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Becqué YN, Rietjens JAC, van der Heide A, Witkamp E. Failed implementation of a nursing intervention to support family caregivers: An evaluation study using Normalization Process Theory. J Adv Nurs 2024. [PMID: 38884574 DOI: 10.1111/jan.16261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/26/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024]
Abstract
AIM To evaluate the failed implementation of the Carer Support Needs Assessment Tool Intervention for family caregivers in end-of-life care, within a trial context using Normalization Process Theory (NPT). DESIGN An evaluation study was conducted to learn lessons from our trial, which was not successful due to the low number of participants. The evaluation study utilized various data sources, including published data from interviews and questionnaires, and unpublished data derived from emails and conversation notes. METHODS Data were retrospectively collected. Thematic analysis was conducted guided by the NPT framework. This framework emphasizes that successful implementation of an intervention relies on its 'normalization', consisting of four constructs: coherence, cognitive participation, collective action and reflexive monitoring. RESULTS Coherence (sense making): Nurses felt the intervention could contribute to their competence in assessing family caregivers' needs, but some were unsure how it differed from usual practice. Cognitive participation (relational work): Nurse champions played a crucial role in building a community of practice. However, sustaining this community was challenging due to staff turnover and shortages. Collective action (work done to enable the intervention): Nurses felt the Carer Support Needs Assessment Tool training enabled them to improve their support of family caregivers. However, contextual factors complicated implementation, such as being used to a patient rather than a family-focused approach and a high workload. Reflexive monitoring (appraisal of the intervention): Positive experiences of the nurses with the intervention motivated them to implement it. However, the research context made nurses hesitant to recruit family caregivers because of the potential burden of participation. CONCLUSION Although the intervention demonstrated potential to assist nurses in providing tailored support to family caregivers, its integration into daily practice was not optimal. Contextual factors, such as a patient-focused approach to care and the research context, hampered normalization of the intervention. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Assessing and considering contextual factors that may influence implementation of a complex care intervention is needed. The NPT provided a valuable framework for evaluating the implementation process in our study. IMPACT What problem did the study address? This evaluation study analysed the factors that promoted or hindered the implementation of a nursing intervention to support family caregivers in end-of-life care. What were the main findings? Both the intervention and the intervention training have potential and value for nurses in providing tailored support to family caregivers. However, the implementation faced challenges due to organizational factors and the research context, including recruitment. Where and on whom will the research have an impact? This insight is valuable for all stakeholders involved in implementing complex nursing interventions, including researchers, nurses and funders. REPORTING METHOD This study has adhered to the relevant EQUATOR guidelines: Standards for Reporting Qualitative Research (SRQR). PATIENT OR PUBLIC CONTRIBUTION There was no patient or public involved. TRIAL REGISTRATION The trial was prospectively registered on the Dutch Trial Register (NL7702).
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Affiliation(s)
- Yvonne N Becqué
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Design, Organisation and Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erica Witkamp
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Wiertz CMH, Hemmen B, Sep SJS, Verbunt JA. Caregiver burden and impact on COVID-19 patient participation and quality of life one year after ICU discharge - A prospective cohort study. PATIENT EDUCATION AND COUNSELING 2024; 123:108221. [PMID: 38460347 DOI: 10.1016/j.pec.2024.108221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES to investigate changes in caregiver strain, mental health complaints and QoL in caregivers of COVID-19 ICU survivors in the first year after discharge, and their associations with patients' participation and quality of life. METHODS Post-ICU COVID-19 survivors, needing inpatient rehabilitation and their informal caregivers were included. Caregiver self-administered questionnaires included quality of life, self-rated health, caregiver strain, anxiety and depression symptoms, post-traumatic stress and coping style. Patients' participation in society was assessed and quality of life. RESULTS 67 patients (78% male) and 57 caregivers (23.6% male) were included. Three months post-ICU, caregivers experienced caregiver strain (32%), anxiety (41%), depressive symptoms (16%) and PTSD (24%). One year post-ICU, rates decreased, still being 11%, 26%, 10% and 5%, respectively. Caregiver anxiety symptoms and self-rated health at three months were associated with worse patient levels of participation and quality of life one year after ICU discharge (p < 0.05). CONCLUSIONS COVID-19 caregivers experience high levels of mental health complaints one year after a patient's ICU discharge. Furthermore, our results indicate that patient participation levels and quality of life one year after ICU discharge may be negatively associated by caregiver complaints. PRACTICAL IMPLICATIONS Counselling and routine assessment of emotional complaints and unmet needs of the informal caregiver should be incorporated and addressed in the rehabilitation treatment of (COVID-19) post-ICU patients.
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Affiliation(s)
- Carolina M H Wiertz
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Bena Hemmen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; Department of Rehabilitation Medicine, Zuyderland, Heerlen, the Netherlands
| | - Simone J S Sep
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Jeanine A Verbunt
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, the Netherlands
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Domeisen Benedetti F, Hechinger M, Fringer A. Self-Assessment Instruments for Supporting Family Caregivers: An Integrative Review. Healthcare (Basel) 2024; 12:1016. [PMID: 38786426 PMCID: PMC11120749 DOI: 10.3390/healthcare12101016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
Family caregivers take on a variety of tasks when caring for relatives in need of care. Depending on the situation and the intensity of care, they may experience multidimensional burdens, such as physical, psychological, social, or financial stress. The aim of the present study was to identify and appraise self-assessment instruments (SAIs) that capture the dimensions of family caregivers' burdens and that support family caregivers in easily identifying their caregiving role, activities, burden, and needs. We performed an integrative review with a broad-based strategy. A literature search was conducted on PubMed, Google Scholar, Google, and mobile app stores in March 2020. After screening the records based on the eligibility criteria, we appraised the tools we found for their usefulness for family care and nursing practice. From a total of 2654 hits, 45 suitable SAIs from 274 records were identified and analyzed in this way. Finally, nine SAIs were identified and analyzed in detail based on further criteria such as their psychometric properties, advantages, and disadvantages. They are presented in multi-page vignettes with additional information for healthcare professionals. These SAIs have proven useful in assessing the dimensions of caregiver burden and can be recommended for application in family care and nursing practice.
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Affiliation(s)
- Franzisca Domeisen Benedetti
- School of Health Professions, Institute of Nursing, ZHAW—Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401 Winterthur, Switzerland (A.F.)
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Welten JJE, Cox VCM, van Eijk RPA, van Heugten CM, Visser-Meily JMA, Schepers VPM. The Effects of a Blended Care Intervention in Partners of Patients With Acquired Brain Injury - Results of the CARE4Carer Randomized Controlled Trial. Arch Phys Med Rehabil 2024; 105:352-358. [PMID: 37690740 DOI: 10.1016/j.apmr.2023.08.024] [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: 03/20/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To assess effects of the CARE4Carer blended care intervention on caregiver mastery and psychosocial functioning compared with usual care in partners of patients with acquired brain injury (ABI). DESIGN Multicenter randomized controlled trial. SETTING Nine sites for rehabilitation medicine. PARTICIPANTS 120 partners of outpatients with ABI were randomly allocated to blended care (N=59) or usual care (N=61). INTERVENTION The blended care intervention (20 weeks) was aimed at improving caregiving skills and consisted of 9 online sessions, combined with 2 face-to-face consultations with a social worker. MAIN OUTCOME MEASURES Mastery was assessed with the Caregiver Mastery Scale, secondary outcome measures were caregiver strain (Caregiver Strain Index), family functioning (Family Assessment Device), anxiety and depression (Hospital Anxiety and Depression Scale), burden (self-rated), and quality of life (CarerQol). Assessments were performed at baseline, 24, and 40 weeks. RESULTS The adjusted mean difference in caregiver mastery between intervention and control group at week 24 was 1.31 (SD3.48, 95% confidence interval (CI) -0.12 to 2.74, P=.072) and at week 40 was 1.31 (SD3.69, 95% CI -0.26 to 2.88, P=.100). In the per protocol analysis, the adjusted mean difference in caregiver mastery at week 24 was 1.53 (SD3.38, 95% CI 0.10 to 2.96, P=.036) and at week 40 was 1.57 (SD3.63, 95% CI 0.01 to 3.14, P=.049). Regarding secondary outcomes, caregiver strain was lower in the intervention group in the per protocol analysis at week 40. Family functioning was higher in the intervention group in week 24, whereas anxiety was lower at both timepoints. CONCLUSIONS In the subset of participants who were able to complete the intervention, caregiver mastery and psychosocial functioning improved. Future work should focus on improving adherence as this will optimize beneficial effects of blended care.
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Affiliation(s)
- Jennifer J E Welten
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
| | - Vincent C M Cox
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Ruben P A van Eijk
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands; Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Caroline M van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands; Limburg Brain Injury Center, Maastricht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vera P M Schepers
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Blanton S, Cotsonis G, Brennan K, Song R, Zajac-Cox L, Caston S, Stewart H, Jayaraman A, Reisman D, Clark PC, Kesar T. Evaluation of a carepartner-integrated telehealth gait rehabilitation program for persons with stroke: study protocol for a feasibility study. Pilot Feasibility Stud 2023; 9:192. [PMID: 38001523 PMCID: PMC10668368 DOI: 10.1186/s40814-023-01411-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Despite family carepartners of individuals post-stroke experiencing high levels of strain and reduced quality of life, stroke rehabilitation interventions rarely address carepartner well-being or offer training to support their engagement in therapeutic activities. Our group has developed creative intervention approaches to support families during stroke recovery, thereby improving physical and psychosocial outcomes for both carepartners and stroke survivors. The purpose of this study is to test the feasibility of an adapted, home-based intervention (Carepartner Collaborative Integrative Therapy for Gait-CARE-CITE-Gait) designed to facilitate positive carepartner involvement during home-based training targeting gait and mobility. METHODS This two-phased design will determine the feasibility of CARE-CITE-Gait, a novel intervention that leverages principles from our previous carepartner-focused upper extremity intervention. During the 4-week CARE-CITE-Gait intervention, carepartners review online video-based modules designed to illustrate strategies for an autonomy-supportive environment during functional mobility task practice, and the study team completes two 2-h home visits for dyad collaborative goal setting. In phase I, content validity, usability, and acceptability of the CARE-CITE-Gait modules will be evaluated by stroke rehabilitation content experts and carepartners. In phase II, feasibility (based on measures of recruitment, retention, intervention adherence, and safety) will be measured. Preliminary effects of the CARE-CITE-Gait will be gathered using a single-group, quasi-experimental design with repeated measures (two baseline visits 1 week apart, posttest, and 1-month follow-up) with 15 carepartner and stroke survivor dyads. Outcome data collectors will be blinded. Outcomes include psychosocial variables (family conflict surrounding stroke recovery, strain, autonomy support, and quality of life) collected from carepartners and measures of functional mobility, gait speed, stepping activity, and health-related quality of life collected from stroke survivors. DISCUSSION The findings of the feasibility testing and preliminary data on the effects of CARE-CITE-Gait will provide justification and information to guide a future definitive randomized clinical trial. The knowledge gained from this study will enhance our understanding of and aid the development of rehabilitation approaches that address both carepartner and stroke survivor needs during the stroke recovery process. TRIAL REGISTRATION ClinicalTrials.gov, NCT05257928. Registered 25 February 2022. TRIAL STATUS This trial was registered on ClinicalTrials.gov (NCT05257928) on March 25, 2022. Recruitment of participants was initiated on May 18, 2022.
