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Basheti IA, Ayasrah SM, Al-Fayyadh S, Abuadas FH, Abu-Snieneh HM, Bachi GE. Medications Adherence and Associated Factors Among Patients with Stroke in Iraq. Patient Prefer Adherence 2024; 18:2027-2039. [PMID: 39351502 PMCID: PMC11441302 DOI: 10.2147/ppa.s459289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/25/2024] [Indexed: 10/04/2024] Open
Abstract
Purpose Stroke poses significant challenges to affected individuals, their families, and healthcare systems, with adherence to medications being a pivotal determinant of health outcomes. In this study, we aim to evaluate the medication adherence of stroke patients living in Iraq, and explore how patients' demographic and clinical details relate to their adherence levels. Furthermore, we seek to assess the self-care practices used by stroke patients and their adherence to them. Patients and Methods We carried out a cross-sectional correlational study conducted from November 2022 to April 2023, stroke patients diagnosed in seven hospitals across Baghdad and Al-Mothanna governorate were recruited, with diagnoses confirmed by physicians and senior neurologists using MRI and/or CT scans. Patients' adherence to medications, demographic data, clinical characteristics, and self-care activities were analyzed using descriptive statistics and regression analyses. Results Of the 200 participants, mean age was 58.27 years, with males constituting 53.5%. About 40.5% had a hemorrhagic stroke, and 59.5% an ischemic stroke. The mean adherence score was 13.36 (SD= 4.658) out of a possible 28. Factors significantly correlated with medication adherence included age, monthly income, time since having a stroke, and education level. Adherence was also significantly linked to having diabetes mellitus or high blood pressure. The assessment of participants' self-care activities and medication adherence revealed that responses to questions about healthcare habits varied, with "None" being the most common response for most items. Notably, we found no significant association between adherence and factors such as gender, marital status, living place, and smoking status. Conclusion Medication adherence remains suboptimal among stroke patients in Iraq. Various demographic and clinical factors play a role in influencing adherence. The conformity to medication regimens and factors associated with it among individuals who have suffered a stroke in Iraq is vital.
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Affiliation(s)
- Iman A Basheti
- Pharmaceutical Sciences Department, Faculty of Pharmacy, Jadara University, Irbid, Jordan
| | - Shahnaz M Ayasrah
- Department of Applied Science/Nursing, Al-Balqa Applied University, Al-Salt, Jordan
| | | | - Fuad H Abuadas
- College of Nursing, Community Health Nursing Department, Jouf University, Sakaka, 72388, Saudi Arabia
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Zhang JJY, Ang J, Saffari SE, Tor PC, Lo YL, Wan KR. Repetitive Transcranial Magnetic Stimulation for Motor Recovery After Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials With Low Risk of Bias. Neuromodulation 2024:S1094-7159(24)00665-2. [PMID: 39320286 DOI: 10.1016/j.neurom.2024.07.010] [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: 04/15/2024] [Revised: 07/07/2024] [Accepted: 07/29/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVES Repetitive transcranial magnetic stimulation (rTMS) has shown promising results in enhancing motor recovery after stroke, but nuances regarding its use, such as the impact of the type and site of stimulation, are not yet established. We aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) with low risk of bias to investigate the effect of rTMS on motor recovery after both ischemic and hemorrhagic stroke. MATERIALS AND METHODS Three databases were searched systematically for all RCTs reporting comparisons between rTMS (including theta-burst stimulation) and either no stimulation or sham stimulation up to August 19, 2022. The primary outcome measure was the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Secondary outcome measures comprised the Action Research Arm Test, Box and Block Test, Modified Ashworth Scale for the wrist, and modified Rankin Scale (mRS). RESULTS A total of 37 articles reporting 48 unique comparisons were included. Pooled mean FMA-UE scores were significantly higher in the experimental group than the control group after intervention (MD = 5.4 [MD = 10.7 after correction of potential publication bias], p < 0.001) and at the last follow-up (MD = 5.2, p = 0.031). On subgroup analysis, the improvements in FMA-UE scores, both after intervention and at the last follow-up, were significant in the acute/subacute stage of stroke (within six months) and for patients with more severe baseline motor impairment. Both contralesional and ipsilesional stimulation yielded significant improvements in FMA-UE at the first assessment after rTMS but not at the last follow-up, while the improvements from bilateral rTMS only achieved statistical significance at the last follow-up. Among the secondary outcome measures, only mRS was significantly improved in the rTMS group after intervention (MD = -0.5, p = 0.013) and at the last follow-up (MD = -0.9, p = 0.001). CONCLUSIONS Current literature supports the use of rTMS for motor recovery after stroke, especially when done within six months and for patients with more severe stroke at baseline. Future studies with larger sample sizes may be helpful in clarifying the potential of rTMS in poststroke rehabilitation.
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Affiliation(s)
- John J Y Zhang
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore.
| | - Jensen Ang
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore
| | - Seyed Ehsan Saffari
- Centre for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore; Program in Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore
| | - Phern-Chern Tor
- Department of Mood and Anxiety, Institute of Mental Health, Singapore
| | - Yew Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Kai Rui Wan
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore General Hospital, Singapore
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Stolwyk RJ, Mihaljcic T, Wong DK, Hernandez DR, Wolff B, Rogers JM. Post-stroke Cognition is Associated with Stroke Survivor Quality of Life and Caregiver Outcomes: A Systematic Review and Meta-analysis. Neuropsychol Rev 2024:10.1007/s11065-024-09635-5. [PMID: 38466357 DOI: 10.1007/s11065-024-09635-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/05/2024] [Indexed: 03/13/2024]
Abstract
Disability arising from post-stroke cognitive impairment is a likely contributor to the poor quality of life (QoL) stroke survivors and their carers frequently experience, but this has not been summarily quantified. A systematic literature review and meta-analysis was completed examining the association between general and domain-specific post-stroke cognitive functioning and adult stroke survivor QoL, caregiver QoL, and caregiver burden. Five databases were systematically searched, and eligibility for inclusion, data extraction, and study quality were evaluated by two reviewers using a standardised protocol. Effects sizes (r) were estimated using a random effects model. Thirty-eight studies were identified, generating a sample of 7365 stroke survivors (median age 63.02 years, range 25-93) followed for 3 to 132 months post-stroke. Overall cognition (all domains combined) demonstrated a significant small to medium association with QoL, r = 0.23 (95% CI 0.18-0.28), p < 0.001. The cognitive domains of speed, attention, visuospatial, memory, and executive skills, but not language, also demonstrated a significant relationship with QoL. Regarding caregiver outcomes, 15 studies were identified resulting in a sample of 2421 caregivers (median age 58.12 years, range 18-82) followed for 3 to 84 months post-stroke. Stroke survivor overall cognitive ability again demonstrated a significant small to medium association with caregiver outcomes (QoL and burden combined), r = 0.17 (95% CI 0.10-0.24), p < 0.001. In conclusion, lower post-stroke cognitive performance is associated with significant reductions in stroke survivor QoL and poorer caregiver outcomes. Cognitive assessment is recommended early to identify those at risk and implement timely interventions to support both stroke survivors and their caregivers.
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Affiliation(s)
- Renerus J Stolwyk
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Monash Clayton Campus, Melbourne, VIC, 3800, Australia.
| | - Tijana Mihaljcic
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Monash Clayton Campus, Melbourne, VIC, 3800, Australia
| | - Dana K Wong
- School of Psychology & Public Health, La Trobe University, Bundoora, Australia
| | - Diana Ramirez Hernandez
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Monash Clayton Campus, Melbourne, VIC, 3800, Australia
| | - Brittany Wolff
- School of Psychological Science, The University of Western Australia, Perth, Australia
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Skajaa N, Farkas DK, Laugesen K, Fuglsang CH, Henderson VW, Plana-Ripoll O, Gaist D, Sørensen HT. Mental Health Conditions in Partners and Adult Children of Stroke Survivors. JAMA Netw Open 2024; 7:e243286. [PMID: 38483386 PMCID: PMC10940969 DOI: 10.1001/jamanetworkopen.2024.3286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/29/2024] [Indexed: 03/17/2024] Open
Abstract
Importance Family caregiving after critical illness has been associated with several adverse health outcomes, including various aspects of mental health, but research focusing specifically on family members of stroke survivors is limited. Objectives To examine the associations of stroke in a partner or parent with the risk of depression, substance use disorders, anxiety disorders, and self-harm or suicide. Design, Setting, and Participants This nationwide, population-based cohort study used data from Danish nationwide administrative and clinical registries (2004-2021). Participants included partners and adult children of survivors of stroke. Data analysis was performed from March to December 2023. Exposure Having a partner or parent who survived stroke. Main Outcomes and Measures The Aalen-Johansen estimator was used to compute propensity score-weighted 3-year absolute risks, risk differences, and risk ratios for depression, substance use disorders, anxiety disorders, and self-harm or suicide among partners or children of survivors of stroke compared with partners or children of survivors of myocardial infarction (MI) and matched individuals from the general population. Results The study included a total of 1 923 732 individuals: 70 917 partners of stroke survivors (median [IQR] age, 68 [59-76] years; 46 369 women [65%]), 70 664 partners of MI survivors (median [IQR] age, 65 [55-73] years; 51 849 women [73%]), 354 570 partners of individuals from the general population (median [IQR] age, 68 [59-76] years; 231 833 women [65%]), 207 386 adult children of stroke survivors (median [IQR] age, 45 [36-52] years; 99 382 women [48%]), 183 309 adult children of MI survivors (median [IQR] age, 42 [33-49] years; 88 078 women [48%]), and 1 036 886 adult children of individuals from the general population (median [IQR] age, 45 [36-52] years; 496 875 women [48%]). Baseline characteristics were well balanced across cohorts after propensity score weighting. Among partners of stroke survivors, the 3-year absolute risk was 1.0% for depression, 0.7% for substance use disorders, 0.3% for anxiety disorders, and 0.04% for self-harm or suicide. Risk ratio point estimates for the assessed outcomes ranged from 1.14 to 1.42 compared with the general population and from 1.04 to 1.09 compared with partners of MI survivors. The elevated risk of depression in partners of stroke survivors was more pronounced after severe or moderate stroke than after mild stroke. Among adult children of stroke survivors, the 3-year absolute risk was 0.6% for depression, 0.6% for substance use disorders, 0.2% for anxiety disorders, and 0.05% for self-harm or suicide. Both absolute risks and risk ratios for adult children of stroke survivors were smaller than those reported in the partner analyses. Conclusions and Relevance In this cohort study of partners and adult children of stroke survivors, risks of several mental health conditions and self-harm or suicide were moderately higher compared with the general population and, to a lesser extent, partners and adult children of MI survivors. These findings highlight the potential consequences of stroke among family members, particularly partners, and its findings may possibly serve as a quantitative foundation for the development of future stroke rehabilitation services.
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Affiliation(s)
- Nils Skajaa
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Dóra Körmendiné Farkas
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Kristina Laugesen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Cecilia Hvitfeldt Fuglsang
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - Victor W. Henderson
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology & Population Health, Stanford University, Stanford, California
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, California
| | - Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
| | - David Gaist
- Research Unit for Neurology, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Aarhus, Denmark
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Lin YN, Hung TH, Rodakowski J, Kang JH, Han DS, Liou TH, Wu YH, Chang FH. Development of a Dyad-Focused Intervention for Stroke Survivors and Their Family Caregivers: A Feasibility Study. Am J Occup Ther 2024; 78:7802180230. [PMID: 38422433 DOI: 10.5014/ajot.2024.050571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
IMPORTANCE Transitioning from the hospital to the community poses significant challenges for stroke survivors and their caregivers. OBJECTIVE To examine the feasibility and preliminary effects of a dyad-focused strategy training intervention. DESIGN Single-arm trial with data collection at baseline, postintervention, and 3-mo follow-up. SETTING Rehabilitation settings in Taiwan. PARTICIPANTS Sixteen stroke survivor-caregiver dyads. INTERVENTIONS Dyad-focused strategy training was provided to stroke survivor-caregiver dyads twice a week over 6 wk. The training included shared decision-making, goal setting, performance evaluation, strategy development and implementation, and therapeutic guided discovery. OUTCOMES AND MEASURES Feasibility indicators were Goal Attainment Scaling, Dyadic Relationship Scale, Participation Measure-3 Domains, 4 Dimensions, Activity Measure for Post-Acute Care, Montreal Cognitive Assessment, Trail Making Test, Stroop Color and Word Test, Preparedness for Caregiving Scale, and Zarit Burden Interview. RESULTS In total, 15 dyads completed all intervention sessions with full attendance. Both stroke survivors and their caregivers demonstrated high engagement and comprehension and reported moderate to high satisfaction with the intervention. From baseline to postintervention, the effects on goal attainment, frequency and perceived difficulty of community participation, executive function, mobility function, and caregiver preparedness were significant and positive. CONCLUSIONS AND RELEVANCE Our study supports the feasibility and preliminary efficacy of dyad-focused strategy training for stroke survivor-caregiver dyads transitioning from the hospital to the community in Taiwan. Our preliminary evidence indicates that dyads who receive strategy training exhibit advancement toward their goals and experience considerable enhancements in their individual outcomes. Plain-Language Summary: This study addresses the scarcity of interventions catering to both stroke survivors and their caregivers. By demonstrating the feasibility of our dyad-focused intervention, the research offers preliminary evidence that supports the potential advantages of involving both stroke survivors and their caregivers in the intervention process.
