care plus the nurse-led program intervention. The disability was evaluated using National Institutes of Health Stroke Scale (NIHSS). The Mental Health Inventory-5 (MHI-5) was used to assess mental health status (MHS). The median duration since ischemic stroke was 8.4 and 8.6 months, respectively. At baseline, there was no difference in the median NIHSS value and the NIHSS category between these 2 groups. After 6 months' follow-up, the median NIHSS value was lower in the active group (4.1 vs 6.3). The proportion of patients with NIHSS of 1 to 4 was higher (50.0% vs 28.6%) while the proportion of patients with NIHSS of 5 to 12 (24.1% vs 51.8%) was lower in the active group. After multivariate regression analysis, the nurse-led program was negatively associated with increased NIHSS category (odds ratio of 0.70 and 95% confidence interval of 0.62-0.88). In the group with MHI-5 less than median, the nurse-led program was not associated with NIHSS category. While in the group with MHI-5 greater than median, the nurse-led program was associated decreased NIHSS category, with a significant interaction (P value = .03). In ischemic stroke patients for more than 6 months, the nurse-led program improves disabilities, which might be related to MHS improvement.
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Affiliation(s)
- Suping Wang
- Department of Nursing, Hainan Geriatric Hospital, Hainan, China
- *Correspondence: Suping Wang, Department of Nursing, Hainan Geriatric Hospital, Haikou, 571100, Hainan, China (e-mail: )
| | - Jingyan You
- Department of Nursing, Hainan Western Central Hospital, Hainan, China
| | - Jing Lin
- Department of Nursing, Hainan Geriatric Hospital, Hainan, China
| | - Xiumei Fu
- Department of Nursing, Hainan Geriatric Hospital, Hainan, China
| | - Min Ning
- Department of Nursing, Hainan Geriatric Hospital, Hainan, China
| | - Yuzhu Mo
- Department of Nursing, Hainan Western Central Hospital, Hainan, China
| | - Shoujiao Yang
- Department of Nursing, Hainan Western Central Hospital, Hainan, China
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Elsheikh MA, Moriyama M, Rahman MM, Kako M, El-Monshed AH, Zoromba M, Zehry H, Khalil MH, El-Gilany AH, Amr M. Effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors: a randomised controlled trial. BMJ Open 2022; 12:e049741. [PMID: 35168963 PMCID: PMC8852666 DOI: 10.1136/bmjopen-2021-049741] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of a tailored multidimensional intervention in reducing the care burden of family caregivers of stroke survivors. This intervention considered caregivers' perceived needs and incorporated three evidence-based dimensions (psychoeducation, skill-building and peer support). DESIGN A prospective randomised control trial. SETTING A community-based study conducted in Egypt. PARTICIPANTS A total of 110 caregivers aged ≥18 years who cared for a survivor within 6 months of stroke, with modified Rankin Scale scores of 3-5, and without other physical disabilities or terminal illnesses were recruited between December 2019 and May 2020. Participants were assigned to the intervention group (IG; n=55) and control group (CG; n=55) through open-label, parallel 1:1 randomisation. INTERVENTION The IG was provided with tailored multidimensional interventions for 6 months until November 2020, including three home visits, six home-based telephone calls and one peer-support session. The CG received simple educational instructions at a single visit. OUTCOME The participants completed the Zarit Burden Interview (primary outcome) and the WHO Quality of Life-BREF (secondary outcome) before the intervention (T0), at 3 months (T1) and at 6 months (T2). RESULTS No differences were observed between the characteristics of the groups at baseline (T0). The independent t-test showed no significant differences in the care burden and Quality of Life (QoL) at T1 and T2 between the groups. The intervention had no significant effect on the outcomes between or within groups over time, as shown by the repeated-measures analysis of variance. However, the group and time interaction had significant main effects on caregivers' QoL (psychological and social domains). CONCLUSION The main results showed that participants in the IG did not experience an improvement in the main outcomes. Nevertheless, the improvement in the psychological and social domains may have been attributed to our intervention. TRIAL REGISTRATION NUMBER NCT04211662.