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Affiliation(s)
- Sarah Blanton
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Room 213, Atlanta, GA, 30322, USA.
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA
| | | | - Robert Song
- Emory Rehabilitation Hospital, Atlanta, GA, USA
| | - Laura Zajac-Cox
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Room 213, Atlanta, GA, 30322, USA
| | - Sarah Caston
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Room 213, Atlanta, GA, 30322, USA
| | | | - Arun Jayaraman
- Technology & Innovation Hub (tiHUB), Department of Physical Medicine and Rehabilitation, Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Max Näder Center for Rehabilitation Technologies & Outcomes Research, Northwestern University, Chicago, IL, 60611, USA
| | - Darcy Reisman
- Department of Physical Therapy and Graduate Program in Biomechanics and Movement Science, Neurologic and Older Adult Clinic, University of Delaware, Newark, DE, USA
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA, USA
| | - Trisha Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Room 213, Atlanta, GA, 30322, USA
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6
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Blanton S, Cotsonis G, Brenan K, Song R, Zajac-Cox L, Caston S, Stewart H, Jayaraman A, Reisman D, Clark PC, Kesar T. Evaluation of a Carepartner-Integrated Telehealth Gait Rehabilitation Program for Persons with Stroke : Study Protocol for a Feasibility Study. RESEARCH SQUARE 2023:rs.3.rs-2689016. [PMID: 37090566 PMCID: PMC10120785 DOI: 10.21203/rs.3.rs-2689016/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Background Despite family carepartners of individuals post-stroke experiencing high levels of strain and reduced quality of life, stroke rehabilitation interventions rarely address carepartner well-being or offer training to support their engagement in therapeutic activities. Our group has developed creative intervention approaches to support families during stroke recovery, thereby improving physical and psychosocial outcomes for both carepartners and stroke survivors. The purpose of this preliminary clinical trial is to test the feasibility of an adapted, home-based intervention (Carepartner Collaborative Integrative Therapy for Gait-CARE-CITE-Gait) designed to facilitate positive carepartner involvement during home-based training targeting gait and mobility. Methods This two-phased study will determine the feasibility of CARE-CITE-Gait, a novel intervention developed by our team that leverages principles from our previous carepartner-focused upper extremity intervention. During the 4-week CARE-CITE-Gait intervention, carepartners review online video-based modules designed to illustrate strategies for an autonomy-supportive environment during functional mobility task practice, and the study team completes two 2-hour (home-based) visits for dyad collaborative goal setting. In Phase I, the usability and acceptability of the CARE-CITE-Gait modules will be evaluated by stroke rehabilitation content experts and carepartners. In Phase II, feasibility (based on measures of recruitment, retention, and intervention adherence) will be measured. Preliminary effects of the CARE-CITE-Gait will be gathered using a single-group, evaluator blinded, quasi-experimental design with repeated measures (two baseline visits one week apart, post-test, and one-month follow-up) with 15 carepartner and stroke survivor dyads. Outcomes include psychosocial variables (strain, family conflict surrounding stroke recovery, autonomy support and life changes) collected from carepartners, and measures of functional mobility, gait speed, stepping activity, and health-related quality of life collected from stroke survivors. Discussion The findings of the feasibility testing and preliminary data on the effects of CARE-CITE-Gait will provide justification and information to guide a future definitive randomized clinical trial. The knowledge gained from this study will enhance our understanding of and aid the development of rehabilitation approaches that address both carepartner and stroke survivor needs during the stroke recovery process. Trial Registration ClinicalTrials.gov, NCT05257928. Registered 25 February 2022, https://clinicaltrials.gov/ct2/show/NCT05257928.
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Affiliation(s)
| | | | | | | | | | | | | | - Arun Jayaraman
- Northwestern University Department of Physical Medicine and Rehabilitation
| | - Darcy Reisman
- University of Delaware Department of Physical Therapy
| | - Patricia C Clark
- Georgia State University Byrdine F Lewis School of Nursing and Health Professions
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7
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van den Kieboom R, Mark R, Snaphaan L, van Assen M, Bongers I. Influence of Sense of Competence, Empathy and Relationship Quality on Burden in Dementia Caregivers: A 15 Months Longitudinal Study. J Appl Gerontol 2023; 42:464-473. [PMID: 36382720 PMCID: PMC9940123 DOI: 10.1177/07334648221138545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: The aim is to explore the trajectory of caregiver burden and how this relates to caregiver and contextual factors in community-dwelling dyads. Methods: At baseline, 201 family caregivers were included. The multidimensional construct of family caregiver burden and the effects of sense of competence, empathy, and quality of the relationship on this burden were assessed over 15 months using semi-structured interviews and questionnaires. Results: We found an increase of burden linked to disruptions in the caregiver's own usual activities (p = 0.002) and physical health complaints (p = 0.001). Caregivers with a high sense of competence experienced lower caregiver burden during the entire caregiving process (p < 0.001). Discussion: Healthcare professionals should alert family caregivers to the importance of taking care of themselves as early as possible in their new caregiver role. Caregiving is demanding and could negatively influence their own activities and physical health.
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Affiliation(s)
- Robin van den Kieboom
- Tranzo, Tilburg School of Social
and Behavioral Sciences, Tilburg
University, Tilburg, The Netherlands,Research Unit Evidence Based
Management of Innovation, Mental Health Care Institute
Eindhoven, Eindhoven, The
Netherlands
| | - Ruth Mark
- Department of Cognitive
Neuropsychology, Tilburg School of Social and Behavioral Sciences,
Tilburg
University, Tilburg, The
Netherlands
| | - Liselore Snaphaan
- Tranzo, Tilburg School of Social
and Behavioral Sciences, Tilburg
University, Tilburg, The Netherlands,Research Unit Evidence Based
Management of Innovation, Mental Health Care Institute
Eindhoven, Eindhoven, The
Netherlands
| | - Marcel van Assen
- Department of Methodology and
Statistics, Tilburg School of Social and Behavioral Sciences,
Tilburg
University, Tilburg, The
Netherlands,Department of Sociology,
Utrecht
University, Utrecht, The
Netherlands
| | - Inge Bongers
- Tranzo, Tilburg School of Social
and Behavioral Sciences, Tilburg
University, Tilburg, The Netherlands,Research Unit Evidence Based
Management of Innovation, Mental Health Care Institute
Eindhoven, Eindhoven, The
Netherlands
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Bremmers LGM, Hakkaart-van Roijen L, Gräler ES, Uyl-de Groot CA, Fabbricotti IN. How Do Shifts in Patients with Mental Health Problems' Formal and Informal Care Utilization Affect Informal Caregivers?: A COVID-19 Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16425. [PMID: 36554308 PMCID: PMC9778175 DOI: 10.3390/ijerph192416425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: This study investigated how potential shifts in patients' formal and informal care utilization during the COVID-19 pandemic impacted their informal caregivers in terms of their subjective burden, psychological wellbeing, and happiness. (2) Methods: A retrospective cohort study design was employed for a panel of Dutch informal caregivers of persons with mental health problems (n = 219) in June 2020. Descriptive statistics and differences between means were determined for the patients' informal and care utilization and informal caregivers' subjective burden, happiness, and psychological wellbeing. Three mediation analyses were conducted using the PROCESS macro. (3) Results: Informal caregivers reported significantly worse happiness and subjective burden scores during the COVID-19 pandemic compared with before the lockdown. There were minimal shifts in patient's care utilization reported, with the exception of a decrease in significant emotional and practical support provided by the informal caregiver. In the mediation analyses, there was not a significant indirect effect of shifts in patients' formal care utilization on informal caregivers' subjective burden, psychological wellbeing, and happiness through shifts in patients' informal care utilization. (4) Discussion and conclusion: Whilst we found that shifts in patients' care utilization during the first wave of the pandemic did not affect the informal caregiver in the short term, it is unclear what the long-term impact of the pandemic might be on informal caregivers. More research should be conducted to understand the implications of short- and long-term impact of substitution on informal caregivers of persons with mental health problems, with special consideration of the COVID-19 context and uptake of e-health technology.
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Affiliation(s)
- Leonarda G. M. Bremmers
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Eleonora S. Gräler
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Isabelle N. Fabbricotti
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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9
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Hvalič-Touzery S, Trkman M, Dolničar V. Caregiving Situation as a Predictor of Subjective Caregiver Burden: Informal Caregivers of Older Adults during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14496. [PMID: 36361373 PMCID: PMC9655837 DOI: 10.3390/ijerph192114496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic has created and exacerbated emotional, financial, and technical challenges for informal caregivers of older people. The aim of this study was to explore the caregiving situation and subjective burden of informal caregivers of older family members during COVID-19, and to investigate how a caregiving situation's characteristics predict the subjective burden of care in times of COVID-19. The study was conducted in April and May 2021 via an online access panel. The sample (n = 612) was determined using a screening test that enabled us to focus on a Slovenian population of informal caregivers aged 40+ caring for a person aged 65+ for at least four hours/week on average. Our findings reveal that the subjective burden of care was high among informal caregivers during COVID-19. Multiple regression analysis showed that the provision of activities of daily living, care duration, average hours of care per week, formal care status, and recipients' health problems related to dementia or other memory problems significantly predicted the subjective burden of caregivers. These findings call for better recognition of the role of informal caregivers. The time and effort devoted to informal care should be supported by legislation and social security.
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Gräler L, Bremmers L, Bakx P, van Exel J, van Bochove M. Informal care in times of a public health crisis: Objective burden, subjective burden and quality of life of caregivers in the Netherlands during the COVID-19 pandemic. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5515-e5526. [PMID: 36068677 PMCID: PMC9538241 DOI: 10.1111/hsc.13975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 07/12/2022] [Accepted: 08/09/2022] [Indexed: 05/11/2023]
Abstract
In the Netherlands, about one-third of the adult population provides unpaid care. Providing informal caregiving can be very straining in normal times, but the impact of a public health crisis on caregivers is largely unknown. This study focuses on the question of how caregiver burden changed following the COVID-19 pandemic, and what characteristics were related to these changes. We use self-reported data from a sample of 965 informal caregivers from the Netherlands 3 months into the pandemic to investigate how the objective burden (i.e. hours spent on caregiving) and the subjective burden had changed, and what their care-related quality of life (CarerQol) was. We found that on average the subjective burden had increased slightly (from 4.75 to 5.04 on a 0-10 scale). However, our analysis revealed that some caregivers were more affected than others. Most affected caregivers were women, and those with low income, better physical health, decreased psychological health, childcare responsibilities, longer duration of caregiving and those caring for someone with decreased physical and psychological health. On average, time spent on care remained the same (a median of 15 h per week), but certain groups of caregivers did experience a change, being those caring for people in an institution and for people with a better psychological health before the pandemic. Furthermore, caregivers experiencing changes in objective burden did not have the same characteristics as those experiencing changes in perceived burden and quality of life. This shows that the consequences of a public health crisis on caregivers cannot be captured by a focus on either objective or subjective burden measures or quality of life alone. Long-term care policies aiming to support caregivers to persevere during a future crisis should target caregivers at risk of increased subjective burden and a lower CarerQol, such as women, people with a low income and people with childcare responsibilities. Such policies should consider that reducing objective burden may not necessarily lead to a reduction in subjective burden for all caregivers.