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Affiliation(s)
- Yen-Nung Lin
- Yen-Nung Lin, MD, MS, is Professor, Graduate Institute of Injury Prevention and Control, College of Public Health, and Director and Visiting Staff, Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Te-Hsun Hung
- Te-Hsun Hung, BS, is Master's Student, Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Juleen Rodakowski
- Juleen Rodakowski, OTD, MS, OTR/L, FAOTA, is Associate Professor and Chair, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Jiunn-Horng Kang
- Jiunn-Horng Kang, MD, PhD, is Dean, College of Biomedical Engineering, and Professor, Graduate Institute of Nanomedicine and Medical Engineering, College of Biomedical Engineering, Taipei Medical University, and Visiting Staff, Taipei Medical University Hospital, Taipei, Taiwan
| | - Der-Sheng Han
- Der-Sheng Han, MD, PhD, is Professor, Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan, and Director and Visiting Staff, National Taiwan University Hospital, Beihu Branch, Taipei, Taiwan
| | - Tsan-Hon Liou
- Tsan-Hon Liou, MD, PhD, is Superintendent, Wan Fang Hospital, Taipei, Taiwan, and Professor, Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei, Taiwan
| | - Yi-Hsuan Wu
- Yi-Hsuan Wu, MS, OTR/L, is Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Feng-Hang Chang
- Feng-Hang Chang, ScD, OTR/L, is Professor, Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei, Taiwan, and Occupational Therapist, Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan;
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Tziaka E, Tsiakiri A, Vlotinou P, Christidi F, Tsiptsios D, Aggelousis N, Vadikolias K, Serdari A. A Holistic Approach to Expressing the Burden of Caregivers for Stroke Survivors: A Systematic Review. Healthcare (Basel) 2024; 12:565. [PMID: 38470676 PMCID: PMC10930970 DOI: 10.3390/healthcare12050565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
This systematic review explores the multifaceted challenges faced by caregivers of stroke survivors, addressing the global impact of strokes and the anticipated rise in survivors over the coming decades. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a thorough literature search identified 34 relevant studies published between 2018 and 2023. The review categorizes caregiver burden into four domains: physical health, social functioning, financial issues, and psychological health. Caregivers often experience a decline in physical health, marked by chronic fatigue, sleep disturbances, and pain. Emotional distress is prevalent, leading to anxiety and depression, especially in cases of high burden. Financial strains arise from medical expenses and employment changes, exacerbating the overall burden. Contextual factors, such as cultural norms and resource availability, influence the caregiver experience. The Newcastle-Ottawa scale assessed the methodological quality of studies. The conclusion emphasizes tailored interventions and support systems for caregivers, with practical recommendations for healthcare professionals, therapists, mental health professionals, financial counselors, and policymakers. This comprehensive review enhances the understanding of caregiver experiences and provides actionable insights to improve stroke care and rehabilitation The study's novelty lies in its holistic examination of caregiver burden in stroke care, its focus on the recent literature, and its emphasis on forecasting caregiver outcomes, contributing valuable insights for proactive intervention strategies.
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Affiliation(s)
- Eftychia Tziaka
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.T.); (F.C.); (K.V.)
| | - Anna Tsiakiri
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.T.); (F.C.); (K.V.)
| | - Pinelopi Vlotinou
- Department of Occupational Therapy, University of West Attica, 12243 Athens, Greece;
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.T.); (F.C.); (K.V.)
| | - Dimitrios Tsiptsios
- 3rd Department of Neurology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece;
| | - Konstantinos Vadikolias
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.T.); (F.C.); (K.V.)
| | - Aspasia Serdari
- Department of Child & Adolescent Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
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Hossin MZ, de la Cruz LF, McKay KA, Oberlander TF, Sandström A, Razaz N. Association of pre-existing maternal cardiovascular diseases with neurodevelopmental disorders in offspring: a cohort study in Sweden and British Columbia, Canada. Int J Epidemiol 2024; 53:dyad184. [PMID: 38150596 PMCID: PMC10859157 DOI: 10.1093/ije/dyad184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 12/16/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND We aimed to investigate the associations of pre-existing maternal cardiovascular disease (CVD) with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) in offspring. METHODS This population-based cohort study included singletons live-born without major malformations in Sweden (n = 2 699 675) and British Columbia (BC), Canada (n = 887 582) during 1990-2019, with follow-up from age 1 year until the outcome, death, emigration or December 2020, whichever came first. The primary exposure was defined as a composite CVD diagnosed prior to conception: cerebrovascular disease, arrhythmia, heart failure, valvular and congenital heart diseases. The incidences of ADHD, ASD and ID, comparing offspring of mothers with versus without CVD, were calculated as adjusted hazard ratios (aHRs). These results were compared with models using paternal CVD as negative control exposure. RESULTS Compared with offspring of mothers without CVD, offspring of mothers with CVD had 1.15-fold higher aHRs of ADHD [95% confidence interval (CI): 1.10-1.20] and ASD (95% CI 1.07-1.22). No association was found between maternal CVD and ID. Stratification by maternal CVD subtypes showed increased hazards of ADHD for maternal heart failure (HR 1.31, 95% CI 1.02-1.61), cerebrovascular disease (HR 1.20, 95% CI 1.08-1.32), congenital heart disease (HR 1.18, 95% CI 1.08-1.27), arrhythmia (HR 1.13, 95% CI 1.08-1.19) and valvular heart disease (HR 1.12, 95% CI 1.00-1.24). Increased hazards of ASD were observed for maternal cerebrovascular disease (HR 1.25, 95% CI 1.04-1.46), congenital heart disease (HR 1.17, 95% CI 1.01-1.33) and arrythmia (HR 1.12, 95% CI 1.01-1.21). Paternal CVD did not show associations with ADHD, ASD or ID, except for cerebrovascular disease which showed associations with ADHD and ASD. CONCLUSIONS In this large cohort study, pre-existing maternal CVD was associated with increased risk of ADHD and ASD in offspring.
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Affiliation(s)
- Muhammad Zakir Hossin
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Kyla A McKay
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Anna Sandström
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Neda Razaz
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Ansong R, Gazarian P. Healthcare self-management support of stroke patients after discharge: A conceptual analysis using Rodger's evolutionary approach. J Adv Nurs 2024. [PMID: 38297450 DOI: 10.1111/jan.16078] [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: 08/03/2023] [Revised: 12/26/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024]
Abstract
AIM(S) To explore the meaning of healthcare self-management support for post-discharged stroke patients. METHOD Rodgers' evolutionary approach was used to identify antecedents, attributes, related terms, surrogate terms and consequences. DATA SOURCE Literature from 2012 to 2022 was searched from MEDLINE, CINAHL, PsycINFO and Google Scholar. RESULTS Three antecedents preceded healthcare self-management support for post-discharged stroke patients: loss of inpatient support, preparedness for self-management and presence of self-management support. Healthcare self-management support for post-discharged stroke patients was defined by eight attributes: pre-discharge assessment and planning; provision of continuous education and training; collaborative goal-setting; reinforcement and documentation of vital information; coordination of post-discharge care; provision of rehabilitation support and promoting community reintegration; provision of counselling support; and using clear communication, patient empowerment and promoting self-efficacy. The identified consequences of the concept were as follows: improved patient outcomes; improved life quality; decreased healthcare cost; decreased re-admission rate and inpatient care burden; and decreased complication rate. CONCLUSION Healthcare self-management support for post-discharged stroke patients is an emerging concept that can help to significantly improve stroke patients' health outcomes and life quality. However, its applicability is uncertain considering the workload, time and resources available to healthcare professionals. There is a need for future studies to focus on the feasibility and applicability of this concept in clinical practice and to identify any challenges healthcare providers may have in supporting stroke patients after discharge. IMPACT This concept analysis brings clarity to the concept of healthcare self-management support of post-discharged stroke patients and distinguishes it from other self-management supports. It provides an opportunity for further studies and a pathway for generalized healthcare self-management support for stroke patients after discharge to improve health outcomes and quality of life. NO PATIENT OR PUBLIC CONTRIBUTION No patients, service users, caregivers or members of the public were involved in conducting this concept analysis.
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Affiliation(s)
- Rockson Ansong
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Priscilla Gazarian
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
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9
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Delvallée M, Marchal M, Termoz A, Habchi O, Derex L, Schott AM, Haesebaert J. Development of a patient-centered transition program for stroke survivors and their informal caregivers, combining case-management and access to an online information platform: A user-centered design approach. Digit Health 2024; 10:20552076241272628. [PMID: 39114116 PMCID: PMC11304490 DOI: 10.1177/20552076241272628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 07/17/2024] [Indexed: 08/10/2024] Open
Abstract
Background During the hospital-to-home transition, stroke survivors and their caregivers face a significant lack of support and information which impacts their psychosocial recovery. We aimed to co-design a program combining individual support by a trained case-manager (dedicated professional providing individual support) and an online information platform to address needs of stroke survivors and caregivers. Methods A two-step methodology was used. The first step followed a "user-centered design" approach during four workshops with stroke survivors, caregivers, and healthcare professionals to develop the platform and define the case-manager profile. The second step was a usability test of the platform following a Think Aloud method with patients and caregivers. The workshops and interviews were analyzed following a qualitative thematic analysis. The analysis of Think Aloud interviews was based on User Experience Honeycomb framework by Morville. Results Eight participants attended the workshops: two patients, two caregivers, three nurses, and a general practitioner. Activities, training, and skills of the case-manager were defined according to stroke survivors and caregivers needs. Name, graphics, navigation, and content of the platform were developed with the participants, a developer and a graphic designer. The usability of the platform was tested with 5 patients and 5 caregivers. The Think Aloud confirmed satisfaction with graphics and content but a need for improvement regarding the navigability. An update of the platform was conducted in order to answer the needs expressed by participants. Conclusion We developed, with a participatory approach, a patient-centered transition program, which will be evaluated in a randomized controlled trial.
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Affiliation(s)
- Marion Delvallée
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Mathilde Marchal
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Anne Termoz
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Ouazna Habchi
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Laurent Derex
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Neuro-vasculaire, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Lyon, France
| | - Anne-Marie Schott
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
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Delvallée M, Garreau R, Termoz A, Ploteau PM, Derex L, Schott AM, Haesebaert J. What are the available online resources targeting psychosocial burden among stroke survivors and their informal caregivers: A scoping review. Digit Health 2024; 10:20552076241240895. [PMID: 38515613 PMCID: PMC10956153 DOI: 10.1177/20552076241240895] [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] [Accepted: 03/05/2024] [Indexed: 03/23/2024] Open
Abstract
Background After discharge home, stroke survivors and their informal caregivers face a significant lack of support and information which accentuates their psychosocial burden. Online resources might provide this support and address psychosocial needs, but existing online stroke programmes mainly target functional rehabilitation. We aimed to map the existing literature on online resources that have been evaluated in stroke rehabilitation and aimed at reducing psychosocial impact in stroke survivors and informal caregivers. Methods MEDLINE was searched (2010-2024) to identify studies investigating online resources targeting psychosocial health. Studies were selected and extracted independently by two reviewers. We described the content, use, and psychosocial impact of these interventions using a narrative approach. Results Eleven studies were included in the review, reporting 10 online resources (two studies relating to the same resource). Online resources were heterogeneous: eight information/resources websites, one mobile app, and one forum. Five online resources were dedicated to stroke survivors, four to stroke survivors and their informal caregivers, and one to informal caregivers. Two randomized controlled trials reported a significant decrease in depressive symptoms associated with the use of online resources. Stroke survivors and informal caregivers find online resources useful and acceptable to address their psychosocial needs. Conclusions Few online stroke resources have been designed and evaluated to support post-stroke psychosocial rehabilitation. Further larger-scale research needs to study the impact of these interventions on psychosocial recovery over time.