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Affiliation(s)
- Mahmoud Ahmed Elsheikh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Community Health Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mayumi Kako
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ahmed Hashem El-Monshed
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
- Nursing Department, College of Health and Sport Sciences, University of Bahrain, Manama, Bahrain
| | - Mohamed Zoromba
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Hamada Zehry
- New Mansoura General Hospital, Neurology, Egypt Ministry of Health and Population, Mansoura, Egypt
| | - Maha Hazem Khalil
- Neurology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Mostafa Amr
- Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Chin WJ, Ho YLS, Ramazanu S, Itoh S, Klainin-Yobas P, Wu XV. Effectiveness of technology-based interventions on psychological morbidities, quality of life for informal caregivers of stroke survivors: A systematic review and meta-analysis. J Adv Nurs 2021; 78:947-967. [PMID: 34904746 DOI: 10.1111/jan.15130] [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: 06/22/2021] [Revised: 10/08/2021] [Accepted: 11/27/2021] [Indexed: 02/03/2023]
Abstract
AIMS To evaluate the effectiveness of technology-based interventions in reducing psychological morbidities such as depressive symptomology, anxiety, burden and improving quality of life and self-efficacy in informal caregivers of stroke survivors. DESIGN A systematic review and meta-analysis. DATA SOURCES An extensive search was systematically undertaken at CENTRAL, PubMed, Embase, Scopus, CINHAL, Web of Science and PsycInfo until January 2021. Grey literature and dissertations were searched in Google Scholar, ProQuest & Scholarbank@NUS. Studies involving registered trials were retrieved from Clinicaltrials.gov and CENTRAL, respectively. REVIEW METHODS Two reviewers independently screened the trials, conducted quality appraisal and extracted the data. Quality of the studies included in the review was assessed using Cochrane Risk of bias tool. Meta-analysis was conducted using RevMan 5.4. Narrative synthesis was performed for studies where results could not be pooled statistically. The results were reported abiding Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS This review included 15 trials with a total of 1276 informal caregivers of stroke survivors. Eleven trials were included in the meta-analysis. Subgroup analyses revealed that technology-based interventions with structured educational programs were statistically significant in reducing depressive symptoms (d = -0.27, 95% CI [-0.49 to -0.05], p = .02). Technology-based interventions with structured educational programs <3-month revealed significant effects (d = -0.31, 95% CI [-0.49 to -0.13], p = .0009). Results of narrative synthesis reported technology-based intervention with face-to-face training minimized depressive symptoms of informal caregivers. Notably, there were no statistically significant effects on anxiety, burden, quality of life and self-efficacy outcomes. CONCLUSION Technology-based interventions had beneficial effects in alleviating depressive symptoms among informal caregivers. IMPACT Technology-based interventions serve as a support mechanism for informal caregivers of stroke survivors who face time-constrains. Further high-quality randomized controlled trials are warranted to elucidate sustainability, optimal format and dosage of intervention.
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Affiliation(s)
- Wei Jien Chin
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yun Ling Selina Ho
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sheena Ramazanu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sakiko Itoh
- Department of Genome Informatics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore
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Elsheikh MA, Moriyama M, Rahman MM, Kako M, El-Monshed AH, Zoromba M, Zehry H, Khalil MH, Amr M. Effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors: study protocol for a randomised controlled trial. BMJ Open 2020; 10:e041637. [PMID: 33323445 PMCID: PMC7745514 DOI: 10.1136/bmjopen-2020-041637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Caring for stroke survivors creates high levels of care burden among family caregivers. Previous initiatives at alleviating the care burden have been unsuccessful. The proposed study aims to evaluate the effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors. Based on the perceived needs of family caregivers, this intervention takes into account scientific recommendations to combine three different approaches: skill-building, psychoeducation and peer support. METHODS AND ANALYSIS Using a prospective, randomised, open-label, parallel-group design, 110 family caregivers will be enrolled from Dakahlia Governorate, Egypt between December 2019 and May 2020, and randomly assigned to either the intervention group or the control group. The tailored multidimensional intervention will be administered for 6 months, including three home visits, six home-based telephone calls and one peer support session. The primary outcome is the care burden as measured using the Zarit Burden Interview. Secondary outcomes include changes in the family caregivers' perceived needs (Family Needs Questionnaire-Revised), coping strategies (Brief-Coping Orientation to Problems Experienced) and quality of life (WHO Quality of Life-BREF). Outcomes evaluation will be conducted at baseline (T0), month 3 (T1) and month 6 (T2). Independent t-test will be performed to compare the mean values of study variables between the two groups at both T1 and T2. After adjusting for confounding variables, analysis of covariance will be used to assess the effect of the intervention. In addition, repeated measures analysis of variance will be conducted to assess changes in effect over time. ETHICS AND DISSEMINATION This study was approved by the Research Ethics Committee of the Faculty of Nursing, Mansoura University, Mansoura, Egypt (P.0195). The results will be published in a scientific peer-reviewed journal, and findings will be disseminated at the local and international levels. TRIAL REGISTRATION NUMBER NCT04211662.
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Affiliation(s)
- Mahmoud Ahmed Elsheikh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Community Health Nursing Department, Faculty of Nursing, Cairo University, Cairo, Egypt
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mayumi Kako
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ahmed Hashem El-Monshed
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Mohamed Zoromba
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Hamada Zehry
- New Mansoura General Hospital, Neurology, Ministry of Health and Population, Mansoura, Egypt
| | | | - Mostafa Amr
- Psychiatry, Mansoura University Faculty of Medicine, Mansoura, Egypt
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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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