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Affiliation(s)
- Leonoor Gräler
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Leonarda Bremmers
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Pieter Bakx
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Job van Exel
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Marianne van Bochove
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
- Knowledge Centre for Governance of Urban TransitionsDe Haagse HogeschoolThe HagueThe Netherlands
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11
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Zonneveld E, van Schelven F, Boeije H. Effects of the COVID-19 pandemic on quality of life among relatives of individuals with intellectual disabilities: A longitudinal study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 36:68-77. [PMID: 36134473 PMCID: PMC9539069 DOI: 10.1111/jar.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
Background The COVID‐19 pandemic poses risks to the quality of life (QoL) of relatives of individuals with intellectual disabilities. This paper investigates relatives' QoL and associated risk and buffering factors before and during the pandemic. Method Surveys were administered to three samples of relatives in the Netherlands in 2019 (N = 105) and during the first waves of COVID‐19 in June (N = 207) and October 2020 (N = 332). Associations between QoL and care burden, care competence, social support, and resilience, and changes over time were analysed using (logistic) regressions. Results No significant changes in overall QoL nor its domains were found. Care burden was negatively associated with QoL and increased during the pandemic. Care competence was lower than in 2019. Competence, social support, and resilience were positively associated with QoL. Conclusions Although relatives' QoL remained stable, the pandemic poses non‐negligible risks to their wellbeing. It is, therefore, crucial to provide relatives with adequate support.
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Affiliation(s)
- Ellen Zonneveld
- Department Perspective of patients and clients in healthcare, Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | - Femke van Schelven
- Department Perspective of patients and clients in healthcare, Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | - Hennie Boeije
- Department Perspective of patients and clients in healthcare, Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
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12
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Cox VC, Welten JJ, Schepers VP, Ketelaar M, Kruithof WJ, van Heugten CM, Visser-Meily JM. Burden, anxiety and depressive symptoms in partners – course and predictors during the first two years after stroke. Top Stroke Rehabil 2022:1-10. [DOI: 10.1080/10749357.2022.2098898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Vincent C.M. Cox
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Jennifer J.E. Welten
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Vera P.M. Schepers
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Willeke J. Kruithof
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
| | - Caroline M. van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands
- Limburg Center for Brain Injury, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Johanna M.A. Visser-Meily
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
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13
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Hicks NM, Sellers SL, Zhang J, Sun N, Harris K. "What Matters Most? Intersectional Correlates of Caregiver Burdens". J Appl Gerontol 2022; 41:2013-2021. [PMID: 35576162 DOI: 10.1177/07334648221100227] [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: 11/16/2022] Open
Abstract
Increasing numbers of older adults require caregiver support from unpaid caregivers. Yet, there is limited research on caregiver burden type and interactions across race, gender, and other sociodemographic characteristics. This quantitative study uses an intersectional framework to examine associations between caregiving burden and sociodemographic factors. Using survey data from the National Survey of Caregiving the sample included unpaid caregivers (N = 1304) of older adult (65+) Medicare beneficiaries. Binary logistic regression analysis revealed that over 40% of the respondents reported emotional difficulties. Correlates to emotional difficulties included race, gender, age, and income with an age by income interaction. For physical difficulties, gender, age, work, and education mattered most, with an age by education interaction. Age and income predicted financial difficulties without interactions. Findings suggest that policymakers target emotional and physical difficulties, attend to age and socioeconomic status, and address the unique challenges faced in midlife by caregivers.
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Affiliation(s)
- Nytasia M Hicks
- Elizabeth Dole Center on Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System, Audie L. Murphy Division, San Antonio, TX, USA
| | - Sherrill L Sellers
- Department of Family Science and Social Work, 6403Miami University, Oxford, OH, USA
| | - Jinghua Zhang
- OMS Analytics, Georgia Institution of Technology, Atlanta, GA, USA
| | - Na Sun
- Department of Sociology and Gerontology, 124575Miami University, Oxford, OH, USA
| | - Karleah Harris
- Department of Human Sciences, University of Arkansas at Pine Bluff, USA
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14
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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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15
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Mulder M, Nikamp C, Nijland R, van Wegen E, Prinsen E, Vloothuis J, Buurke J, Kwakkel G. Can telerehabilitation services combined with caregiver-mediated exercises improve early supported discharge services poststroke? A study protocol for a multicentre, observer-blinded, randomized controlled trial. BMC Neurol 2022; 22:29. [PMID: 35039010 PMCID: PMC8762867 DOI: 10.1186/s12883-021-02533-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recovery of walking ability is an important goal for patients poststroke, and a basic level of mobility is critical for an early discharge home. Caregiver-mediated exercises could be a resource-efficient strategy to augment exercise therapy and improve mobility in the first months poststroke. A combination of telerehabilitation and face-to-face support, blended care, may empower patient-caregiver dyads and smoothen the transition from professional support to self-management. The Armed4Stroke study aims to investigate the effects of a caregiver-mediated exercise program using a blended care approach in addition to usual care, on recovery of mobility in the first 6 months poststroke. METHODS A multicentre, observer-blinded randomized clinical trial in which 74 patient-caregiver dyads will be enrolled in the first 3 months poststroke. Dyads are randomly allocated to a caregiver-mediated exercises intervention or to a control group. The primary endpoint is the self-reported mobility domain of the Stroke Impact Scale. Secondary endpoints include care transition preparedness and psychological functioning of dyads, length of inpatient stay, gait-related measures and extended ADL of patients, and caregiver burden. Outcomes are assessed at enrolment, end of treatment and 6 months follow-up. RESULTS During 8 weeks, caregivers are trained to become an exercise coach using a blended care approach. Dyads will receive a tailor-made, progressive training program containing task-specific exercises focusing on gait, balance, physical activity and outdoor activities. Dyads are asked to perform the training program a minimum of 5 times a week for 30 min per session, supported by a web-based telerehabilitation system with instruction videos and a messaging environment to communicate with their physiotherapist. CONCLUSIONS We hypothesize that the Armed4Stroke program will increase self-reported mobility and independence in ADL, facilitating an early discharge poststroke. In addition, we hypothesize that active involvement of caregivers and providing support using blended care, will improve the care transition when professional support tapers off. Therefore, the Armed4Stroke program may complement early supported discharge services. TRIAL REGISTRATION Netherlands Trial Register, NL7422 . Registered 11 December 2018.
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Affiliation(s)
- Marijn Mulder
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, location VU University Medical Centre, Amsterdam Movement Sciences, PO Box 7057, 1007, MB, Amsterdam, The Netherlands.,Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Corien Nikamp
- Roessingh Research and Development, Enschede, The Netherlands.,Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Rinske Nijland
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Erwin van Wegen
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, location VU University Medical Centre, Amsterdam Movement Sciences, PO Box 7057, 1007, MB, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands
| | - Erik Prinsen
- Roessingh Research and Development, Enschede, The Netherlands.,Department op Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Judith Vloothuis
- Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands
| | - Jaap Buurke
- Roessingh Research and Development, Enschede, The Netherlands.,Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.,Roessingh, Centre for Rehabilitation, Enschede, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam University Medical Centre, location VU University Medical Centre, Amsterdam Movement Sciences, PO Box 7057, 1007, MB, Amsterdam, The Netherlands. .,Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, The Netherlands. .,Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, The Netherlands. .,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.
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16
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Handlery R, Regan E, Lewis AF, Larsen C, Handlery K, Flach A, Fritz S. Active Participation of Care Partners in a Physical Activity Intervention Alongside People with Stroke: A Feasibility Study. Physiother Can 2022; 74:97-110. [PMID: 35185254 PMCID: PMC8816353 DOI: 10.3138/ptc-2020-0035] [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: 04/15/2020] [Revised: 07/20/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023]
Abstract
Purpose: This study investigated the feasibility of a physical activity intervention for people with stroke and their care partners and the role social support plays in physical activity adherence. Method: The study used a single-group, pretest-posttest design with follow-up. Participants were adults with chronic stroke and their care partners. The intervention consisted of 8 weeks of structured, group-based physical activity classes, followed by 19 weeks of self-directed physical activity. Recruitment, adherence, safety, and retention were assessed. Familial social support was assessed before and after the 8-week structured portion and again 19 weeks later. Results: A total of 21 participants (15 people with stroke, 6 care partners), mean age 67.6 (SD 11.6) years, were recruited; 19 (90.5%) completed the 19-week assessment. No adverse events were experienced during the programme. Attendance during the 8-week portion was better than during the 19-week portion (mean difference 0.95; p < 0.001; 95% CI: 0.71, 1.19 visits/wk). No relationship was found between social support and physical activity adherence (p > 0.05). Conclusions: Involvement of care partners in a physical activity intervention is feasible and safe. Both people with stroke and their care partners may require ongoing support to participate in long-term physical activity. The relationship between social support and physical activity adherence requires further study.
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Affiliation(s)
- Reed Handlery
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Elizabeth Regan
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Allison Foster Lewis
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Chelsea Larsen
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Kaci Handlery
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Alicia Flach
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Stacy Fritz
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
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17
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Kum C, Miller EL, Jones H, Kean EB, Kreitzer N, Bakas T. Theoretically Based Factors Affecting Stroke Family Caregiver Health: An Integrative Review. West J Nurs Res 2021; 44:338-351. [PMID: 34636275 DOI: 10.1177/01939459211050955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stroke family caregivers often neglect their own health while providing care. Rigorous reviews have focused on stroke caregiver needs and outcomes; however, a comprehensive review of stroke caregiver health is lacking. The purpose of this integrative review was to determine factors associated with stroke family caregiver health. Using a PRISMA flow diagram and Rayyan software, 41 studies were identified published from January 2000 to December 2020. Databases included Cochrane Reviews, Cochrane Trials, PsycINFO, Ovid MEDLINE, PubMed, EBSCOhost MEDLINE, Embase, and CINAHL. Rigorous guidelines were used to critique the 41 articles. Health measures were global in nature, lacking details regarding health promotion activities important to stroke family caregiver health. Common factors associated with caregiver health were depressive symptoms and burden. Further research is needed to design more situation-specific instruments to measure stroke family caregiver health, as well as interventions to reduce depressive symptoms and burden while promoting caregiver health.
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Affiliation(s)
- Cleopatra Kum
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
| | - Elaine L Miller
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
| | - Holly Jones
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
| | - Emily B Kean
- University of Cincinnati, Health Sciences Library, Cincinnati, OH, USA
| | - Natalie Kreitzer
- University of Cincinnati, Department of Emergency Medicine, Cincinnati, OH, USA
| | - Tamilyn Bakas
- University of Cincinnati, College of Nursing, Cincinnati, OH, USA
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18
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Madavanakadu S, Grills NJ, Scaria L, Benny AM, Joubert L. Prevalence and predictive factors of strain among caregivers of people with disability: results from R-Care community survey, Kerala, India. Disabil Rehabil 2021; 44:6333-6339. [PMID: 34460345 DOI: 10.1080/09638288.2021.1965231] [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: 10/20/2022]
Abstract
PURPOSE Caregivers of people with disability experience difficulties in a variety of care domains. Understanding the predictive factors of caregiver strain is important in developing and implementing evidence-based intervention to reduce the difficulties experienced by the carers. METHODS The current study is a cross sectional comprehensive one-phase survey conducted in randomly selected sub-districts (taluks) of the Ernakulam district in Kerala. Primary caregivers (n = 851) for persons with different kinds of disability were identified with the help of ASHAs (Accredited Social Health Activities) from the selected geographical locations and were interviewed in a house-to-house survey after obtaining written informed consent. Validated tools measuring caregiver strain, financial burden, access to services and wellbeing were used to study the population. RESULTS Majority of the caregivers were females (77.3%) and spouses (35.2%). Of the caregivers 27% reported high levels of caregiver strain. The major factors associated with caregiver strain were female gender (B = 1.379, p = 0.000), financial issues (B = 0.105, p = 0.000), the general health of caregivers (B = 0.467, p = 0.000) and issues relating to employment (B = 0.956, p = 0.000) and the availability of government welfare services (B = 1.138, p = 0.000). CONCLUSION High caregiver burden and strain is experienced by almost a third of people caring for a person with a disability. Comprehensive interventions to reduce caregiver strain should be developed.Implications for rehabilitationThe rehabilitation sector needs to be made aware of the high levels of caregiver strain (especially in carers who were female, unemployed, have health issues and lack formal support).To improve wellbeing for people with disability we firstly need to promote social inclusion and support schemes for caregiver.Co-designed systems are needed to assist carers to access formal and informal support resources, and increase social connectedness.