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Affiliation(s)
- Marion Delvallée
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Romain Garreau
- Pharmacy Department, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Evolutive, UMR CNRS 5558, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne Termoz
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Pierre-Marie Ploteau
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Laurent Derex
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Neuro-vasculaire, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Lyon, France
| | - Anne-Marie Schott
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
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11
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Damaiyanti M, Amir H, Cahyani DD, Alhidayat NS, Afrianti N, Rahmiati C, Hastuti H, Sari AS, Hidayat R. Improving caregiver preparedness in the care transition of stroke patients: a scoping review. J Med Life 2023; 16:1723-1731. [PMID: 38585525 PMCID: PMC10994610 DOI: 10.25122/jml-2023-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/11/2023] [Indexed: 04/09/2024] Open
Abstract
Stroke is a life-threatening condition caused by the rupture of a brain blood vessel, potentially causing brain damage within minutes, severe disability, and even death. After initial hospitalization and rehabilitation, most stroke survivors return home, relying on their family members as caregivers for activities of daily living and treatments. This scoping review aimed to evaluate caregivers' readiness for transitioning stroke patient care to a home environment. We conducted a comprehensive search on Scopus, PubMed, ScienceDirect, and Google Scholar databases, followed by a secondary search to identify articles based on predefined criteria. A total of 14 articles were synthesized, leading to a series of findings: (1) there is a need to assess and identify caregiver needs, (2) the process needs relevant information, (3) caregivers are involved in the care process until the patients are discharged from the hospital, and (4) there is a need to offer support to caregivers. These results indicate that implementing strategies to enhance caregiver preparedness is crucial for the effective home-based care of stroke survivors.
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Affiliation(s)
- Mukhripah Damaiyanti
- Faculty of Nursing, Universitas Muhammadiyah Kalimantan Timur, Kalimantan Timur, Indonesia
| | - Haeril Amir
- Faculty of Public Health, Universitas Muslim Indonesia, Makassar, Indonesia
| | - Desy Dwi Cahyani
- Midwifery Department, Poltekkes Kemenkes Malang, Malang, Indonesia
| | | | - Novi Afrianti
- Faculty of Nursing, Universitas Syiah Kuala, Aceh, Indonesia
| | - Cut Rahmiati
- Akademi Keperawatan Kesdam Iskandar Muda Banda Aceh, Aceh, Indonesia
| | - Hera Hastuti
- Sekolah Tinggi Ilmu Kesehatan Fatmawati, Jakarta, Indonesia
| | | | - Rahmat Hidayat
- Faculty of Public Health, Universitas Muslim Indonesia, Makassar, Indonesia
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12
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Rodriquez J, Bullock D, Cotsonis G, Clark PC, Blanton S. Neighborhood socioeconomic disadvantage measures in rehabilitation clinical trials: Lessons learned in recruitment. Appl Nurs Res 2023; 73:151718. [PMID: 37722786 DOI: 10.1016/j.apnr.2023.151718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/19/2023] [Accepted: 07/28/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE The Area Deprivation Index (ADI) measures the relative disadvantage of an individual or social network using US Census indicators. Although a strong re-hospitalization predictor, ADI has not been routinely incorporated into rehabilitation research. The purposes of this paper are to examine the use of ADI related to study recruitment, association with carepartner psychosocial factors, and recruitment strategies to increase participant diversity. METHODS Descriptive analysis of baseline data from a pilot stroke carepartner-integrated therapy trial. Participants were 32 carepartners (N = 32; 62.5 % female; mean age 57.8 ± 13.0 years) and stroke survivors (mean age (60.6 ± 14.2) residing in an urban setting. Measures included ADI, Bakas Caregiver Outcome Scale, Caregiver Strain Index, and Family Assessment Device. RESULTS Most carepartners were Non-Hispanic White participants (61.3 %), part or fully employed (43 %), with >$50,000 (67.7 %) income, and all had some college education. Most stroke survivors were Non-Hispanic White participants (56.3 %) with some college (81.3 %). Median ADI state deciles were 3.0 (interquartile range 1.5-5, range 1-9), and mean national percentiles were 41.7 ± 23.5 with only 6.3 % of participants from the most disadvantaged neighborhoods. For the more disadvantaged half of the state deciles, the majority were Black or Asian participants. No ADI and carepartner factors were statistically related. CONCLUSIONS The use of ADI data highlighted a recruitment gap in this stroke study, lacking the inclusivity of participants from disadvantaged neighborhoods and with lower education. Using social determinants of health indicators to identify underrepresented neighborhoods may inform recruitment methods to target marginalized populations and broaden the generalizability of clinical trials.
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Affiliation(s)
- Josue Rodriquez
- Emory University, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
| | - DeAndrea Bullock
- Emory University, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America.
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA, United States of America.
| | - Sarah Blanton
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Rd. NE, Room 213, Atlanta, GA 30322, United States of America.
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13
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McCarthy MJ, Garcia YE, Cassady M, Mall NS, Bosch PR, Barger SD. Barriers and strategies for engagement and retention of rural Latino and Native American dyads in psychosocial interventions after stroke. PATIENT EDUCATION AND COUNSELING 2023; 115:107869. [PMID: 37473605 DOI: 10.1016/j.pec.2023.107869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Michael J McCarthy
- Department of Social Work, Northern Arizona University, 19 W McConnell Dr, Flagstaff, AZ 86011, USA.
| | - Y Evie Garcia
- Department of Educational Psychology, Northern Arizona University, Flagstaff, AZ, USA
| | - Mara Cassady
- Department of Communication Sciences and Disorders, Northern Arizona University, Flagstaff, AZ, USA
| | - Neshay S Mall
- Department of Educational Psychology, Northern Arizona University, Flagstaff, AZ, USA
| | - Pamela R Bosch
- Department of Physical Therapy and Athletic Training, Northern Arizona University Phoenix Bioscience Core, Phoenix, AZ, USA
| | - Steven D Barger
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, AZ, USA
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14
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Takashi N, McCarthy MJ, Ono-Kihara M, Kihara M, Nakayama T. Disagreement about perceptions of patient disability between the stroke patient and caregiver: a cross sectional study exploring the association to patient and caregiver quality of life. Aging Ment Health 2023; 27:1729-1737. [PMID: 36036267 PMCID: PMC9339023 DOI: 10.1080/13607863.2022.2116400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/21/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study explored the association of disagreement in the perception of patient disability between patients and family caregivers with physical and psychological quality of life (QOL) in both parties. METHODS A cross-sectional analysis of data collected from male stroke patients and family caregivers was conducted. Physical and psychological QOL in patients and caregivers were measured using the WHOQOL BREF. Perceptions of patient disability were measured using the 12-item WHO Disability Assessment Schedule 2.0 (DAS). Using DAS scores reported independently by patients and caregivers, dyads were categorized into one of four groups representing agreement or disagreement about patient disability. Generalized estimating equations were used to examine the associations between WHOQOL scores in patients and caregivers and these four groups. RESULTS Among 56 dyads enrolled, approximately 52% were categorized into 'agreement' groups and 48% were categorized into 'disagreement' groups. The disagreement in perception about patient disability were significantly associated with poor patient physical QOL. However, the disagreement in perception were not significantly associated with caregiver QOL. CONCLUSION Findings suggest the association of disagreement with QOL differs between patients and caregivers. Further research is needed to carefully appraise the relationship and interaction between patient and caregiver.
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Affiliation(s)
- Naoki Takashi
- Graduate School of Medicine, School of Public Health, Department of Health Informatics, Kyoto University, Kyoto, Japan
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Tokyo, Japan
| | - Michael J McCarthy
- College of Social and Behavioral Sciences, Department of Social Work, Northern Arizona University, Flagstaff, AZ, USA
| | - Masako Ono-Kihara
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
| | - Masahiro Kihara
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
| | - Takeo Nakayama
- Graduate School of Medicine, School of Public Health, Department of Health Informatics, Kyoto University, Kyoto, Japan
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15
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Quinn EB, LeLaurin JH, Eliazar-Macke ND, Orozco T, Montague M, Freytes IM, Uphold CR. Effect of a telephone and web-based problem-solving intervention for stroke caregivers on stroke patient activities of daily living: A randomized controlled trial. Clin Rehabil 2023; 37:1062-1073. [PMID: 36847253 DOI: 10.1177/02692155231157301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To test for effects of a problem-solving intervention for stroke caregivers on stroke survivor activities of daily living. DESIGN Two-arm parallel randomized clinical trial with repeated measures at 11 weeks and 19 weeks. SETTING Medical centers for US military Veterans. SUBJECTS Caregivers of stroke survivors. INTERVENTION A registered nurse guided caregivers in using problem-solving strategies emphasizing creative thinking, optimism, planning, and expert information to address challenges associated with caregiving. Caregivers in the intervention completed one telephone orientation session followed by eight online, asynchronous messaging center sessions. The messaging center sessions involved (a) education on the Resources and Education for Stroke Caregivers' Understanding and Empowerment website (https://www.stroke.cindrr.research.va.gov/en/), (b) supportive communication between the nurse and caregiver, (c) nurse and caregiver interactions to improve problem-solving, and (d) maintain adherence to discharge planning instructions. MAIN OUTCOME The Barthel Index was used to measure activities of daily living. RESULTS 174 participants (standard care n = 88, intervention n = 86) were enrolled at baseline. There were no significant differences between groups at baseline. Change scores in activities of daily living between baseline and 11 weeks were significantly higher in the intervention group than the standard care group (group difference = 6.43, 95% confidence interval: 1.28, 11.58). Group differences in change scores between baseline and 19 weeks were not statistically significant (group difference = 3.89, 95% confidence interval: -3.58, 11.36). CONCLUSIONS This web-based caregiver intervention improved stroke survivor activities of daily living by 11 weeks, but intervention effects were undetectable after 19 weeks.
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Affiliation(s)
- Edward B Quinn
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Department of Anthropology, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, USA
| | - Jennifer H LeLaurin
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Tatiana Orozco
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Magda Montague
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - I Magaly Freytes
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Constance R Uphold
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Department of Aging & Geriatrics, College of Medicine, University of Florida, Gainesville, FL, USA
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16
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Lobo EH, Abdelrazek M, Frølich A, Rasmussen LJ, Livingston PM, Islam SMS, Kensing F, Grundy J. Detecting user experience issues from mHealth apps that support stroke caregiver needs: an analysis of user reviews. Front Public Health 2023; 11:1027667. [PMID: 37304084 PMCID: PMC10247988 DOI: 10.3389/fpubh.2023.1027667] [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] [Received: 08/25/2022] [Accepted: 05/05/2023] [Indexed: 06/13/2023] Open
Abstract
Background Existing research has demonstrated the potential of mHealth apps in improving the caregiving outcomes of stroke. Since most of the apps were published in commercially available app stores without explaining their design and evaluation processes, it is necessary to identify the user experience issues to promote long-term adherence and usage. Objective The purpose of this study was to utilize published user reviews of commercially available apps to determine the user experience issues to guide future app development in stroke caregiving. Methods User reviews were extracted from the previously identified 46 apps that support stroke caregiving needs using a python-scraper. The reviews were pre-processed and filtered using python scripts to consider English reviews that described issues faced by the user. The final corpus was categorized based on TF-IDF vectorization and k-means clustering technique, and the issues extracted from the various topics were classified based on the seven dimensions of user experience to highlight factors that may affect the usage of the app. Results A total of 117,364 were extracted from the two app stores. After filtration, 13,368 reviews were included and classified based on the user experience dimensions. Findings highlight critical issues that affect the usability, usefulness, desirability, findability, accessibility, credibility, and value of the app that contribute to decreased satisfaction and increased frustration. Conclusion The study identified several user experience issues due to the inability of the app developers to understand the needs of the user. Further, the study describes the inclusion of a participatory design approach to promote an improved understanding of user needs; therefore, limiting any issues and ensuring continued use.
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Affiliation(s)
- Elton H. Lobo
- School of Information Technology, Deakin University, Geelong, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
| | - Lene J. Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - John Grundy
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
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Hiyoshi A, Rostila M, Fall K, Montgomery S, Grotta A. Caregiving and changes in health-related behaviour. Soc Sci Med 2023; 322:115830. [PMID: 36930838 DOI: 10.1016/j.socscimed.2023.115830] [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: 12/06/2022] [Revised: 02/12/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
Potential health risks for informal caregivers have been hypothesised to be partly related to adverse changes in health-related behaviour, but evidence is limited. We examined whether smoking, drinking, eating, physical activity or leisure pursuits change in relation to co-resident or out-of-home caregiving (for someone outside the household), and if associations differ by sex, educational attainment, and welfare state typology. We conducted a longitudinal study using six waves of the Survey of Health, Ageing and Retirement in Europe, collecting data repeatedly from 2004 to 2017 for adults aged 50 years and older living in 17 European countries (57,962 individuals). To control for measured and unmeasured within-individual time-invariant confounders, we used fixed effects logistic models to analyse the repeated measures of caregiving, behaviour and covariates and estimated odds ratios (OR) with 95% confidence intervals (95%CI). Among male participants, unhealthy eating increased while smoking decreased [ORs 1.26 (95%CI 1.01-1.58) and 0.53 (0.36-0.78), respectively] in survey waves in which they provided co-resident care, compared with the waves that they did not. Among female participants, there was little change in behaviour between waves with and without co-resident caregiving. When providing out-of-home care, lacks of physical activity and leisure pursuits declined. But in the same time, drinking increased both men and women, and especially among individuals with lower educational attainment and residing in non-Nordic countries. To conclude, overall, increased drinking when providing out-of-home care was most consistent, especially among individuals with lower educational attainment and residing in non-Nordic countries. Otherwise, the associations varied by the type of care, behaviour and population subgroups. These findings indicated that not all caregivers are susceptible to behavioural changes, and that not all behaviour may be involved similarly in linking caregiving to health risks. This opens possibilities to target specific behaviour and groups to prevent adverse changes in health behaviour in caregivers.
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Affiliation(s)
- Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK; Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden.
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Epidemiology and Public Health, University College London, London, UK; Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
| | - Alessandra Grotta
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden; Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden.
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18
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Freytes IM, Schmitzberger MK, Rivera-Rivera N, Lopez J, Motta-Valencia K, Wu SS, Orozco T, Hale-Gallardo J, Eliazar-Macke N, LeLaurin JH, Uphold CR. Study protocol of a telephone problem-solving intervention for Spanish-speaking caregivers of veterans post-stroke: an 8-session investigator-blinded, two-arm parallel (intervention vs usual care), randomized clinical trial. BMC PRIMARY CARE 2023; 24:73. [PMID: 36932321 PMCID: PMC10022053 DOI: 10.1186/s12875-022-01929-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/25/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND Stroke is one of the leading causes of death and the main cause of long-term disability in the United States. The significant risk factors of stroke among Hispanics are well-documented. The majority of stroke survivors return home following a stroke and are cared for by family caregivers. Due to the abrupt nature of strokes, caregivers experience unexpected changes and demands that oftentimes lead to caregiver burden and depression. Given the significant risk factors for stroke in Hispanics and the influence of culture in family norms and family management, we developed a telephone and online problem-solving intervention for Spanish-speaking stroke caregivers. This study tests the impact of a telephone and online problem-solving intervention for Spanish-speaking stroke caregivers on caregiver outcomes. METHODS The design is a two-arm parallel randomized clinical trial with repeated measures. We will enroll 290 caregivers from 3 Veterans Affairs (VA) medical centers. Participants randomized into the intervention arm receive a problem-solving intervention that uses telephone and online education and care management tools on the previously developed and nationally available RESCUE en Español Caregiver website. In the usual care group, participants receive the information and/or support caregivers of veterans with stroke normally receive through existing VA resources (e.g., stroke-related information and support). The primary outcome is change in caregiver's depressive symptoms at 1- and 12-weeks post-intervention. Secondary outcomes include changes in stroke caregivers' burden, self-efficacy, problem-solving, and health-related quality of life (HRQOL) and veterans' functional abilities. We will also determine the budgetary impact, the acceptability of the intervention and participation barriers and facilitators for Spanish-speaking stroke caregivers. DISCUSSION This is an ongoing study. It is the first known randomized controlled trial testing the effect of a telephone and online problem-solving intervention in Spanish for caregivers of veterans post-stroke. If successful, findings will support an evidence-based model that can be transported into clinical practice to improve the quality of caregiving post-stroke. TRIAL REGISTRATION ClinicalTrials.gov: NCT03142841- Spanish Intervention for Caregivers of Veterans with Stroke (RESCUE Español). Registered on February 23, 2018. Protocol version 8. 08.11.2022.
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Affiliation(s)
- I Magaly Freytes
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA.
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA.
| | - Magda K Schmitzberger
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
| | - Naiomi Rivera-Rivera
- Research Service, VA Caribbean Healthcare System, 10 Casia St, San Juan, PR, 00921, USA
| | - Janet Lopez
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
| | - Keryl Motta-Valencia
- Physical Medicine and Rehabilitation Service, VA Caribbean Healthcare System, 10 Casia St, San Juan, PR, 00921, USA
| | - Samuel S Wu
- College of Medicine, Department of Biostatistics, University of Florida, CTRB Room 5243, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Tatiana Orozco
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
| | - Jennifer Hale-Gallardo
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
| | - Nathaniel Eliazar-Macke
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
| | - Jennifer H LeLaurin
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
| | - Constance R Uphold
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
- College of Medicine, Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32603, USA
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19
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Berg A, Tapiola T, Hujala M. Spouses' need for information and satisfaction with the patient's care and rehabilitation after stroke. Importance of depression and prescheduled follow-up. PATIENT EDUCATION AND COUNSELING 2023; 107:107589. [PMID: 36508974 DOI: 10.1016/j.pec.2022.107589] [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: 05/18/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES We aimed to study the information needs of the spouses of stroke survivors, and whether the functional ability, depressive mood, or demographic factors of the survivors or spouses associate with the information needs or satisfaction with care. We also investigated whether prescheduled follow-up improves information provision. METHODS Ninety-six spouses of consecutive stroke survivors completed a questionnaire on their information needs and satisfaction with care 21 months post-stroke. The results of samples before (n = 59) and after (n = 37) the implementation of the prescheduled follow-up were compared. RESULTS Before the follow-up, 75% of the spouses had received information on stroke and the well-being of the survivor, with 31% having received information on the survivors' and 18% on the spouses' own mood. The information provision improved after the follow-up: 86%, 44%, and 50%, respectively. The need for more information and satisfaction with care were associated with the spouse's depression, but not with functional impairment. CONCLUSIONS Even if information on stroke is satisfactorily provided, the mood and well-being of spouses is often neglected. Information provision and support can be improved with systematic prescheduled follow-up. PRACTICE IMPLICATIONS Our results suggest the routine assessment of the depressive symptoms and needs of spouses of stroke survivors.
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Affiliation(s)
- Anu Berg
- Neurological Unit, South Karelia Central Hospital, South Karelia Social and Health Care District, Lappeenranta, Finland.
| | - Tero Tapiola
- Neurological Unit, South Karelia Central Hospital, South Karelia Social and Health Care District, Lappeenranta, Finland
| | - Maija Hujala
- School of Business and Management, Lappeenranta-Lahti University of Technology LUT, Lappeenranta, Finland
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Petrizzo A, Lyons KS, Bartoli D, Simeone S, Alvaro R, Lee CS, Vellone E, Pucciarelli G. The moderating role of caregiver preparedness on the relationship between depression and stroke-specific quality of life in stroke dyads: a longitudinal study. Eur J Cardiovasc Nurs 2023; 22:53-63. [PMID: 35670198 DOI: 10.1093/eurjcn/zvac037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 02/03/2023]
Abstract
AIMS To examine the moderating role of caregiver preparedness on the association between stroke survivors' depression and stroke-specific quality of life dimensions. METHODS AND RESULTS We used a multilevel modelling approach to analyse trajectories of change in the eight Stroke Impact Scale 3.0 subscales [i.e. strength, communication, mobility, activities of daily living (ADL)/instrumental activities of daily living (IADL), memory, emotion, hand function, participation] using Hierarchical Linear Modeling. Caregiver preparedness significantly moderated the association between survivor depressive symptoms and survivor communication (B = -0.95, P < 0.01), mobility (B = -0.60, P < 0.05), and ADL/IADL (B = -0.73, P < 0.01) at baseline; linear change for strength (B = 0.83, P < 0.05) and communication (B = 0.66, P < 0.05); and quadratic change for strength (B = -0.19, P < 0.01). Although caregiver preparedness did not significantly moderate the association between survivor depressive symptoms and strength at baseline, there was a significant moderating effect for change over time. Higher levels of caregiver preparedness were significantly associated with higher survivor scores of emotion, hand function, and participation at baseline. CONCLUSIONS Including immediate caregivers in the care process, through a psycho-educational training, would mean having better-prepared caregivers and consequently more-healthy stroke survivors. Given that preparedness includes coping with stress, responding and managing emergencies, assessing help and information may require tailored interventions aimed at improving the caregivers' skills and knowledge about stroke survivors' management.
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Affiliation(s)
- Antonello Petrizzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
| | - Karen S Lyons
- Boston College, William F. Connell School of Nursing, Boston, MA, USA
| | - Davide Bartoli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
| | - Silvio Simeone
- Department of Clinical and Experimental Medicine, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
| | - Christopher S Lee
- Boston College, William F. Connell School of Nursing, Boston, MA, USA
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome 00133, Italy
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21
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Greenway MRF, Robinson MT. Palliative care approaches to acute stroke in the hospital setting. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:13-27. [PMID: 36599505 DOI: 10.1016/b978-0-12-824535-4.00010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Stroke is a prevalent neurologic condition that portends a high risk of morbidity and mortality such that patients impacted by stroke and their caregivers can benefit from palliative care at the time of diagnosis and throughout the disease trajectory. Clinicians who care for stroke patients should be adept at establishing rapport with patients and caregivers, delivering serious news, responding to emotions, discussing prognosis, and establishing goals of care efficiently in an acute stroke setting. Aggressive stroke care can be integrated with a palliative approach to care that involves aligning the available treatment options with a patient's values and goals of care. Reassessing the goals throughout the hospitalization provides an opportunity for continued shared decision-making about the intensity of poststroke interventions. The palliative needs for stroke patients may increase over time depending on the severity of disease, poststroke complications, stroke-related symptoms, and treatment intensity preferences. If the decision is made to transition the focus of care to comfort, the support of an interdisciplinary palliative care or hospice team can be beneficial to the patient, family members, and surrogate decision makers.
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Affiliation(s)
| | - Maisha T Robinson
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States; Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, United States.
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22
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Morgenstern LB, Almendarez EM, Mehdipanah R, Kwicklis M, Case E, Smith MA, Lisabeth LD. Methods and early recruitment of the Brain Attack Surveillance in Corpus Christi-Post-acute Care (BASIC-PAC) Project. J Stroke Cerebrovasc Dis 2022; 31:106851. [PMID: 36335753 PMCID: PMC10024336 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Compared with non-Hispanic whites (NHWs), Mexican Americans (MAs) have worse stroke outcomes. We report here the methods, background literature, and initial recruitment of the Brain Attack Surveillance in Corpus Christi-Post Acute Care (BASIC-PAC) Project which aims to explore PAC in MAs and NHWs from multiple perspectives: patients, caregivers, and community. MATERIALS AND METHODS Rigorous active and passive stroke surveillance captures all strokes in Nueces County, Texas. Stroke patients are followed for 90 days to determine their care transitions and factors influencing their rehabilitation setting. Informal caregivers of the stroke patients are identified and interviewed at 90 days to determine aspects of their caregiving and caregiver outcomes. Available community resources are compared with stated needs among stroke patient and caregivers to determine unmet needs. RESULTS Between October, 2019 and October, 2021, among the 629 stroke patients eligible, 413 were MA, 227 were NHW. Of the 629, all of the six follow-up calls were completed by 355 of the MAs (87%) and 191 of the NHWs (87%). During this same time period, we attempted to approach 621 potential caregivers. Of these, 458 (73.8%) potential caregivers participated in interviews to determine caregiver eligibility, and 373 (81.4%) of these participating potential caregivers met the eligibility criteria. CONCLUSIONS BASIC-PAC has strong initial recruitment and is poised to provide valuable data on multiple aspects of PAC and how PAC differs by ethnicity and contributes to worse stroke outcomes in MAs. Based on the study findings, interventions can be developed that will improve stroke health equity.
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Affiliation(s)
- Lewis B Morgenstern
- Stroke Program, University of Michigan Medical School, Ann Arbor, United States; Department of Epidemiology, University of Michigan School of Public Health, United States.
| | - Elizabeth M Almendarez
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - Roshanak Mehdipanah
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, United States
| | - Madeline Kwicklis
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - Erin Case
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - Melinda A Smith
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - Lynda D Lisabeth
- Stroke Program, University of Michigan Medical School, Ann Arbor, United States; Department of Epidemiology, University of Michigan School of Public Health, United States
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23
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Fu B, Mei Y, Lin B, Guo Y, Zhang Z, Qi B, Wang Y. Effects of A Benefit-Finding Intervention in Stroke Caregivers in Communities. Clin Gerontol 2022; 45:1317-1329. [PMID: 32496892 DOI: 10.1080/07317115.2020.1765062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: To verify the effectiveness and feasibility of a nine-week benefit-finding intervention on the burden, quality of life, and benefit finding of caregivers, as well as on the quality of life of stroke survivors.Methods: Benefit finding refers to the individual, social, psychological and spiritual benefits perceived by an individual experiencing stress or post-traumatic events. A randomized controlled trial was performed in which 68 stroke survivors and their caregivers were recruited from the Zhengzhou community, China, and randomly split into two groups. The intervention group included those having undergone a nine-week benefit-finding intervention, while the control group included those individuals having undergone a nine-week routine health education. At baseline and one-week post-intervention (after a 9-week intervention), the quality of life of stroke survivors and caregivers and the burden and benefit finding of caregivers were determined.Results: In comparison to the control group, caregiver benefit finding, quality of life, burden, and stroke survivor quality of life were significantly improved (P <.005).Conclusions: The intervention appears to be feasible for stroke patients and caregivers. The intervention is capable of improving the quality of life of caregivers and survivors, increasing the benefit finding of caregivers and reducing the burden of caregivers.Clinical Implications: The benefit-finding intervention is capable of improving the health condition of stroke patients and caregivers.