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Affiliation(s)
- Saju Madavanakadu
- Rajagiri College of Social Sciences (Autonomous), Cochin, Kerala, India.,Rajagiri International Centre for Consortium Research in Social Care (ICRS), Cochin, Kerala, India
| | - Nathan John Grills
- Nossal Institute for Global Health, University of Melbourne, Carlton, Australia.,Australia India Institute, Melbourne Australia
| | - Lorane Scaria
- Rajagiri College of Social Sciences (Autonomous), Cochin, Kerala, India.,Rajagiri International Centre for Consortium Research in Social Care (ICRS), Cochin, Kerala, India
| | - Anuja Maria Benny
- Rajagiri College of Social Sciences (Autonomous), Cochin, Kerala, India.,Rajagiri International Centre for Consortium Research in Social Care (ICRS), Cochin, Kerala, India
| | - Lynette Joubert
- Melbourne School of Health Sciences, University of Melbourne, Carlton, Australia
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19
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Kanters TA, Brugts JJ, Manintveld OC, Versteegh MM. Burden of Providing Informal Care for Patients with Atrial Fibrillation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:236-243. [PMID: 33518030 DOI: 10.1016/j.jval.2020.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/07/2020] [Accepted: 09/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Patients with atrial fibrillation (AF) have rapid and irregular heart rates, increasing the risk of comorbidities and mortality. Next to formal medical care, many patients receive informal care from their social environment. The objective of this study was to examine the well-being and economic burden of providing informal care to patients with AF in the UK, Italy, and Germany. METHODS Caregivers of patients with AF completed an online survey based on the iMTA Valuation of Informal Care Questionnaire, with questions about their caregiving situation, perceived burden of caregiving, and absence from work due to health problems resulting from caregiving. Care-related quality-of-life utilities were calculated using the Care-related Quality of Life instrument and associated tariffs. Societal costs of caregiving were calculated based on the proxy good method. RESULTS A total of 585 caregivers participated in this study. On average, caregivers provided 33 hours of informal care per week to patients (SD 29 hours). On a scale from 0 to 10, their self-rated burden was 5.4. The average Care-related Quality of Life utility was 72. Caregivers primarily indicated problems with daily activities, mental health, and physical health. Still, the vast majority of caregivers (87%) derived fulfillment from providing care. Weekly societal costs of caregiving were on average €636. Comorbidities contributed substantially to the caregiver time and burden. CONCLUSIONS Caring for a patient with AF is associated with substantial objective and subjective burden, but also provides fulfillment from being able to care for a loved one.
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Affiliation(s)
- Tim A Kanters
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Matthijs M Versteegh
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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20
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Birkenhäger‐Gillesse EG, Achterberg WP, Janus SIM, Zuidema SU. Caregiver dementia training in caregiver-patient dyads: Process evaluation of a randomized controlled study. Int J Geriatr Psychiatry 2021; 36:127-135. [PMID: 33411391 PMCID: PMC7756880 DOI: 10.1002/gps.5404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/31/2020] [Accepted: 08/08/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We performed a randomized controlled study to evaluate the effects of caregiver training on the well-being of both people with dementia and their caregivers. Before the effect analysis, we conducted a process evaluation to estimate internal and external validity. This was anticipated to augment our understanding of the outcomes. METHODS We focused on three questions. (a) Was the intervention performed as planned (internal validity)? (b) Can qualitative data be used to inform how the intervention evoked change? (c) Can the study outcomes be extrapolated to all caregivers living with people who have dementia (external validity)? RESULTS Responses from participants assigned to the intervention group suggested that the intervention was feasible, could be performed as planned, and that modelling and discussions between participants were important. However, participant recruitment to the entire study was ultimately laborious because participants had issues with the study design (risk of being assigned to the control group) and referrers lacked familiarity with the training (new type of intervention). Participants were also younger and better educated compared with the general population. Some dropouts in the follow-up period occurred due to the number of questionnaires, and this was more pronounced in the control group. CONCLUSIONS Although we achieved high internal validity, we lack certainty about the external validity. We not only experienced general difficulty in recruiting participants but also tended to recruit a biased sample that was relatively young and well educated. These factors combine to limit our ability to extrapolate the results to the general population.
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Affiliation(s)
- Elizabeth G. Birkenhäger‐Gillesse
- Department of General Practice and Elderly Care MedicineUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Laurens Care Centers, Division Long StayRotterdamThe Netherlands
| | - Wilco P. Achterberg
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenThe Netherlands
| | - Sarah I. M. Janus
- Department of General Practice and Elderly Care MedicineUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care MedicineUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
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21
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Zhang X, Zhang XF, Wang L, Guo DY, Zhang JM, Chen YG, Wang ZC, Pei LS, Chen JX, Shi YJ, Zou JB. Analysis of Clinical Efficacy of Traditional Chinese Medicine in Recovery Stage of Stroke: A Systematic Review and Meta-Analysis. Cardiovasc Ther 2020; 2020:7172052. [PMID: 33042224 PMCID: PMC7528130 DOI: 10.1155/2020/7172052] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/15/2020] [Accepted: 09/08/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We provide an updated meta-analysis with detailed information on a combination of TCM and routine treatment. METHODS Retrieve appropriate articles with no language restrictions on keywords until 8 July 2019 in an electronic database. All trajectories are screened according to certain criteria. The quality of certified research was also evaluated. We made a detailed record of the results of the measurement. Meta-analysis was carried out by using the Revman 5.3 software. RESULTS Sixty-seven RCTs were included, and 6594 subjects were analyzed. Compared with routine treatment, the total effective rate (TER) of TCM combined with routine treatment was improved, and the recovery of stroke was also significantly accelerated. Regulation of blood lipids by notably shrinking the contents of TC, TG, and LDL and enhancing the levels of HDL. The levels of serum hs-CRP, WHV, and WLV decreased significantly, indicating that the expression of thrombomodulin was decreased after the comprehensive treatment of traditional Chinese medicines (TCMs). The combination of TCM treatment could enhance the protection of neural function by decreasing the NIHSS scoring while increasing the BI scoring. Paeoniae Radix Rubra, Angeticae Sinensis Radix, etc., can effectively improve the clinical symptoms of stroke convalescent patients and promote the recovery of neurological function. ACU of Baihui, Renzhong, etc., can improve the clinical rehabilitation effect of patients. However, our findings must be handled with care because of the small sample size and low quality of clinic trials cited. Other rigorous and large-scale RCTs are in need to confirm these results. CONCLUSION A combination of TCM and routine treatment in the treatment of stroke could improve TER, and it is beneficial to the rehabilitation of patients in the recovery period of apoplexy. These effects can be mediated by a combination of several mechanisms. Nevertheless, due to the limitations of this study, these results should be handled with caution.
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Affiliation(s)
- Xue Zhang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Xiao-Fei Zhang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Lin Wang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Dong-Yan Guo
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Jia-Min Zhang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Yong-Gang Chen
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Zhi-Chao Wang
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Li-Shan Pei
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Jiang-Xue Chen
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Ya-Jun Shi
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
| | - Jun-Bo Zou
- Shaanxi Province Key Laboratory of New Drugs and Chinese Medicine Foundation Research, Pharmacy College, Shaanxi University of Chinese Medicine, Xianyang, China 712046
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van Roij J, Zijlstra M, Ham L, Brom L, Fransen H, Vreugdenhil A, Raijmakers N, van de Poll-Franse L. Prospective cohort study of patients with advanced cancer and their relatives on the experienced quality of care and life (eQuiPe study): a study protocol. BMC Palliat Care 2020; 19:139. [PMID: 32907564 PMCID: PMC7488051 DOI: 10.1186/s12904-020-00642-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/28/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Palliative care is becoming increasingly important because the number of patients with an incurable disease is growing and their survival is improving. Previous research tells us that early palliative care has the potential to improve quality of life (QoL) in patients with advanced cancer and their relatives. According to limited research on palliative care in the Netherlands, patients with advanced cancer and their relatives find current palliative care suboptimal. The aim of the eQuiPe study is to understand the experienced quality of care (QoC) and QoL of patients with advanced cancer and their relatives to further improve palliative care. METHODS A prospective longitudinal observational cohort study is conducted among patients with advanced cancer and their relatives. Patients and relatives receive a questionnaire every 3 months regarding experienced QoC and QoL during the palliative trajectory. Bereaved relatives receive a final questionnaire 3 to 6 months after the patients' death. Data from questionnaires are linked with detailed clinical data from the Netherlands Cancer Registry (NCR). By means of descriptive statistics we will examine the experienced QoC and QoL in our study population. Differences between subgroups and changes over time will be assessed while adjusting for confounding factors. DISCUSSION This study will be the first to prospectively and longitudinally explore experienced QoC and QoL in patients with advanced cancer and their relatives simultaneously. This study will provide us with population-based information in patients with advanced cancer and their relatives including changes over time. Results from the study will inform us on how to further improve palliative care. TRIAL REGISTRATION Trial NL6408 ( NTR6584 ). Registered in Netherlands Trial Register on June 30, 2017.
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Affiliation(s)
- Janneke van Roij
- The Netherlands Comprehensive Cancer Organization, PO Box 19079, 3501 DB, Utrecht, The Netherlands.
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands.
- Department of Psychology, Pantein, Boxmeer, The Netherlands.
| | - Myrte Zijlstra
- The Netherlands Comprehensive Cancer Organization, PO Box 19079, 3501 DB, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
- Department of Internal Medicine, St. Jans Gasthuis, Weert, The Netherlands
| | - Laurien Ham
- The Netherlands Comprehensive Cancer Organization, PO Box 19079, 3501 DB, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Linda Brom
- The Netherlands Comprehensive Cancer Organization, PO Box 19079, 3501 DB, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Heidi Fransen
- The Netherlands Comprehensive Cancer Organization, PO Box 19079, 3501 DB, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Art Vreugdenhil
- Department of Medical Oncology, Maxima Medical Centre, Eindhoven, The Netherlands
| | - Natasja Raijmakers
- The Netherlands Comprehensive Cancer Organization, PO Box 19079, 3501 DB, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Lonneke van de Poll-Franse
- The Netherlands Comprehensive Cancer Organization, PO Box 19079, 3501 DB, Utrecht, The Netherlands
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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23
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Ghazawy ER, Mohammed ES, Mahfouz EM, Abdelrehim MG. Determinants of caregiver burden of persons with disabilities in a rural district in Egypt. BMC Public Health 2020; 20:1156. [PMID: 32703271 PMCID: PMC7376710 DOI: 10.1186/s12889-020-09266-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family caregivers are critical partners in the plan of care of people with disabilities. The study aims to demonstrate the factor structure and internal consistency of the Caregiver Burden Inventory (CBI) among the studied caregivers of disabled persons and to determine the effects of patients' and caregivers' characteristics on the burden and its dimensions. METHODS A cross-sectional study among 260 family caregivers of disabled patients was carried out in a randomly chosen rural area, Minia, Egypt, 2019. Exploratory factor analysis (EFA) was conducted to determine the factorial validity of the CBI. Multiple linear regression was used to identify the significant factors affecting the burden. RESULTS Factor analysis resulted in a five-factor solution using 20 items (four for each dimension) accounting for 72.7% of the total variance. The CBI and its dimensions showed high internal consistency (Cronbach's alpha value > 0.70). Education of caregiver, family income, mental impairments, and mixed disabilities were significant predictors of total CBI burden. CONCLUSIONS CBI is an effective multidimensional measure of the caregiver burden of disabled subjects. Caregivers experienced a distinct level of burden that is determined by caregiver and care recipient characteristics. Therefore, support and individualized counseling services should be optimized.
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Affiliation(s)
- Eman Ramadan Ghazawy
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Eman Sameh Mohammed
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Eman Mohamed Mahfouz
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Marwa Gamal Abdelrehim
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Minia University, Minia, Egypt.
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24
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Beurskens-Meijerink J, Huisman-de Waal G, Wanten G. Evaluation of quality of life and caregiver burden in home parenteral nutrition patients: A cross sectional study. Clin Nutr ESPEN 2020; 37:50-57. [DOI: 10.1016/j.clnesp.2020.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/07/2020] [Accepted: 03/25/2020] [Indexed: 11/29/2022]
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25
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Formica C, La Face A, Lo Buono V, Di Cara M, Micchìa K, Bonanno L, Logiudice AL, Todaro A, Palmeri R, Bramanti P, Marino S, Corallo F. Factors related to cognitive reserve among caregivers of severe acquired brain injury. J Clin Neurosci 2020; 77:94-97. [PMID: 32402612 DOI: 10.1016/j.jocn.2020.05.027] [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: 04/07/2020] [Accepted: 05/03/2020] [Indexed: 11/29/2022]
Abstract
Stroke is one of the severe cause of motor and cognitive disabilities. These type of disabilities occurred a strong impact on whole family system. Caregiver burden may determine in relatives of patients with brain injury a decreasement of mental and physical health. The present study aims to better clarify the mechanism through which chronic stress influence caregivers' cognitive functioning and how the psychological and cognitive resources may represent as a predictive factor. Caregivers were submitted to neuropsychological tests that evaluated level of mental health ad level of burden. Our results showed a significant correlation between cognitive reserve and self-efficacy skills in health care of patients. Findings suggested that the caregiver burden and the level of general distress influenced the cognitive performance. An improvement of cognitive functions is associated with a reduction of self-efficacy skills, causing a caregiver burden improvement.
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Affiliation(s)
- Caterina Formica
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113 C.da Casazza, Messina, Italy; Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Italy
| | - Annalisa La Face
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113 C.da Casazza, Messina, Italy
| | - Viviana Lo Buono
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113 C.da Casazza, Messina, Italy
| | - Marcella Di Cara
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113 C.da Casazza, Messina, Italy
| | - Katia Micchìa
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113 C.da Casazza, Messina, Italy
| | - Lilla Bonanno
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113 C.da Casazza, Messina, Italy.
| | - Anna Lisa Logiudice
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113 C.da Casazza, Messina, Italy
| | - Antonino Todaro
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113 C.da Casazza, Messina, Italy
| | - Rosanna Palmeri
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113 C.da Casazza, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113 C.da Casazza, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113 C.da Casazza, Messina, Italy
| | - Francesco Corallo
- IRCCS Centro Neurolesi "Bonino Pulejo", S.S. 113 C.da Casazza, Messina, Italy
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26
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Boumans NPG, Dorant E. The relationships of job and family demands and job and family resources with family caregivers' strain. Scand J Caring Sci 2020; 35:567-576. [PMID: 32400014 PMCID: PMC8247051 DOI: 10.1111/scs.12873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/18/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Abstract
Background Because of an expected increase in the number of family caregivers, there is a growing public and scientific interest in family caregiving and more specifically in the combination of family care with paid employment. It is important to gain insight in the family caregivers’ strain and determining factors in the job and family domain. Aim The aim of the study was to examine the associations of job and family demands and job and family resources with indicators of caregivers’ psychological strain, that is caregiver burden, work‐related emotional exhaustion and general ill mental health. In our research, we focused on individuals who combine paid employment with family caregiving. Methods A cross‐sectional design was used. The study sample was derived in 2011 from a Dutch financial organisation and a healthcare organisation. A digital fully structured questionnaire was used. The sample consisted of 187 employees who identified themselves as family caregivers. Descriptive statistics and hierarchical linear regression analysis were performed. Results Job demands (i.e. workload, work–family conflict) and family demands (i.e. family care hours and family–work conflict) were significantly positively associated with all three domain‐specific indicators of strain. The resources of work–family and family–work enrichment and autonomy did not contribute to less experienced strain. More supervisor and colleague support was associated with lower ill mental health. Conclusion Our study showed that job demands (workload, work–family conflict) and family demands (family care hours, family–work conflict) were clearly associated with caregiver strain, while associations for job and family resources were not evident. It remains necessary to pay attention to the demanding aspects of dual roles of family caregivers but also to investigate the resources they have available at work as well as in their home situation and explore their potential reducing effect on family caregivers’ strain.
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Affiliation(s)
- Nicolle P G Boumans
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Elisabeth Dorant
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
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27
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Swinkels JC, Broese van Groenou MI, de Boer A, Tilburg TGV. Male and Female Partner-Caregivers' Burden: Does It Get Worse Over Time? THE GERONTOLOGIST 2020; 59:1103-1111. [PMID: 30321338 DOI: 10.1093/geront/gny132] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The general view is that partner-caregiver burden increases over time but findings are inconsistent. Moreover, the pathways underlying caregiver burden may differ between men and women. This study examines to what degree and why partner-caregiver burden changes over time. It adopts Pearlin's Caregiver Stress Process Model, as it is expected that higher primary and secondary stressors will increase burden and larger amounts of resources will lower burden. Yet, the impact of stressors and resources may change over time. The wear-and-tear model predicts an increase of burden due to a stronger impact of stressors and lower impact of resources over time. Alternatively, the adaptation model predicts a decrease of burden due to a lower impact of stressors and higher impact of resources over time. RESEARCH DESIGN AND METHODS We used 2 observations with a 1-year interval of 279 male and 443 female partner-caregivers, derived from the Netherlands Older Persons and Informal Caregivers Survey Minimum Data Set. We applied multilevel regression analysis, stratified by gender. RESULTS Adjusted for all predictors, caregiver burden increased over time for both men and women. For female caregivers, the impact of poor spousal health on burden increased and the impact of fulfillment decreased over time. Among male caregivers, the impact of predictors did not change over time. DISCUSSION AND IMPLICATIONS The increase of burden over time supports the wear-and-tear model, in particular for women. This study highlights the need for gender-specific interventions that are focused on enabling older partners to be better prepared for long-term partner-care.
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Affiliation(s)
- Joukje C Swinkels
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam
| | | | - Alice de Boer
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam.,The Netherlands Institute for Social Research, The Hague, The Netherlands
| | - Theo G van Tilburg
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam
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28
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Cox V, Mulder M, Nijland R, Schepers V, Van Wegen E, Van Heugten C, Kwakkel G, Visser-Meily J. Agreement and differences regarding family functioning between patients with acquired brain injury and their partners. Brain Inj 2020; 34:489-495. [PMID: 32064947 DOI: 10.1080/02699052.2020.1725978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PRIMARY OBJECTIVE To investigate the level of agreement and differences regarding the perception of family functioning between patients with acquired brain injury and their partners. Our hypothesis was that patients would report better family functioning than their partners. RESEARCH DESIGN Cross-sectional studyMethods and Procedures: Baseline data were used from 77 patient-partner dyads (87.0% stroke) who were participating in the ongoing CARE4Patient and CARE4Carer trials. Family functioning was assessed using the General Functioning subscale of the McMaster Family Assessment Device (FAD-GF). Agreement was assessed with intraclass correlation coefficient, a Bland-Altman plot, percentages absolute agreement and weighted kappa values. Differences were tested with Wilcoxon signed-rank tests. MAIN OUTCOMES AND RESULTS Patients and their partners differed in their perception of family functioning. Within-dyad agreement was poor regarding the overall FAD-GF scores with partners reporting significantly poorer family functioning compared to the patients (32.5% versus 18.2%). Agreement regarding the individual items ranged from slight to moderate. CONCLUSIONS Health care professionals should assess family functioning after stroke in both patients and their partners, and any discrepancies should be discussed with both members of the patient-partner dyad.
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Affiliation(s)
- Vincent Cox
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marijn Mulder
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Rinske Nijland
- Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Vera Schepers
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Amsterdam, The Netherlands
| | - Erwin Van Wegen
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Caroline Van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands.,Limburg Center for Brain Injury, Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Johanna Visser-Meily
- Center of Excellence in Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Amsterdam, The Netherlands
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29
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Becqué YN, Rietjens JAC, van der Heide A, Witkamp E. The effectiveness of a nurse-led intervention to support family caregivers in end-of-life care: Study protocol for a cluster randomized controlled trial. J Adv Nurs 2020; 76:1266-1272. [PMID: 32048316 PMCID: PMC7187191 DOI: 10.1111/jan.14326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/14/2020] [Accepted: 02/05/2020] [Indexed: 12/31/2022]
Abstract
Aim To evaluate the feasibility of a structured nurse‐led supportive intervention and its effects on family caregivers in end‐of‐life care at home. Background Family caregivers are crucial in end‐of‐life care. They may experience burden due to the responsibilities associated with caregiving. Some family caregivers feel insufficiently prepared for their caregiver role. Nurses have a unique position to provide supportive interventions at home to reduce caregivers’ burden and improve preparedness. However, few nurse‐led interventions are available to support family caregivers in end‐of‐life care at home. Design We will perform a cluster randomized controlled trial. The clusters consist of twelve home care services, randomly assigned to the intervention group or the control group. Methods The study population consists of family caregivers of patients in the last phase of life. In the intervention group, nurses will systematically assess the supportive needs of family caregivers, using an assessment tool and the method of clinical reasoning. Family members of the control group receive care as usual. Primary outcome is burden measured by the Self‐Rated Burden Scale. Secondary outcomes are preparedness for caregiving, caregiving reactions and acute (hospital) admissions of the patient. In addition, the feasibility of the intervention will be evaluated. The study was funded in October 2016 and was ethically approved in April 2019. Impact Findings from this study will contribute to the scientific and practical knowledge of nursing interventions to support family caregivers in end‐of‐life care. Trial registration The Netherlands Trial Register (NL7702).