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Affiliation(s)
- Bo Fu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Yongxia Mei
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Beilei Lin
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Yawen Guo
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Bei Qi
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Yongli Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
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24
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Zhou J, He B, He Y, Zhu H, Zhang M, Huang W, Wang Y. The effectiveness of psychoeducational interventions on family function among families after stroke: A meta-analysis. Int J Nurs Pract 2022; 28:e13081. [PMID: 35855498 DOI: 10.1111/ijn.13081] [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: 09/27/2020] [Revised: 11/18/2021] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
AIMS This meta-analysis aimed to synthesize the available evidence on the effectiveness of psychoeducational interventions on family function among families after stroke. BACKGROUND Family function may be improved by psychoeducational intervention, but findings about the effect of psychoeducation on family function among families after stroke have been mixed. METHODS This was a meta-analysis carried out by searching five international electronic databases, including Cochrane Library, PubMed, EMBASE, Web of Science and CINAHL, as well as four national electronic databases, including Chinese Biological Medicine (CBM), China National Knowledge Infrastructure (CNKI), VIP and Wanfang. Two groups of researchers screened the studies independently, assessed the quality of the studies and extracted data. Meta-analysis was performed by using the RevMan 5.3 software. RESULTS Five studies on psychoeducational interventions were included. Pooled analysis of these studies showed a small effect of the interventions on improving family function (WMD: -0.13, 95% CI: -0.24 to -0.01, P < 0.05). Subgroup analysis showed significant differences between the psychoeducation and control groups at 1 month postintervention (WMD: -0.12, 95% CI: -0.18 to -0.05, P < 0.05) and more than 6 months postintervention (WMD: -0.14, 95% CI: -0.24 to -0.04, P < 0.05). The psychoeducational interventions also had positive effect on improving the problem solving (WMD: -0.22, 95% CI: -0.14 to -0.03, P < 0.05) and communication (WMD: -0.23, 95% CI: -0.41 to -0.05, P < 0.05) functions of the family. There were significant differences in the group of dyad intervention (WMD: -0.14, 95% CI: -0.25 to -0.02, P < 0.05) and the group using face to face method (WMD: -0.58, 95% CI: -0.84 to -0.32, P < 0.05). CONCLUSIONS Synthesized results demonstrated the favourable effect of psychoeducational interventions on the improvement of the family function among families after stroke, especially in terms of family problem solving and family communication. Future psychoeducational intervention research design should consider the combination of multiple intervention methods and the applicable population of intervention.
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Affiliation(s)
- Jia Zhou
- Shihezi University School of Medicine, Xinjiang, China
| | - Bin He
- The People's Hospital of Shihezi City, Xinjiang, China
| | - Yaoyu He
- Liaoning He University, Liaoning, China
| | - Hongxu Zhu
- Shihezi University School of Medicine, Xinjiang, China
| | | | - Wei Huang
- The Shaanxi Provincial People's Hospital, Shaanxi, China
| | - Yuhuan Wang
- Shihezi University School of Medicine, Xinjiang, China
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25
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Fusar-Poli L, Surace T, Meo V, Patania F, Avanzato C, Pulvirenti A, Aguglia E, Signorelli MS. Psychological well-being and family distress of Italian caregivers during the COVID-19 outbreak. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2243-2259. [PMID: 34897728 DOI: 10.1002/jcop.22772] [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: 07/21/2021] [Revised: 10/18/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
The present study aimed to investigate the personal well-being and family distress of Italian caregivers during the lockdown. Five hundred sixty-five family caregivers and 638 age- and sex-matched noncaregivers completed a web-based survey. The following scales were administered to all participants: General Health Questionnaire-12 items (GHQ-12), Insomnia Severity Index (ISI), Brief Resilient Coping Scale (BRCS), and Family Distress Index (FDI). Caregivers were also asked to provide information about their family members with disabilities. Individual and family distress, as well as insomnia, were significantly higher in caregivers than controls. Contrariwise, caregivers reported lower resilience levels. Multiple linear regression showed that distress was higher in caregivers living in Central and Southern Italy. Individual well-being was negatively predicted by low independence measured by the activities of daily living (ADL). Family distress was higher in households of psychiatric patients. Finally, low resilience levels appeared as the strongest predictors of both individual and family distress. The lockdown caused severe distress among caregivers and families of people with disabilities. Support networks for people with disabilities and their families are fundamental to prevent severe consequences from a psychological, social, and economical point of view.
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Affiliation(s)
- Laura Fusar-Poli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Teresa Surace
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Valeria Meo
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Federica Patania
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Chiara Avanzato
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Alfredo Pulvirenti
- Department of Clinical and Experimental Medicine, Unit of Bioinformatics and Computer Science, University of Catania, Catania, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
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26
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Lutz BJ, Kucharska-Newton AM, Jones SB, Psioda MA, Gesell SB, Coleman SW, Johnson AM, Radman MD, Levy S, Bettger JP, Freburger JK, Chou A, Celestino J, Rosamond WD, Bushnell CD, Duncan PW. Familial caregiving following stroke: findings from the comprehensive post-acute stroke services (COMPASS) pragmatic cluster-randomized transitional care study. Top Stroke Rehabil 2022; 30:436-447. [PMID: 35603644 DOI: 10.1080/10749357.2022.2077520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Stroke patients discharged home often require prolonged assistance from caregivers. Little is known about the real-world effectiveness of a comprehensive stroke transitional care intervention on relieving caregiver strain. OBJECTIVES To describe the effect of the COMPASS transitional care (COMPASS-TC) intervention on caregiver strain and characterize the types, duration, and intensity of caregiving. METHODS The cluster-randomized COMPASS pragmatic trial evaluated the effectiveness of COMPASS-TC versus usual care with patients with mild stroke and TIA at 40 hospitals in North Carolina, USA. Of 5882 patients enrolled, 4208 (71%) identified a familial caregiver. A follow-up Caregiver Questionnaire, including the Modified Caregiver Strain Index, was administered at approximately three months post-discharge. Demographics and frequency, duration, and intensity of caregiving were compared between groups. RESULTS 1228 caregivers (29%) completed the questionnaire. Completion was positively associated with older patient age, white race, and spousal relationship. One-third of the caregivers provided ≥30 hours of care per week and 889 (79%) provided care ≥9 weeks. Average standardized caregiver strain was 21.9 (0-100), increasing with stroke severity and comorbidity burden. Women caregivers reported higher strain than men. Treatment allocation was not associated with caregiver strain. CONCLUSIONS This sample of mild stroke and TIA survivors received significant assistance from familial caregivers. However, caregiver strain was relatively low. Findings support the importance of familial caregiving in stroke, the continued disproportionate burden on women within the family, and the need for future research on caregiver support.
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Affiliation(s)
- Barbara J. Lutz
- School of Nursing, College of Health and Human Services, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Anna M. Kucharska-Newton
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sara B. Jones
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew A. Psioda
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sabina B. Gesell
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sylvia W. Coleman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Anna M. Johnson
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Meghan D Radman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Samantha Levy
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Janet K Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, USA
| | - Aileen Chou
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, USA
| | - Joan Celestino
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Wayne D. Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Cheryl D. Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Pamela W. Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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27
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Qureshi A, Hargest C, Swain N, Aldabe D, Hale L. Psychosocial interventions for building resilience of informal carers of people living with stroke: a systematic review. Disabil Rehabil 2022; 45:1419-1432. [PMID: 35468030 DOI: 10.1080/09638288.2022.2063419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To identify and synthesise the evidence of interventions purported to build resilience among informal carers of stroke survivors. METHODS A systematic review of randomised controlled trials of psychosocial interventions to build resilience for carers of people post-stroke was planned. A systematic search was conducted in seven online databases from inception to March 2021. Outcomes measured were resilience and its proxy constructs including copying, adaptation, adjustment, problem-solving, self-efficacy, locus of control, competence and strength. RESULTS Twelve studies were included in the review and were grouped into four intervention categories (i) Education and social support, (ii) problem-solving skills, (iii) problem-solving skills, and psychoeducation and (iv) information provision, problem-solving skills and psychoeducation. Level of evidence A exists for interventions that combine information provision, problem-solving skills and psychoeducation over the interventions that only use problem-solving skills intervention or problem-solving skills with psychoeducation strategies. All interventions apart from one reported significant within and/or between group changes in outcomes. CONCLUSION Interventions comprising of information provision, problem-solving skills and psychoeducation appear to be beneficial to improve resilience of carers. However, because of the heterogeneity of the interventions and outcome measures reported across the twelve studies no particular intervention could be definitively supported. CLINICAL TRIAL REGISTRATION Systematic review registration: CRD 42020172824 https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172824 IMPLICATIONS FOR REHABILITATIONProviding care for stroke survivors is particularly demanding due to the lack of preparation for managing the unexpected and complex nature of stroke, resulting in negative physical, social, behavioral, emotional, and financial outcomes.The long-term nature of stroke and its many residual problems can negatively affect the physical and psychological well-being of the individual and their carers, which may subsequently affect the recovery of the stroke survivor.Evidence suggests that resilience is the protective shield for carers' stress and burnout.Integrating interventions focusing on carers' resilience as part of the stroke rehabilitation process is imperative to ensure the well-being of carers and the sustainability of the care provided to the stroke survivor.
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Affiliation(s)
- Ayesha Qureshi
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy - University of Otago, Dunedin, New Zealand
| | - Claire Hargest
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Nicola Swain
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Daniela Aldabe
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Leigh Hale
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
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28
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Garnett A, Ploeg J, Markle-Reid M, Strachan PH. Factors impacting the access and use of formal health and social services by caregivers of stroke survivors: an interpretive description study. BMC Health Serv Res 2022; 22:433. [PMID: 35365130 PMCID: PMC8975449 DOI: 10.1186/s12913-022-07804-x] [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: 08/04/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence has shown that family and friend caregivers of stroke survivors are significantly and negatively impacted by caregiving. The negative effects of caregiving may persist over time suggesting that caregivers might benefit from ongoing engagement with supportive services. However, little is known about caregivers' use of formally funded health and social services, or the factors influencing their access to and use of these services. The aim of this study is to increase understanding of the factors that influence stroke caregivers' access and use of formal health and social services, from the perspective of stroke caregivers and healthcare providers. METHODS A qualitative study was conducted with stroke caregivers and health providers in Ontario, Canada using interpretive description. In-depth interviews were conducted with caregivers of survivors who experienced a stroke between six months to five years previous and healthcare providers who support caregivers and stroke survivors. All participants provided written informed consent. Interview data were analyzed using constant comparison to identify codes and develop key thematic constructs. RESULTS A total of 40 interviews were conducted with 22 stroke caregivers at an average 30-months post-stroke and 18 health providers. Factors that influenced stroke caregivers' access and use of services included: finances and transportation; challenges caregivers faced in caring for their health; trust that they could leave their family member and trust in health providers; limited information pertaining to services and a lack of suitable services; and the response of their social networks to their caregiving situation. CONCLUSION Stroke caregivers experience significant challenges in accessing and using formal health and social services. These challenges could be addressed by increasing availability of subsidized community-based supports such as respite and counselling tailored to meet the ongoing needs of caregivers. Systemic change is needed by the health system that readily includes and supports caregivers throughout the stroke recovery continuum, particularly in the community setting.