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Affiliation(s)
- Yvonne N Becqué
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erica Witkamp
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.,Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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30
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Swinkels J, Tilburg TV, Verbakel E, Broese van Groenou M. Explaining the Gender Gap in the Caregiving Burden of Partner Caregivers. J Gerontol B Psychol Sci Soc Sci 2019; 74:309-317. [PMID: 28379560 PMCID: PMC6327655 DOI: 10.1093/geronb/gbx036] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 03/09/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives We examine gender differences in the experienced burden of partner caregivers using the stress-appraisal model. Gender differences can be explained by differences in conditions of burden (primary stressors, help from others, hours of caregiving, and secondary stressors) and how strong their effects are. Method The data are from the Netherlands’ Older Persons and Informal Caregivers Survey—Minimum Data Set (N = 1,611 caregivers). We examine mediation and moderation effects using structural equation modeling. Results Women experience greater partner caregiver burden than men, which is related to women experiencing more secondary stressors (relational and financial problems, problems combining different tasks). For women and men alike, there is a positive association between burden and more primary stressors (partner’s care need indicated by health impairment), help from other caregivers, and secondary stressors. For male caregivers, caregiving intensity also contributes to a greater burden. Discussion This study corroborates the structural impact of gender on the conditions of as well as their effects on the partner caregiver burden. Reducing the hours of caregiving for male caregivers in severe care situations and helping female and male caregivers deal emotionally with the caregiving situation can reduce the partner caregiver burden.
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Affiliation(s)
- Joukje Swinkels
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, The Netherlands
| | - Theo van Tilburg
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, The Netherlands
| | - Ellen Verbakel
- Department of Sociology, Radboud University Nijmegen, The Netherlands
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31
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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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32
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Scheffler E, Mash R. Surviving a stroke in South Africa: outcomes of home-based care in a low-resource rural setting. Top Stroke Rehabil 2019; 26:423-434. [PMID: 31169468 DOI: 10.1080/10749357.2019.1623473] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Little is known of stroke outcomes in low- and middle-income countries with limited formal stroke rehabilitation services and of homebased-stroke services delivered within the primary health care (PHC) context by community health workers (CHWs). Objectives: To describe and analyze the outcomes of patients with stroke from a rural PHC setting in the Western Cape, South Africa. Methods: In a longitudinal survey, 93 stroke patients, referred to home and community-based care services (HCBC) between June 2015 and December 2017, were assessed at baseline, one month and three months. Changes in function (Barthel Index (BI)), caregiver strain (Caregiver Strain Index (CSI)), impact of environmental factors and satisfaction with stroke care were measured. Results: HCBC was delayed, fragmented and brief (median session duration 20 minutes (IQR 15.0-30.0)). Although function improved significantly, dependence remained high: median BI score changed from 40.0 (IQR 15.0-70.0) to 62.5 (IQR 30.0-81.25) (p = .019). A third (33.0% (30/91)) of caregivers initially experienced strain and the median CSI score remained 3.0 (IQR 0.0-7.0) (p = .672). Overall, patient and caregiver satisfaction with HCBC was low with only 46.9% (31/66) of caregivers and 17.4% (12/69) of patients satisfied with all aspects of care. Only 47.6% of assistive product needs were met. Environmental factors negatively impacted on patient function and caregiving. Conclusions: Clinical practice pathways and referral guidelines should be developed for the HCBC platform. Specific training of CHWs, focusing on how to educate, support and train family caregivers, provide assistive devices and refer to health services is needed.
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Affiliation(s)
- Elsje Scheffler
- a Division of Family Medicine and Primary Care, Stellenbosch University , Stellenbosch , South Africa
| | - Robert Mash
- a Division of Family Medicine and Primary Care, Stellenbosch University , Stellenbosch , South Africa
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33
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A web-based carepartner-integrated rehabilitation program for persons with stroke: study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2019; 5:58. [PMID: 31057807 PMCID: PMC6485162 DOI: 10.1186/s40814-019-0439-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/04/2019] [Indexed: 11/27/2022] Open
Abstract
Background Family carepartner management and support can improve stroke survivor recovery, yet research has placed little emphasis on how to integrate families into the rehabilitation process without increasing negative carepartner outcomes. Our group has developed creative approaches for engaging family carepartners in rehabilitation activities to improve physical and psychosocial health for both the carepartner and stroke survivor. The purpose of this study is to explore a novel, web-based intervention (Carepartner and Constraint-Induced Therapy; CARE-CITE) designed to facilitate positive carepartner involvement during a home-based application of constraint-induced movement therapy (CIMT) for the upper extremity. Methods The primary aim of the study is to determine feasibility of CARE-CITE for both stroke survivors and their carepartners. Carepartner mental health, family conflict surrounding stroke recovery, and stroke survivor upper extremity function will be evaluated using an evaluator blinded, two-group experimental design (blocked randomization protocol according to a 2:1 randomization schema) with 32 intervention dyads and 16 control dyads (who will receive CIMT without structured carepartner involvement). CARE-CITE consists of online education modules for the carepartner to review in parallel to the 30-h CIMT that the stroke survivor receives. The intent of CARE-CITE is to enhance the home-based intervention of CIMT, by helping the carepartner support the therapy and create a therapeutic home environment encouraging practice of the weaker arm in functional tasks. Discussion The CARE-CITE study is testing the feasibility of a family-integrated rehabilitation approach applied in the home environment, and results will provide the foundation for larger clinical studies. The overall significance of this research plan is to increase the understanding and further development of interventions that may serve as models to promote family involvement in the rehabilitation process. Trial registration ClinicalTrials.gov, NCT02703532. Registered 9 March 2016
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Abstract
UNLABELLED ABSTRACTBackground:Neuropsychiatric symptoms (NPI) of dementia are important determinants of caregiver burden, while caregiver coping styles and competences can relieve burden. Caregivers differ in coping with the demands made on them and in experienced burden. What changes in caregivers explain recovery from burden, and which caregiver characteristics predict recovery from burden over time, and does treatment make a difference? METHODS This study into recovery from burden was a secondary analysis of data collected in a formerly conducted randomized controlled trial (RCT) on the integrated reactivation and rehabilitation (IRR) programme in a psychiatric-skilled nursing home, compared to usual care (UC; i.e. day care, assisted living arrangements, and nursing home wards). For this secondary analysis, longitudinal data on persons with dementia and caregivers were used from baseline (T1), end of treatment (T2), and at nine months (T3). RESULTS Caregivers with an improved sense of competence (SCS) who care for persons with dementia with a decreased severity of NPI have the highest chance of recovering from burden (CSI). Caregivers with a tendency to feel involved with others and sympathize with others (affiliation, ICL-R) have a slightly lower probability of improvement with respect to their sense of competence in the short term. The number of improved caregivers was higher in IRR than UC. CONCLUSION Recovery depends on both an improved sense of competence and a decreased severity of NPI. Combined interventions that address both NPI and focus on enhancing caregiver's sense of competence have added value when it comes to decreasing caregiver burden.
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Zhu W, Jiang Y. Determinants of caregiver burden of patients with haemorrhagic stroke in China. Int J Nurs Pract 2018; 25:e12719. [PMID: 30561838 DOI: 10.1111/ijn.12719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/08/2018] [Accepted: 11/09/2018] [Indexed: 02/05/2023]
Abstract
AIM The aim of this study was to assess the caregiver burden over time of patients with haemorrhagic stroke and the determinants of this. BACKGROUND Identification of the predictors for caregiver burden can be used to improve the outcomes of stroke survivors and caregivers. Few studies focus on the caregiver burden of patients with haemorrhagic stroke and how this changes over time. DESIGN This was a prospective longitudinal study. METHODS A convenience sample of 202 stroke survivor/caregiver pairs were recruited in the neurosurgery unit from March 2015 to March 2016. The participants were assessed at three different times by face to face or telephone interview. Caregiver burden was assessed using the Bakas Caregiver Outcomes Scale. Sociodemographic data and other characteristics of the pairs were also collected. Multiple linear regression was performed to identify the determinants. RESULTS Caregiver burden decreased from T1 to T3 significantly. The physical function, depression of stroke survivors, and self-rated burden of caregivers were the most important determinants for overall caregiver burden. The factors identified explained 41.6% to 67.4% of overall burden. CONCLUSION Caregiver burden decreased over time, affected by factors from patients and caregivers. More professional caregivers are needed to support informal carers.
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Affiliation(s)
- Wei Zhu
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Yan Jiang
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
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Riffin C, Van Ness PH, Wolff JL, Fried T. Multifactorial Examination of Caregiver Burden in a National Sample of Family and Unpaid Caregivers. J Am Geriatr Soc 2018; 67:277-283. [PMID: 30452088 PMCID: PMC6367031 DOI: 10.1111/jgs.15664] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/11/2018] [Accepted: 09/15/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine factors associated with caregiver burden from a multifactorial perspective by examining caregiver and care recipient characteristics and a full range of caregiving tasks. DESIGN Nationally representative surveys of community-dwelling older adults and their family caregivers residing in the United States. SETTING 2011 National Health and Aging Trends Study and National Study of Caregiving. PARTICIPANTS Community-dwelling older adults and their family caregivers. MEASUREMENTS Caregiver burden, comprising emotional, physical, and financial difficulties associated with caregiving. RESULTS An estimated 14.9 million caregivers assisted 7.6 million care recipients. More than half of caregivers reported burden related to caregiving. In a multivariable regression model, caregivers who assisted with more activities of daily living and instrumental activities of daily living, health management tasks, and health system logistics were more likely to experience burden, as were female caregivers, adult child caregivers, caregivers in poor health, caregivers with anxiety symptoms, and those using respite care. Dementia was the only care recipient characteristic associated with burden. CONCLUSION Caregiver characteristics and provision of caregiving tasks determine caregiver burden more than care recipient characteristics. Absence of an association between type of a care recipient's chronic conditions and burden, except for dementia, suggests that the tasks that caregivers who assist older adults with a variety of health conditions undertake shape the experience of caregiving. J Am Geriatr Soc 67:277-283, 2019.
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Affiliation(s)
- Catherine Riffin
- Department of Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Peter H Van Ness
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Jennifer L Wolff
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Terri Fried
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
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Everink IHJ, van Haastregt JCM, Tan FES, Schols JMGA, Kempen GIJM. The effectiveness of an integrated care pathway in geriatric rehabilitation among older patients with complex health problems and their informal caregivers: a prospective cohort study. BMC Geriatr 2018; 18:285. [PMID: 30445923 PMCID: PMC6240181 DOI: 10.1186/s12877-018-0971-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/01/2018] [Indexed: 11/26/2022] Open
Abstract
Background To improve continuity and coordination of care in geriatric rehabilitation, an integrated care pathway was developed and implemented in The Netherlands. The purpose of this study was to assess the effects of this pathway on patients and informal caregivers. Methods Two cohorts of patients and their informal caregivers were prospectively recruited before implementation of the pathway (2011–2012) and after implementation of the pathway (2013–2014). Primary outcome measures were dependence in activities of daily living in patients (KATZ-15) and self-rated burden among informal caregivers (SRB-VAS). Secondary outcome measures were the frequency of performing extended daily activities, social participation, psychological well-being, quality of life and discharge location (patients) and quality of life and objective care burden (informal caregivers). Outcomes were measured at baseline, after three and after nine months. Results No effect was shown on the KATZ-15 after three and nine months. However, a larger percentage of patients were discharged home in the care pathway cohort (83% vs 58.1% after three months and 88.6% vs 67.4% after nine months; p = 0.004). Furthermore, after three months, patients from the care pathway cohort performed more extended daily activities (p = 0.014) and informal caregivers experienced a lower self-rated burden (p = 0.05). After nine months, these effects disappeared. No differences were found for the other outcome measures. Conclusions Due to the positive effects of the integrated care pathway, we are inclined to recommend implementing the care pathway in regular care. To have longer lasting effects among patients and informal caregivers, we suggest actively disseminating information about the pathway to primary care providers who are currently still unaware of its content. Trial registration ISRCTN90000867 (date of registration: 07-04-2016).