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Affiliation(s)
- Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, ON, Canada.,McMaster University, 1280 Main St. W, Hamilton, ON, Canada
| | - Maureen Markle-Reid
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, ON, Canada.,McMaster University, 1280 Main St. W, Hamilton, ON, Canada
| | - Patricia H Strachan
- School of Nursing, McMaster University, Hamilton, ON, Canada.,McMaster University, 1280 Main St. W, Hamilton, ON, Canada
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29
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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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30
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Pipatsrisawat S, Klaphajone J, Kitisak K, Sungkarat S, Wivatvongvana P. Effects of combining two techniques of non-invasive brain stimulation in subacute stroke patients: a pilot study. BMC Neurol 2022; 22:98. [PMID: 35300622 PMCID: PMC8928603 DOI: 10.1186/s12883-022-02607-3] [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: 07/28/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Strokes have recently become a leading cause of disability among Thai people. Non-invasive brain stimulation (NIBS) seems to give promising results in stroke recovery when combined with standard rehabilitation programs. Objective To evaluate the combined effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) and cathodal transcranial direct current stimulation (tDCS) over the non-lesional primary motor cortex on upper limb motor recovery in patients with subacute stroke. No reports of a combination of these two techniques of NIBS were found in the relevant literature. Methods This pilot study was a double-blinded, randomized controlled trial of ten patients with subacute stroke admitted to the Rehabilitation Medicine Inpatient Unit, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. They were randomized into two groups: five in an active and five in a sham intervention group. Fugl-Meyer’s upper extremity motor score (FMA-UE) and Wolf Motor Function Test (WMFT) were used to assess motor recovery at baseline, immediately, and 1 week after stimulation. Results A two-way repeated ANOVA (mixed design) showed a significant improvement in FMA-UE scores in the active intervention group both immediately and 1 week after stimulation in comparison to the baseline, [time, F (2, 16) = 27.44, p < 0.001, time x group interaction, F (2, 16) = 13.29, p < 0.001]. Despite no statistical significance, a trend toward higher WMFT scores was shown in the active intervention group. Conclusions A single session of low-frequency rTMS and cathodal tDCS over the non-lesional primary motor cortex may enhance upper limb motor recovery in patients with subacute stroke. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02607-3.
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Affiliation(s)
- Sutthikit Pipatsrisawat
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Jakkrit Klaphajone
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Kittipong Kitisak
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Somporn Sungkarat
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Pakorn Wivatvongvana
- Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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31
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Welten JJE, Cox VCM, Kruithof WJ, Visser-Meily JMA, Post MWM, van Heugten CM, Schepers VPM. Intra- and interpersonal effects of coping style and self-efficacy on anxiety, depression and life satisfaction in patient-partner couples after stroke. Neuropsychol Rehabil 2022; 33:849-870. [PMID: 35297736 DOI: 10.1080/09602011.2022.2051564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many stroke patients and partners suffer from anxiety, depression, and low life satisfaction. Psychological factors such as coping style and self-efficacy can be protective factors within individuals. The close relationship between stroke patients and partners suggests that there may be interdependence in psychological functioning. The aim of this study was to examine intra- and interpersonal effects of coping style and self-efficacy on anxiety, depression, and life satisfaction in patient-partners couples. In this prospective cohort study, pro-active coping (UPCC), general self-efficacy (GSES), anxiety (HADS-A), depression (HADS-D), and life satisfaction (1-6 scale) were assessed in 215 couples at 2 and 12 months post-stroke. Effects within couples were assessed using structural equation modelling. Several intra- and interpersonal effects of coping style and self-efficacy at 2 months post-stroke were related to emotional health at 12 months post-stroke. Most effects were intrapersonal effects. The interpersonal effects were small but showed that pro-active coping by the patient was associated with lower anxiety of the partner. Higher self-efficacy of the partner was associated with lower depression scores and higher life satisfaction of the patient. This study underscores the importance of a dyadic approach to post-stroke functioning. It supports a family-based approach for treating post-stroke emotional problems.
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Affiliation(s)
- J J E Welten
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - V C M Cox
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - W J Kruithof
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C M van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - V P M Schepers
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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32
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Camicia M, Lutz BJ, Theodore BR. The preparedness assessment for the transition home after stroke predicts key domains of caregiver health. Top Stroke Rehabil 2022; 30:384-392. [PMID: 35156562 DOI: 10.1080/10749357.2022.2038835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Caregivers of stroke survivors often experience adverse health effects due to poor preparation. OBJECTIVES We evaluate the concurrent and predictive validity of the Preparedness Assessment for the Transition Home after Stroke (PATH-s) family caregiver assessment tool relative to important domains of caregiver health and stroke survivor outcomes. METHODS A convenience sample of caregivers (N = 183) was assessed on several health-related quality of life instruments prior to stroke survivor discharge (T1), and at 30-days (T2) and 90-days (T3) post-discharge. RESULTS Caregivers completed assessments at T1 (N = 183), T2 (N = 116, 63%), and T3 (N = 97, 53%). At T1, the PATH-s demonstrated concurrent validity with depressive symptoms (r = -0.26, p < .001), global health (r = 0.45 p < .001) and activation (r = 0.34, p < .001). The PATH-s also has predicted improvements in T2 outcomes including depressive symptoms (radj = -0.21, p < .05), global health (radj = 0.30, p < .01), perceived stress (radj = -0.30, p < .01), activation (radj = 0.21, p < .05), caregiving-specific health-related quality of life (r = 0.23, p < .05), and caregiver strain (r = -0.36, p < .001). At T3, higher scores on the PATH-s were a significant predictor for improvements in activation (radj = 0.24, p < .05). CONCLUSION The PATH-s demonstrates good concurrent and predictive validity and predicts important domains relevant to caregiver well-being. This can be used to identify gaps in caregiver preparedness so interventions can be tailored to optimize the transition home and mitigate adverse effects of caregiving.
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Affiliation(s)
- Michelle Camicia
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo, Vallejo, USA
| | - Barbara J. Lutz
- School of Nursing,University of North Carolina-Wilmington, Wilmington, USA
| | - Brian R. Theodore
- Kaiser Foundation Rehabilitation Center, Kaiser Permanente Vallejo, Vallejo, USA
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Woodward AT, Fritz MC, Hughes AK, Coursaris CK, Swierenga SJ, Freddolino PP, Reeves MJ. Effect of transitional care stroke case management interventions on caregiver outcomes: the MISTT randomized trial. SOCIAL WORK IN HEALTH CARE 2021; 60:1-14. [PMID: 34933665 DOI: 10.1080/00981389.2021.2009958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
This study reports on outcomes for 169 caregivers enrolled in the Michigan Stroke Transitions Trial (MISTT), an RCT of social work case management for stroke patients returning home. A mixed-model approach examined the mean change from 7- to 90-days post-discharge with group-by-time interactions for differences between treatment groups. Caregivers reported few life changes or depressive symptoms from caregiving. There was no significant change over time or treatment effects. Negative aspects of stroke caregiving may take longer to develop. Focused caregiver assessment at discharge and a better understanding of how caregiving develops over time may improve the type and timing of support.
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Affiliation(s)
- Amanda T Woodward
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Michele C Fritz
- Dean's Office, Academic Programs, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Anne K Hughes
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | | | - Sarah J Swierenga
- Professor of Practice in User Experience, Department of Media and Information, Michigan State University, East Lansing, Michigan, USA
| | - Paul P Freddolino
- School of Social Work, Michigan State University, East Lansing, Michigan, USA
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
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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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35
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Pucciarelli G, Lyons KS, Petrizzo A, Ambrosca R, Simeone S, Alvaro R, Lee CS, Vellone E. Protective Role of Caregiver Preparedness on the Relationship Between Depression and Quality of Life in Stroke Dyads. Stroke 2021; 53:145-153. [PMID: 34496626 DOI: 10.1161/strokeaha.120.034029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Depression and quality of life (QOL) have an interdependent and transactional nature in stroke survivor-caregiver dyads. While the strong relationship between depression and physical and emotional QOL in stroke survivor-caregiver dyads is well known, it is less clear if this relationship is moderated by caregiver preparedness, which could easily be targeted with interventions. In this study, we examined the moderating role of caregiver preparedness on the association between depression and QOL in stroke survivor-caregiver dyads. METHODS We used a longitudinal design with follow-ups every 3 months over a 1-year period. Considering the nonindependent nature of the data (survivors and their caregivers), we used multilevel modeling to analyze data at the dyad level. We implemented 4 longitudinal dyadic moderation models (one for each QOL domain: physical, psychological, social, and environmental) using hierarchical linear modeling. RESULTS A sample of 222 stroke survivor-caregiver dyads was analyzed. Stroke survivors were older (M=70.8, SD=11.9) than their caregivers (M=52.4, SD=13.1). Stroke survivors predominantly had an ischemic stroke, equally distributed by site. Caregivers were primarily female (66%), with a medium to high educational level (57%). Caregiver preparedness significantly moderated the association between survivor depression and survivor psychological (B=0.56, P<0.01) and environmental (B=0.58, P<0.01) QOL at baseline and social QOL over time (B=0.24, P<0.05). Similarly, caregiver preparedness significantly moderated the association between caregiver depression and caregiver physical (B=0.25, P<0.01) and environmental (B=0.18, P<0.05) QOL over time. CONCLUSIONS Caregiver preparedness has a positive influence on both members of the dyad. Assessment of stroke-caregiver preparedness could be helpful to motivate clinicians to develop and implement interventions for stroke survivor-caregiver dyads.
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Affiliation(s)
- Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (G.P.)
| | - Karen S Lyons
- Boston College, William F. Connell School of Nursing (K.S.L., C.S.L.)
| | - Antonello Petrizzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (A.P.)
| | - Rossella Ambrosca
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (R. Ambrosca)
| | - Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (S.S.)
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (R. Alvaro)
| | - Christopher S Lee
- Boston College, William F. Connell School of Nursing (K.S.L., C.S.L.)
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy. (E.V.)
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36
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The Effects of Patients' and Caregivers' Characteristics on the Burden of Families Caring for Stroke Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147298. [PMID: 34299748 PMCID: PMC8306485 DOI: 10.3390/ijerph18147298] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022]
Abstract
Background: Vascular strokes are the leading cause of long-term disability for adults. They impose high levels of burden on the patient, the family, and national healthcare systems worldwide. This study aimed to assess the effects of patients’ and caregivers’ characteristics on the perceptions of burden in families caring for a loved one living with stroke in Greece. Methods: Using purposive sampling, 109 dyads of patients and their respective caregivers were recruited from the Attica region. Patients completed a questionnaire that included personal characteristics and the Barthel Index, while caregivers completed a set of questionnaires—personal characteristics, revised Bakas Caregiving Outcomes Scale (BCOS), Personal Resource Questionnaire (PRQ 2000), and Center for Epidemiological Studies-Depression (CES-D). Results: Caregiving burden was linked to both patients’ and caregivers’ characteristics. A patient’s educational level, the number of family members living in the same house, the existence of equipment and facilities in the house, and the duration of provided care were associated with perception of greater burden. Regarding caregivers’ characteristics, those in good health had a significantly lower perception of burden. Higher PRQ 2000 scores were significantly associated with higher BCOS scores (less burden), and higher CES-D scores were significantly associated with lower BCOS scores (more burden). Conclusion: Caring for a loved one affected by stroke places a considerable burden on the caregiver. Systematic assessment and intervention strategies can help to identify caregivers at risk so that suitably targeted assistance may be provided.
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Kazemi A, Azimian J, Mafi M, Allen KA, Motalebi SA. Caregiver burden and coping strategies in caregivers of older patients with stroke. BMC Psychol 2021; 9:51. [PMID: 33794995 PMCID: PMC8017750 DOI: 10.1186/s40359-021-00556-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/22/2021] [Indexed: 12/14/2022] Open
Abstract
Background Coping strategies play a key role in modulating the physical and psychological burden on caregivers of stroke patients. The present study aimed to determine the relationship between the severity of burden of care and coping strategies amongst a sample of Iranian caregivers of older stroke patients. It also aimed to examine the differences of coping strategies used by male and female caregivers. Methods A total of 110 caregivers of older patients who previously had a stroke participated in this descriptive and cross-sectional study. The Zarit Burden Interview and Lazarus coping strategies questionnaires were used for data collection. Questionnaires were completed by the caregivers, who were selected using convenience sampling. The collected data were analyzed using Pearson's correlations and independent t-tests.
Results The mean age of participants was 32.09 ± 8.70 years. The majority of the caregivers sampled reported mild to moderate (n = 74, 67.3%) burden. The most commonly used coping strategies reported were positive reappraisal and seeking social support. Results of the independent t-test showed that male caregivers used the positive reappraisal strategy (t(110) = 2.76; p = 0.007) and accepting responsibility (t(110) = 2.26; p = 0.026) significantly more than female caregivers. Pearson’s correlations showed a significant positive correlation between caregiver burden and emotional-focused strategies, including escaping (r = 0.245, p = 0.010) and distancing (r = 0.204, p = 0.032). Conclusions Caregivers with higher burden of care used more negative coping strategies, such as escape-avoidance and distancing. In order to encourage caregivers to utilize effective coping skills, appropriate programs should be designed and implemented to support caregivers. Use of effective coping skills to reduce the level of personal burden can improve caregiver physical health and psychological well-being. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00556-z.