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Affiliation(s)
- Irma H J Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Jolanda C M van Haastregt
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Frans E S Tan
- Department of Methodology and Statistics and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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Smaling HJA, Joling KJ, van de Ven PM, Bosmans JE, Simard J, Volicer L, Achterberg WP, Francke AL, van der Steen JT. Effects of the Namaste Care Family programme on quality of life of nursing home residents with advanced dementia and on family caregiving experiences: study protocol of a cluster-randomised controlled trial. BMJ Open 2018; 8:e025411. [PMID: 30327407 PMCID: PMC6196971 DOI: 10.1136/bmjopen-2018-025411] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Quality of life of people with advanced dementia living in nursing homes is often suboptimal. Family caregivers can feel frustrated with limited contact with their relatives, which results in visits that are perceived as stressful and not very meaningful. Few psychosocial interventions are specifically developed for people with advanced dementia, and actively involve family caregivers or volunteers. Also, interventions usually stop when it becomes difficult for people to participate. The Namaste Care Family programme aims to increase the quality of life of people with advanced dementia, and improve family caregiving experiences through connecting to people and making them comfortable. METHODS AND ANALYSIS Our study will evaluate the effects of the Namaste Care Family programme on quality of life of people with advanced dementia living in nursing homes and family caregiving experiences using a cluster-randomised controlled trial. Longitudinal analyses will be performed taking into account clustering at the nursing home level. Both a cost-effectiveness and a cost-utility analysis from a societal perspective will be performed. We will modify the Namaste Care Family programme to increase family and volunteer involvement in ongoing and end-of-life care. Data collection involves assessments by family caregivers, nursing staff and elderly care physicians using questionnaires, and observations by the researchers at baseline and multiple times over 12 months. The last questionnaire will be sent up to month 24 after the death of the person with dementia. During semistructured interviews, the feasibility, accessibility and sustainability of the Namaste Care Family programme will be assessed. ETHICS AND DISSEMINATION The study protocol is approved by the Medical Ethics Review Committee of the VU University Medical Center in Amsterdam (protocol no. 2016.399) and registered with the Nederlands Trial Register (NTR5692). The findings will be disseminated via publications in peer-reviewed journals, conference presentations and presentations for healthcare professionals where appropriate. TRIAL REGISTRATION NUMBER NTR5692.
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Affiliation(s)
- Hanneke J A Smaling
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Karlijn J Joling
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands
| | - Joyce Simard
- School of Nursing and Midwifery, College of Health and Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Ladislav Volicer
- School of Aging Studies, University of South Florida, Land O'Lakes, Florida, USA
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Anneke L Francke
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Pont W, Groeneveld I, Arwert H, Meesters J, Mishre RR, Vliet Vlieland T, Goossens P. Caregiver burden after stroke: changes over time? Disabil Rehabil 2018; 42:360-367. [DOI: 10.1080/09638288.2018.1499047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Winke Pont
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Sophia Rehabilitation, The Hague, The Netherlands
| | - Iris Groeneveld
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Henk Arwert
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Rehabilitation Medicine, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Jorit Meesters
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Radha Rambaran Mishre
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Rehabilitation Medicine, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Thea Vliet Vlieland
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Paulien Goossens
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
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Heesterbeek M, Van der Zee EA, van Heuvelen MJG. Passive exercise to improve quality of life, activities of daily living, care burden and cognitive functioning in institutionalized older adults with dementia - a randomized controlled trial study protocol. BMC Geriatr 2018; 18:182. [PMID: 30107789 PMCID: PMC6092789 DOI: 10.1186/s12877-018-0874-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 08/06/2018] [Indexed: 12/18/2022] Open
Abstract
Background Dementia affects cognitive functioning, physical functioning, activities of daily living (ADLs), and quality of life (QOL). Pharmacological treatments to manage, cure or prevent dementia remain controversial. Therefore development of non-pharmacological approaches to prevent, or at least delay the onset and progression of dementia is urgently needed. Passive exercise is proposed to be such a non-pharmacological alternative. This study primarily aims to investigate the effects of three different forms of passive exercise on QOL and ADLs of institutionalized patients with dementia. The secondary aims are to assess the effects of three different forms of passive exercise on cognitive functioning and physical functioning of institutionalized patients with dementia as well as on care burden of both the primary formal and primary informal caregivers of these patients. Methods This is a multicenter randomized controlled trial. Three forms of passive exercise are distinguished; motion simulation (MSim), whole body vibration (WBV), and a combination of both MSim + WBV. Intervention effects are compared to a control group receiving regular care. Institutionalized patients with dementia follow a six-week intervention program consisting of four 4–12 min sessions a week. The primary outcome measures QOL and ADLs and secondary outcome measure care burden are assessed with questionnaires filled in by the primary formal and informal caregivers of the patient. The other secondary outcome measures cognitive and physical functioning are assessed by individual testing. The four groups are compared at baseline, after 6 weeks of intervention, and 2 weeks after the intervention has ended. Discussion This study will provide insight in the effects of different forms of passive exercise on QOL, ADLs, cognitive and physical functioning and care burden of institutionalized patients with dementia and their primary formal and informal caregivers. The results of this study might support the idea that passive exercise can be an efficient alternative for physical activity for patients not able to be or stay involved in active physical exercise. Trial registration The Netherlands National Trial Register (NTR6290). Retrospectively registered 29 March 2017.
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Affiliation(s)
- Marelle Heesterbeek
- Molecular Neurobiology, Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Nijenborgh 7, 9747, AG, Groningen, The Netherlands.
| | - Eddy A Van der Zee
- Molecular Neurobiology, Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Nijenborgh 7, 9747, AG, Groningen, The Netherlands
| | - Marieke J G van Heuvelen
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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de Wit J, Beelen A, Drossaert CHC, Kolijn R, van den Berg LH, Visser-Meily JMA, Schröder CD. A blended psychosocial support program for partners of patients with amyotrophic lateral sclerosis and progressive muscular atrophy: protocol of a randomized controlled trial. BMC Psychol 2018; 6:20. [PMID: 29716660 PMCID: PMC5930742 DOI: 10.1186/s40359-018-0232-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/16/2018] [Indexed: 12/13/2022] Open
Abstract
Background Informal caregivers of patients with Amyotrophic Lateral Sclerosis (ALS) or Progressive Muscular Atrophy (PMA) face stressful demands due to severe impairments and prospect of early death of the patients they care for. Caregivers often experience feelings of psychological distress and caregiver burden, but supportive interventions are lacking. The objective of this study is to investigate the effectiveness of a psychosocial support program aimed at enhancing feelings of control over caregiving tasks and reducing psychological distress. This support program is based on an existing program for adult partners of people with cancer and is adapted to meet the needs of ALS caregivers. Methods This study is a randomized controlled trial using a wait-list control design. One hundred and forty caregiver-patient dyads, recruited from a nationwide database and through the website of the Dutch ALS Center, will be either randomized to a support program or a wait-list control group. The blended intervention is based on Acceptance and Commitment Therapy and consists of 1 face-to-face contact, 6 online guided modules and 1 telephone contact. The intervention can be worked through in 8 weeks. The effectiveness and the participants’ satisfaction with the intervention will be evaluated using a mixed method design. Caregivers and patients will be asked to fill in questionnaires on 4 occasions during the study: baseline, 3 months, 6 months and 9 months. The main study outcome is the psychological distress of the caregiver assessed with the Hospital Anxiety and Depression Scale. Secondary outcomes are caregiver burden, caregiver quality of life, quality of life of the patient and psychological distress of the patient. Group differences in primary and secondary outcomes at 6 months will be compared with linear mixed model analysis. In a subgroup of caregivers we will explore experiences with the support program through semi-structured interviews. Usage of the online modules will be logged. Discussion The study will provide insights into the effectiveness of a blended psychosocial support program on psychological distress of caregivers of patients with ALS or PMA, as well as into indirect relations with patients’ wellbeing. Trial registration Netherlands Trial Registry NTR5734, registered 28 March 2016.
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Affiliation(s)
- Jessica de Wit
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Anita Beelen
- Department of Rehabilitation, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Constance H C Drossaert
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Ruud Kolijn
- Patient Association ALS Patients Connected, Rotterdam, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Carin D Schröder
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands. .,Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Pouw MA, Calf AH, van Munster BC, Ter Maaten JC, Smidt N, de Rooij SE. Hospital at Home care for older patients with cognitive impairment: a protocol for a randomised controlled feasibility trial. BMJ Open 2018; 8:e020332. [PMID: 29593022 PMCID: PMC5875621 DOI: 10.1136/bmjopen-2017-020332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION An acute hospital admission is a stressful life event for older people, particularly for those with cognitive impairment. The hospitalisation is often complicated by hospital-associated geriatric syndromes, including delirium and functional loss, leading to functional decline and nursing home admission. Hospital at Home care aims to avoid hospitalisation-associated adverse outcomes in older patients with cognitive impairment by providing hospital care in the patient's own environment. METHODS AND ANALYSIS This randomised, non-blinded feasibility trial aims to assess the feasibility of conducting a randomised controlled trial in terms of the recruitment, use and acceptability of Hospital at Home care for older patients with cognitive impairment. The quality of care will be evaluated and the advantages and disadvantages of the Hospital at Home care programme compared with usual hospital care. Eligible patients will be randomised either to Hospital at Home care in their own environment or usual hospital care. The intervention consists of hospital level care provided at patients' homes, including visits from healthcare professionals, diagnostics (laboratory tests, blood cultures) and treatment. The control group will receive usual hospital care. Measurements will be conducted at baseline, during admission, at discharge and at 3 and 6 months after the baseline assessment. ETHICS AND DISSEMINATION Institutional ethics approval has been granted. The findings will be disseminated through public lectures, professional and scientific conferences, as well as peer-reviewed journal articles. The study findings will contribute to knowledge on the implementation of Hospital at Home care for older patients with cognitive disorders. The results will be used to inform and support strategies to deliver eligible care to older patients with cognitive impairment. TRIAL REGISTRATION NUMBER e020313; Pre-results.