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Affiliation(s)
- Azar Kazemi
- Student Research Committee, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Jalil Azimian
- School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Maryam Mafi
- School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Kelly-Ann Allen
- Faculty of Education, Monash University, Clayton, Australia.,The Centre for Wellbeing Science, Melbourne Graduate School of Education, University of Melbourne, Parkville, Australia
| | - Seyedeh Ameneh Motalebi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
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King A, Ringel JB, Safford MM, Riffin C, Adelman R, Roth DL, Sterling MR. Association Between Caregiver Strain and Self-Care Among Caregivers With Diabetes. JAMA Netw Open 2021; 4:e2036676. [PMID: 33570574 PMCID: PMC7879235 DOI: 10.1001/jamanetworkopen.2020.36676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Caregiver strain has been shown to be associated with adverse effects on caregivers' health, particularly among those with cardiovascular disease. Less is known about the association of caregiver strain with health behaviors among caregivers with diabetes, a disease that requires a high degree of self-care. OBJECTIVE To examine the association between caregiver strain and diabetes self-care among caregivers with diabetes. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted between July 13, 2018, and June 25, 2020, using data on 795 US caregivers aged 45 years or older with self-reported diabetes from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, which comprised 30 239 Black and White adults 45 years or older throughout the US enrolled from January 2003 to October 2007. EXPOSURES Caregiver strain, assessed by self-report in response to the question, "How much of a mental or emotional strain is it to provide this care?" Response options were no strain, some strain, or a lot of (high) strain. MAIN OUTCOMES AND MEASURES Diabetes self-care, which was assessed across 4 domains (Mediterranean diet adherence, physical activity, smoking status, and medication adherence), and a composite self-care score summing performance across these domains. The association between caregiver strain and diabetes self-care was examined with multivariable Poisson regression adjusting for demographic, clinical, physical and mental functioning, and caregiving covariates. RESULTS Among the 795 caregivers with diabetes included in the study, the mean (SD) age was 63.7 (8.6) years, 469 (59.0%) were women, and 452 (56.9%) were Black individuals. Overall, 146 caregivers (18.4%) reported high caregiver strain. In unadjusted models, high caregiver strain was associated with less physical activity (prevalence ratio [PR], 0.66; 95% CI, 0.45-0.97), low medication adherence (PR, 0.80; 95% CI, 0.68-0.94), and worse self-care (PR, 0.65; 95% CI, 0.44-0.98). In adjusted models, the association between some and high caregiving strain with low medication adherence remained significant (adjusted PR: some strain, 0.88 [95% CI, 0.78-0.99]; high strain, 0.83 [95% CI, 0.69-0.99]). CONCLUSIONS AND RELEVANCE In this cohort study of US adult caregivers with diabetes, a high level of strain was associated with low medication adherence. Increased awareness of the prevalence of caregiver strain and potential ramifications on caregivers' self-care appears to be warranted among health care professionals and caregivers.
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Affiliation(s)
- Alexandra King
- New York Presbyterian Hospital/Weill Cornell Medicine, New York
| | - Joanna Bryan Ringel
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Catherine Riffin
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
| | - Ronald Adelman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
| | - David L. Roth
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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Darley S, Knowles S, Woodward-Nutt K, Mitchell C, Grande G, Ewing G, Rhodes S, Bowen A, Patchwood E. Challenges implementing a carer support intervention within a national stroke organisation: findings from the process evaluation of the OSCARSS trial. BMJ Open 2021; 11:e038129. [PMID: 33436462 PMCID: PMC7805355 DOI: 10.1136/bmjopen-2020-038129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 11/02/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To examine the implementation of an intervention to support informal caregivers and to help understand findings from the Organising Support for Carers of Stroke Survivors (OSCARSS) cluster randomised controlled trial (cRCT). DESIGN Longitudinal process evaluation using mixed methods. Normalisation process theory informed data collection and provided a sensitising framework for analysis. SETTING Specialist stroke support services delivered primarily in the homes of informal carers of stroke survivors. PARTICIPANTS OSCARSS cRCT participants including carers, staff, managers and senior leaders. INTERVENTION The Carer Support Needs Assessment Tool for Stroke (CSNAT-Stroke) intervention is a staff-facilitated, carer-led approach to help identify, prioritise and address support needs. RESULTS We conducted qualitative interviews with: OSCARSS cRCT carer participants (11 intervention, 10 control), staff (12 intervention, 8 control) and managers and senior leaders (11); and obtained 140 responses to an online staff survey over three separate time points. Both individual (carer/staff) and organisational factors impacted implementation of the CSNAT-Stroke intervention and how it was received by carers. We identified four themes: staff understanding, carer participation, implementation, and learning and support. Staff valued the idea of a structured approach to supporting carers, but key elements of the intervention were not routinely delivered. Carers did not necessarily identify as 'carers', which made it difficult for staff to engage them in the intervention. Despite organisational enthusiasm for OSCARSS, staff in the intervention arm perceived support and training for implementation of CSNAT-Stroke as delivered primarily by the research team, with few opportunities for shared learning across the organisation. CONCLUSIONS We identified challenges across carer, staff and organisation levels that help explain the OSCARSS cRCT outcome. Ensuring training is translated into practice and ongoing organisational support would be required for full implementation of this type of intervention, with emphasis on the carer-led aspects, including supporting carer self-identification. TRIAL REGISTRATION NUMBER ISRCTN58414120.
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Affiliation(s)
- Sarah Darley
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Sarah Knowles
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Kate Woodward-Nutt
- NIHR Collaboration for Leadership in Applied Health Research and Care, Greater Manchester, Manchester, UK
| | - Claire Mitchell
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Sarah Rhodes
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Audrey Bowen
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Emma Patchwood
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
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LeLaurin JH, Lamba AH, Eliazar-Macke ND, Schmitzberger MK, Freytes IM, Dang S, Vogel WB, Levy CE, Klanchar SA, Beyth RJ, Shorr RI, Uphold CR. Postdischarge Intervention for Stroke Caregivers: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e21799. [PMID: 33174856 PMCID: PMC7688383 DOI: 10.2196/21799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The majority of stroke survivors return to their homes and need assistance from family caregivers to perform activities of daily living. These increased demands coupled with the lack of preparedness for their new roles lead to a high risk for caregivers developing depressive symptoms and other negative outcomes. Follow-up home support and problem-solving interventions with caregivers are crucial for maintaining stroke survivors in their homes. Problem-solving interventions are effective but are underused in practice because they require large amounts of staff time to implement and are difficult for caregivers logistically. OBJECTIVE The aim of this study is to test a problem-solving intervention for stroke caregivers that can be delivered over the telephone during the patient's transitional care period (time when the stroke survivor is discharged to home) followed by 8 asynchronous online sessions. METHODS The design is a two-arm parallel randomized clinical trial with repeated measures. We will enroll 240 caregivers from eight Veterans Affairs (VA) medical centers. Participants randomized into the intervention arm receive a modified problem-solving intervention that uses telephone and web-based support and training with interactive modules, fact sheets, and tools on the previously developed and nationally available Resources and Education for Stroke Caregivers' Understanding and Empowerment Caregiver website. In the usual care group, no changes are made in the information, discharge planning, or care the patients who have had a stroke normally receive, and caregivers have access to existing VA resources (eg, caregiver support line, self-help materials). The primary outcome is a change in caregiver depressive symptoms at 11 and 19 weeks after baseline data collection. Secondary outcomes include changes in stroke caregivers' burden, knowledge, positive aspects of caregiving, self-efficacy, perceived stress, health-related quality of life, and satisfaction with care and changes in stroke survivors' functional abilities and health care use. The team will also determine the budgetary impact, facilitators, barriers, and best practices for implementing the intervention. Throughout all phases of the study, we will collaborate with members of an advisory panel. RESULTS Study enrollment began in June 2015 and is ongoing. The first results are expected to be submitted for publication in 2021. CONCLUSIONS This is the first known study to test a transitional care and messaging center intervention combined with technology to decrease caregiver depressive symptoms and to improve the recovery of stroke survivors. If successful, findings will support an evidence-based model that can be transported into clinical practice to improve the quality of caregiving post stroke. TRIAL REGISTRATION ClinicalTrials.gov NCT01600131; https://www.clinicaltrials.gov/ct2/show/NCT01600131. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21799.
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Affiliation(s)
- Jennifer H LeLaurin
- North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Avi H Lamba
- Flint Hill School, Oakton, VA, United States
| | | | | | - I Magaly Freytes
- North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States
| | - Stuti Dang
- Geriatric Research Education and Clinical Center, Miami VA Healthcare System, Miami, FL, United States.,Miller School of Medicine, University of Miami, Miami, FL, United States
| | - W Bruce Vogel
- North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Charles E Levy
- Physical Medicine and Rehabilitation Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Department of Occupational Therapy and Center for Arts in Medicine, University of Florida, Gainesville, FL, United States
| | | | - Rebecca J Beyth
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Ronald I Shorr
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States
| | - Constance R Uphold
- North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States
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Persson J, Sheehan OC, Strömberg U, Roth DL. All-cause mortality for cohabiting spouses of stroke survivors: Evidence from Swedish national registries. Top Stroke Rehabil 2020; 28:432-442. [PMID: 33048024 DOI: 10.1080/10749357.2020.1834270] [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: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVES Spousal concordance for cardiovascular risk factors and lifestyle behaviors may affect prevalence rates of diabetes, hypertension, and stroke. Spouses of stroke survivors, therefore, would be expected to have elevated mortality rates, but this has not been established. Thus, the aim of this study was to investigate whether cohabitant spouses of stroke survivors have higher mortality rates compared to a matched reference cohort. METHODS Data for this population-based cohort study were extracted from Swedish national registries from 2010 to 2016. The national sample consisted of 13,049 spouses of first ever stroke survivors and a reference cohort of 51,685 cohabitant individuals from the general population matched by age, gender, and place of residence. Effects on mortality were analyzed using Cox proportional hazard survival analyses. RESULTS Female and male spouses of stroke survivors were found to have 5-year hazard ratios of death of 1.26 (95% confidence interval 1.17, 1.36) and 1.24 (95% confidence interval 1.16, 1.33), respectively, when compared to the reference cohort. Both female and male spouses had higher mortality from diseases in the circulatory system compared to the reference cohort. CONCLUSION Spouses of stroke survivors have higher mortality rates than a matched reference population that persist for a minimum of 5 years. Policy-makers should acknowledge and address the health status of spouses when evaluating and planning the health and social care of stroke survivors.
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Affiliation(s)
- Josefine Persson
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Orla C Sheehan
- Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ulf Strömberg
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - David L Roth
- Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Persson J, Hensing G, Bonander C. Employment transitions for spouses of stroke survivors: evidence from Swedish national registries. BMC Public Health 2020; 20:1522. [PMID: 33028247 PMCID: PMC7542721 DOI: 10.1186/s12889-020-09625-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The sudden occurrence of stroke often leads to impaired physical, emotional, and cognitive abilities. Many stroke survivors therefore require support from their family members. However, little is known about the effects of a stroke event on the spouses' employment transition probabilities. The aim of this study was twofold 1) to investigate whether a first ever stroke has an effect on employment transition probabilities for employed and unemployed spouses and 2) to analyze whether heterogeneity with respect to age, gender, education and comorbidities influence the size of the effect. METHOD Data for this population-based cohort study were extracted from Swedish national registries from 2005 to 2016. The national sample consisted of 1818 spouses of first ever stroke survivors during 2010 and 2011, and 7399 matched controls that were employed or unemployed during 5 years prior stroke onset. Effects of stroke on spousal employment transitions were analyzed using linear regression, stratified by employment status prior to stroke onset. RESULTS Employed spouses prior stroke onset reduced their employment by - 1.3 percentage points (95% CI, - 2.4, - 0.2). The data also indicated that employed spouses with lower age, comorbid conditions, and low educational attainment may be at even greater risk of transitioning to unemployment. On the other hand, stroke events appear to have limited impact on spouses that were unemployed prior to stroke onset. CONCLUSION The risk of transitioning to unemployment appears to increase after stroke onset for spouses of stroke survivors, and disadvantaged groups may be at even greater risk. Thus, it is important for policy-makers to implement interventions to ensure that these groups of spouses have the possibilities to combine their caregiving role and remaining in the labor market.