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Affiliation(s)
- Maaike A Pouw
- Department of Geriatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Internal Medicine, Martini Hospital, Groningen, The Netherlands
| | - Agneta H Calf
- Department of Geriatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara C van Munster
- Department of Geriatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Jan C Ter Maaten
- Department of Internal Medicine, Emergency Department, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nynke Smidt
- Department of Geriatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sophia E de Rooij
- Department of Geriatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Hillebregt CF, Scholten EWM, Ketelaar M, Post MWM, Visser-Meily JMA. Effects of family group conferences among high-risk patients of chronic disability and their significant others: study protocol for a multicentre controlled trial. BMJ Open 2018; 8:e018883. [PMID: 29523560 PMCID: PMC5855389 DOI: 10.1136/bmjopen-2017-018883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/21/2017] [Accepted: 01/15/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Many patients and family members experience a large gap between the protected environment during inpatient medical rehabilitation and life in the community after discharge. They feel insufficiently prepared to cope with the consequences of their disability in daily life. This study protocol describes the design measuring the effectiveness and implementation of family group conferences on the empowerment of patients with a high risk of chronic disability and their significant others. METHODS AND ANALYSIS A multicentre controlled trial will be carried out in 12 rehabilitation centres in the Netherlands. A total of 328 clinically admitted patients will participate (≥18 years, diagnosed with acquired brain injury, spinal cord injury or leg amputation), and their significant others will be included. During three family group conferences, supported by the social worker, the patient, significant other and their social network will be stimulated in collaboration, to set up participation goals, determine the needed help and make a concrete action plan. Self-reported questionnaires will be collected at baseline, clinical discharge, and 3 months and 6 months following clinical discharge. Empowerment as the primary outcome is operationalised as self-efficacy and participation. Secondary outcome measures are psychological (eg, coping, neuroticism) and environmental (eg, family functioning, social support) factors. This is the first controlled trial evaluating the effectiveness of family group conferences in rehabilitation medicine among adult patients and their significant others, providing us with knowledge in improving rehabilitation care. ETHICS AND DISSEMINATION This study has been approved by the Medical Ethics Committee of the University Medical Center Utrecht (number 15-617/C). The results will be published in peer-reviewed journals and presented in local, national and international conferences. TRIAL REGISTRATION NUMBER NTR5742; Pre-results.
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Affiliation(s)
- Chantal F Hillebregt
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, the Netherlands
| | - Eline W M Scholten
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, the Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, the Netherlands
| | - Marcel W M Post
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, the Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, the Netherlands
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Janse B, Huijsman R, Looman WM, Fabbricotti IN. Formal and informal care for community-dwelling frail elderly people over time: A comparison of integrated and usual care in the Netherlands. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e280-e290. [PMID: 29181877 DOI: 10.1111/hsc.12516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/10/2017] [Indexed: 06/07/2023]
Abstract
UNLABELLED While integration has become a central tenet of community-based care for frail elderly people, little is known about its impact on formal and informal care and their dynamics over time. The aim of this study was therefore to examine how an integrated care intervention for community-dwelling frail elderly people affects the amount and type of formal and informal care over 12 months as compared to usual care. A quasi-experimental design with a control group was used. Data regarding formal and informal care were collected from frail elderly patients (n = 207) and informal caregivers (n = 74) with pre/post-questionnaires. Within- and between-group comparisons and multiple linear regression analyses were performed. The results showed marginal changes over time in the amount of formal and informal care in both integrated care and usual care. However, different associations between changes in formal and informal care were found in integrated and usual care. Most notably, informal caregivers provided more instrumental assistance over time if formal caregivers provided less personal care (and vice versa) in integrated care but not in usual care. These results suggest that integrated care does not necessarily change the contribution of formal or informal care, but changes the interaction between formal (personal care) and informal (instrumental) activities. Implications and recommendations for research and practice are discussed. TRIAL REGISTRATION Current Controlled Trials ISRNT05748494.
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Affiliation(s)
- Benjamin Janse
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Robbert Huijsman
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Willemijn Mijntje Looman
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Cox VC, Schepers VP, Ketelaar M, van Heugten CM, Visser-Meily JM. Evaluating the CARE4Carer Blended Care Intervention for Partners of Patients With Acquired Brain Injury: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e60. [PMID: 29453189 PMCID: PMC5834754 DOI: 10.2196/resprot.9108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Support programs for partners of patients with acquired brain injury are necessary since these partners experience several unfavorable consequences of caregiving, such as a high burden, emotional distress, and poor quality of life. Evidence-based support strategies that can be included in these support programs are psychoeducation, skill building, problem solving, and improving feelings of mastery. A promising approach would seem to be to combine web-based support with face-to-face consultations, creating a blended care intervention. OBJECTIVE This paper outlines the protocol of a randomized controlled trial to evaluate the CARE4Carer blended care intervention for partners of patients with acquired brain injury. METHODS A multicenter two-arm randomized controlled trial will be conducted. A total of 120 partners of patients with acquired brain injury will be recruited from five rehabilitation centers in the Netherlands. The blended care intervention consists of a nine-session web-based support program and two face-to-face consultations with a social worker. Themes that will be addressed are: giving partners insight into their own situation, including possible pitfalls and strengths, learning how to cope with the situation, getting a grip on thoughts and feelings, finding a better balance in the care for the patient with acquired brain injury, thinking about other possible care options, taking care of oneself, and communication. The intervention lasts 20 weeks and the control group will receive usual care. The outcome measures will be assessed at baseline and at 24- and 40-week follow-up. The primary outcome is caregiver mastery. Secondary outcome measures are strain, burden, family functioning, emotional functioning, coping, quality of life, participation, and social network. RESULTS The effect of the intervention on the primary and secondary outcome measures will be determined. Additional a process evaluation will be conducted. CONCLUSIONS The findings of this study will be used to improve the care for partners of patients with acquired brain injury. Barriers and facilitators that emerge from the process evaluation will be used in the nationwide implementation of the intervention. TRIAL REGISTRATION Dutch Trial Register NTR6197; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6197 (Archived by WebCite at http://www.webcitation.org/6xHBAxx0y).
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Affiliation(s)
- Vincent Cm Cox
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Vera Pm Schepers
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Caroline M van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, Netherlands.,Limburg Center for Brain Injury, Maastricht, Netherlands
| | - Johanna Ma Visser-Meily
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Liao WW, McCombe Waller S, Whitall J. Kinect-based individualized upper extremity rehabilitation is effective and feasible for individuals with stroke using a transition from clinic to home protocol. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1428038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Wan-wen Liao
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, 100 Penn street, Allied Health Building, Baltimore, MD, USA
| | - Sandy McCombe Waller
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, 100 Penn street, Allied Health Building, Baltimore, MD, USA
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, 100 Penn street, Allied Health Building, Baltimore, MD, USA
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Joling KJ, O'Dwyer ST, Hertogh CM, van Hout HP. The occurrence and persistence of thoughts of suicide, self-harm and death in family caregivers of people with dementia: a longitudinal data analysis over 2 years. Int J Geriatr Psychiatry 2018; 33:263-270. [PMID: 28379646 PMCID: PMC5811919 DOI: 10.1002/gps.4708] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/02/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Family caregivers of people with dementia often report high levels of stress and depression, but little is known about those who contemplate suicide or self-harm. This study explores thoughts of suicide, self-harm and death in dementia caregivers and investigates the characteristics that distinguish them from those without such thoughts. METHODS Data were collected every 3 months, for 24 months, from 192 family caregivers of people with dementia living in the Netherlands. Caregivers did not have a clinical depression or anxiety disorder at baseline. Suicide-related thoughts were measured with an item from the Mini International Neuropsychiatric Interview, a diagnostic instrument for DSM-IV mental disorders. Fisher exact, analysis of variance or Kruskal-Wallis tests compared the characteristics of caregivers who had contemplated suicide with two comparison groups. RESULTS Within 24 months, 76 caregivers reported symptoms of a potential depression and were further assessed for suicidal thoughts. Nine carers (11.8%, 4.7% of the total sample) reported suicidal thoughts with three of those at multiple points. Caregivers with suicidal thoughts had more severe depressive and anxious symptoms, had a lower sense of competence and mastery, felt less happy and experienced more health problems, less family support and more feelings of loneliness than caregivers who had not. CONCLUSION Suicidal thoughts are present in dementia caregivers and can persist across the care trajectory. Various psychological and social characteristics significantly distinguish caregivers with suicidal thoughts from those without. More research is needed to enable the identification of high-risk caregivers and provide an evidence base for the development of preventive strategies and interventions. © 2017 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Karlijn J. Joling
- Amsterdam Public Health research instituteVU University Medical CentreAmsterdamThe Netherlands
| | - Siobhan T. O'Dwyer
- Amsterdam Public Health research instituteVU University Medical CentreAmsterdamThe Netherlands
| | - Cees M.P.M. Hertogh
- Amsterdam Public Health research instituteVU University Medical CentreAmsterdamThe Netherlands
| | - Hein P.J. van Hout
- Amsterdam Public Health research instituteVU University Medical CentreAmsterdamThe Netherlands
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Hu X, Hu X, Su Y, Qu M. Quality of Life Among Primary Family Caregivers of Patients with Heart Failure in Southwest China. Rehabil Nurs 2018; 43:26-34. [DOI: 10.1002/rnj.290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Arwert H, Schut S, Boiten J, Vliet Vlieland T, Meesters J. Patient reported outcomes of hand function three years after stroke. Top Stroke Rehabil 2017; 25:13-19. [PMID: 29025365 DOI: 10.1080/10749357.2017.1385232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To comprehensively describe hand function and associated factors among stroke survivors by means of the Michigan Hand Outcomes Questionnaire (MHQ; 6 domains; score 0-100, worst-best). METHODS In this cross-sectional study, stroke patients were invited to complete a set of questionnaires on hand function, socio-demographic characteristics, mental functioning, daily activities, quality of life, and caregiver strain. Stroke characteristics were collected retrospectively from medical records. Multiple linear regression analysis adjusted for age, sex, and duration of follow-up was used to identify factors associated with MHQ score. RESULTS 207 out of 576 eligible patients responded (36%); mean age 63.8 years (SD14.2), 125 males (60.4%). Mean time since stroke was 36.3 months (SD9.9). In 85% of the patients, the MHQ Total score was less than 100 points (median 79.9, IQR 63.0-95.8). The median scores of the domains were: overall hand function 75.0, daily activities 90.5, work 85.0, pain 100, appearance 93.8, and satisfaction with hand function 83.3. A lower MHQ Total score was significantly associated with a lower Barthel Index at hospital discharge, a lower level of education, a supratentorial stroke and with unfavorable outcomes regarding physical and mental functioning, quality of life, and caregiver strain. CONCLUSION Patients can perceive limitations on several domains with respect to hand function 2-5 years after stroke. Problems related to the appearance of the hand and satisfaction with hand function can be relevant and should be considered accordingly. Persistent hand problems after stroke are related to a more severe, supratentorial stroke in lower educated patients.
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Affiliation(s)
- Henk Arwert
- a Sophia Rehabilitation Center , The Hague , The Netherlands.,b Department of Rehabilitation , Haaglanden Medical Center , The Hague , The Netherlands
| | - Selma Schut
- a Sophia Rehabilitation Center , The Hague , The Netherlands
| | - Jelis Boiten
- c Department of Neurology , Haaglanden Medical Center , The Hague , The Netherlands
| | - Thea Vliet Vlieland
- a Sophia Rehabilitation Center , The Hague , The Netherlands.,d Department of Orthopedics, Rehabilitation and Physical Therapy , Leiden University Medical Center , Leiden , The Netherlands.,e Rijnland Rehabilitation Center , Leiden , The Netherlands
| | - Jorit Meesters
- a Sophia Rehabilitation Center , The Hague , The Netherlands.,d Department of Orthopedics, Rehabilitation and Physical Therapy , Leiden University Medical Center , Leiden , The Netherlands
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