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Affiliation(s)
- Josefine Persson
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Gunnel Hensing
- Insurance Medicine, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Carl Bonander
- Health Economics and Policy, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Labberton AS, Augestad LA, Thommessen B, Barra M. The association of stroke severity with health-related quality of life in survivors of acute cerebrovascular disease and their informal caregivers during the first year post stroke: a survey study. Qual Life Res 2020; 29:2679-2693. [PMID: 32388786 PMCID: PMC7561590 DOI: 10.1007/s11136-020-02516-3] [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] [Accepted: 04/24/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE To describe the health-related quality of life (HRQoL) of caregivers and survivors of transient ischaemic attack (TIA) and stroke during one year post discharge in comparison to age- and sex-matched population norms; and to analyse the association of initial stroke severity, measured by a routinely used stroke-specific scale, on subsequent HRQoL of caregivers and survivors. METHODS Cohort of hospitalized patients with TIA and stroke discharged alive from a large university hospital in Norway, and their informal caregivers. Questionnaires at 3 and 12 months post discharge were filled out by caregivers (n = 320 and n = 326, respectively) and survivors (n = 368 and n = 383, respectively). Multivariable linear regression analyses tested associations between initial stroke severity (National Institutes of Health Stroke Scale, NIHSS) and HRQoL (EQ-5D-3L) in caregivers and survivors. RESULTS Caregivers of survivors with TIA or stroke did not report lower HRQoL than matched norms. There was some evidence of an association of the NIHSS with caregiver HRQoL at 3 months only (age-sex-adjusted coefficient - 0.01, p = 0.008), however, this was attenuated after additional adjustments. Survivors with stroke, but not TIA, reported lower HRQoL than population norms at both time points. There was a negative association between higher NIHSS scores and survivors' HRQoL; fully adjusted coefficient - 0.01 at both time points (p = 0.001). CONCLUSION The informal caregivers and survivors with TIA did not report lower than expected HRQoL. Increasing stroke severity was associated with decreasing HRQoL among survivors, but had limited predictive value among caregivers. Other factors may therefore be better indicators of 'at risk' caregivers.
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Affiliation(s)
- Angela S Labberton
- Health Services Research Unit, Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway.
| | - Liv Ariane Augestad
- Department of Health Management and Health Economics, Medical Faculty, University of Oslo, Oslo, Norway
| | - Bente Thommessen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Mathias Barra
- Health Services Research Unit, Akershus University Hospital, PO Box 1000, 1478, Lørenskog, Norway
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Liu C, Fabius CD, Howard VJ, Haley WE, Roth DL. Change in Social Engagement among Incident Caregivers and Controls: Findings from the Caregiving Transitions Study. J Aging Health 2020; 33:114-124. [PMID: 32962491 DOI: 10.1177/0898264320961946] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives:We aimed to compare incident family caregivers and matched controls on change in social network variables and satisfaction with social activities. Methods: A total of 479 participants from the Caregiving Transitions Study were included in the analysis, 244 (50.9%) of whom began substantial and sustained caregiving between baseline and follow-up interviews. We assessed associations between incident caregiving and change in social network size, change in monthly social contact, and satisfaction with social activities. Results: Incident caregivers reported lower satisfaction with social activities and greater decline in social network size than controls. Among only the caregivers, dementia caregivers reported greater decline in social network size while caregivers who were spouses, experienced higher strain, and provided more hours of care reported lower satisfaction with social activities. Discussion: Social engagement declined more among incident caregivers than controls. Future studies should aim to understand why subgroups of caregivers reported lower social engagement.
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Affiliation(s)
- Chelsea Liu
- Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Chanee D Fabius
- Bloomberg School of Public Health, Johns Hopkins University, USA
| | | | | | - David L Roth
- Center on Aging and Health, Johns Hopkins University, USA
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Feldner HA, Papazian C, Peters K, Steele KM. "It's All Sort of Cool and Interesting…but What Do I Do With It?" A Qualitative Study of Stroke Survivors' Perceptions of Surface Electromyography. Front Neurol 2020; 11:1037. [PMID: 33041981 PMCID: PMC7527473 DOI: 10.3389/fneur.2020.01037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/10/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Stroke is one of the most common neurologic injuries worldwide. Over decades, evidence-based neurorehabilitation research and advancements in wireless, wearable sensor design have supported the deployment of technologies to facilitate recovery after stroke. Surface electromyography (sEMG) is one such technology, however, clinical application remains limited. To understand this translational practice gap and improve clinical uptake, it is essential to include stakeholder voices in an analysis of neurorehabilitation practice, the acceptability of current sEMG technologies, and facilitators and barriers to sEMG use in the clinic and the community. The purpose of this study was to foreground the perspectives of stroke survivors to gain a better understanding of their experiences in neurorehabilitation, the technologies they have used during their recovery, and their opinions of lab-designed and commercially-available sEMG systems. Methods: A qualitative, phenomenological study was completed. In-depth, semi-structured interviews were conducted with eight stroke survivors (age range 49-78 years, 6 months to 12 years post-stroke) and two caregivers from a large metropolitan region. A demonstration of four sEMG systems was provided to gather perceptions of sensor design, features and function, and user interface. Interviews were audio-recorded, transcribed verbatim, and coded for analysis using constant comparison until data saturation was reached. Results: Three themes emerged from the data: (1) "Surface EMG has potential….but…" highlights the recognition of sEMG as a valuable tool but reveals a lack of understanding and need for clear meaning from the data; (2) "Tracking incremental progress over days or years is important" highlights the persistence of hope and potential benefit of sEMG in detecting small changes that may inform neurorehabilitation practice and policy; and (3) "Neurorehabilitation technology is cumbersome" highlights the tension between optimizing therapy time and trying new technologies, managing cost, logistics and set-up, and desired technology features. Conclusion: Further translation of sEMG technology for neurorehabilitation holds promise for stroke survivors, but sEMG system design and user interface needs refinement. The process of using sEMG technology and products must be simple and provide meaningful insight to recovery. Including stroke survivors directly in translational efforts is essential to improve uptake in clinical environments.
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Affiliation(s)
- Heather A. Feldner
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Christina Papazian
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Keshia Peters
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Katherine M. Steele
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
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46
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LeLaurin JH, Freytes IM, Findley KE, Schmitzberger MK, Eliazar-Macke ND, Orozco T, Uphold CR. Feasibility and acceptability of a telephone and web-based stroke caregiver intervention: a pilot randomized controlled trial of the RESCUE intervention. Clin Rehabil 2020; 35:253-265. [PMID: 32907399 DOI: 10.1177/0269215520957004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Assess the feasibility and acceptability of an Internet and telephone support and problem-solving intervention for stroke caregivers. DESIGN Randomized controlled pilot trial with four arms: four-week intervention (n = 13), eight-week intervention (n = 13), eight-week attention control (n = 13), and standard care (n = 14). SETTING Southeastern U.S. Veterans Health System. PARTICIPANTS Informal caregivers of Veterans who suffered a stroke in the preceding 2.5 years were enrolled over an 18-month period. INTERVENTIONS Intervention participants received RESCUE, a support and problem-solving intervention delivered via telephone and Internet by registered nurses. Attention control participants received active listening with no advice delivered by nurses via telephone. MAIN MEASURES Feasibility of a larger trial was assessed via recruitment and retention. Acceptability was assessed using an adapted enactment tool and qualitative interviews. Changes in caregiver depressive symptoms and burden were measured by the Center for Epidemiologic Studies Depression Scale and Zarit Burden Interview. The study was not powered for significance testing. RESULTS Of 340 eligible caregivers, 53 (16%) agreed to participate. Among those enrolled, 51 (96%) completed the study. Caregiver mean age was 60.3 (10.1), 49 (93%) were female and 36 (68%) were white. At baseline, 21 (39%) caregivers had high risk of depression and 18 (33%) had significant burden. Acceptability and enactment tool findings indicated positive participant responses to the intervention. Most rated the amount of sessions the "right amount". Qualitative analysis revealed the intervention was valued by and acceptable to caregivers. CONCLUSIONS Findings indicate the RESCUE intervention is feasible and acceptable to caregivers and warrants further testing.
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Affiliation(s)
- Jennifer H LeLaurin
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.,Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - I Magaly Freytes
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.,Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Kimberly E Findley
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Magda K Schmitzberger
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | | | - Tatiana Orozco
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Constance R Uphold
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.,Department of Aging & Geriatrics, College of Medicine, University of Florida, Gainesville, FL, USA
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Supported cognitive-behavioural therapy self-help versus treatment-as-usual for depressed informal caregivers of stroke survivors (CEDArS): feasibility randomised controlled trial. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Demands placed on informal caregivers can result in an increased likelihood of experiencing common mental health difficulties that may affect their ability to undertake the caring role. Currently, however, few evidence-based interventions have been specifically developed for informal caregivers and available interventions are difficult to access. The Improving Access to Psychological Therapies (IAPT) programme aims to improve access to evidence-based psychological therapies for all groups and may therefore present an opportunity to meet informal caregiver needs. Located within the MRC Complex Intervention Framework, a Phase II feasibility randomised controlled trial (RCT) examines key methodological, procedural and clinical uncertainties associated with running a definitive Phase III RCT of an adapted written cognitive behavioural therapy (CBT) self-help intervention for informal caregivers of stroke survivors. Recruitment was low despite different recruitment strategies being adopted, highlighting significant challenges moving towards a Phase III RCT until resolved. Difficulties with study recruitment may reflect wider challenges engaging informal caregivers in psychological interventions and may have implications for IAPT services seeking to improve access for this group. Further attempts to develop a successful recruitment protocol to progress to a Phase III RCT examining effectiveness of the adapted CBT self-help intervention should be encouraged.
Key learning aims
After reading this article, readers should be able to:
(1)
Consider key feasibility issues with regard to recruitment and attrition when running a randomised controlled trial of an adapted written cognitive behavioural therapy (CBT) self-help intervention for informal caregivers of stroke survivors.
(2)
Understand potential barriers experienced by an informal caregiving population to accessing psychological interventions.
(3)
Appreciate implications for clinical practice to enhance access to IAPT services and low-intensity CBT working with an informal caregiver population.
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Gibbs LAL, Anderson MI, Simpson GK, Jones KF. Spirituality and resilience among family caregivers of survivors of stroke: A scoping review. NeuroRehabilitation 2020; 46:41-52. [PMID: 32039873 DOI: 10.3233/nre-192946] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Stroke is the leading cause of disability in Australia and the third-leading cause of disability worldwide and a significant burden on caregivers. OBJECTIVE To map the extent, range and nature of the literature investigating spirituality and resilience among family caregivers of survivors of stroke. METHOD A scoping review. RESULTS Six studies were identified, conducted in the United States, United Kingdom, China and Turkey. These included two quantitative, one experimental and three qualitative designs. No studies linked spirituality to resilience. For the qualitative studies, spirituality was the primary focus of one, and the secondary focus of two others. Qualitative data reflected the lived experience of caregivers drawing upon spirituality to help cope with the burden of caregiving. For the two quantitative studies, spirituality was measured as a secondary focus and showed no significant links between spirituality or adjustment in caregivers. The one experimental study comprised a psycho-educational intervention focused on building resilience, finding a significant increase in social support not reflected in a matched control group. Clinical implications suggested the need for strength-based interventions, including spiritual needs and religious beliefs of the family caregiver. CONCLUSIONS Spirituality and resilience following stroke are essential factors in caregiver adjustment following stroke. Further research with a focus on causality and the link between spirituality, resilience and adjustment in this population is needed.
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Affiliation(s)
| | | | - Grahame Kenneth Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.,School of Human Services and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Kate Fiona Jones
- School of Human Services and Social Work, Griffith University, Gold Coast, QLD, Australia.,Royal Rehab Centre, Ryde, NSW, Australia.,Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia
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Lee HJ, Small BJ, Haley WE. Health and Well-Being in the Year before Death: The Association with Quality of Life and Care at the End-of-Life. J Aging Health 2020; 32:1475-1485. [PMID: 32618482 DOI: 10.1177/0898264320935297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: We examined whether older adults' health and well-being during their final year of life predicts end-of-life (EOL) quality of life (QOL) and quality of care (QOC). Methods: Using data from deceased participants (n = 1125) in the 2011-2015 National Health and Aging Trends Study, we performed latent class analysis to identify profiles of health and well-being, and we examined the association between these classes and EOL QOL and QOC. Results: Four classes were identified: healthy/happy (20%), frail/happy (37%), cognitively impaired/moderately distressed (27%), and highly impaired/highly distressed (16%). Persons in the highly impaired/highly distressed class showed a poorer QOL at the EOL, whereas those in the healthy/happy class reported a lower level of QOC at the EOL. Discussion: The benefits of maintaining health and well-being often carry forward to EOL. Older adults with high impairment and distress merit greater attention such as assuring care and advance care plans.
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Affiliation(s)
- Hyo Jung Lee
- 54761Nanyang Technological University, Singapore
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50
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Kariyawasam PN, Pathirana KD, Hewage DC. Factors associated with health related quality of life of patients with stroke in Sri Lankan context. Health Qual Life Outcomes 2020; 18:129. [PMID: 32384894 PMCID: PMC7206769 DOI: 10.1186/s12955-020-01388-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 04/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is a major global health concern which affects the health related quality of life (HRQOL). As the prevalence of stroke is increasing especially in lower-middle income countries, it is vital to identify the factors associated with the HRQOL of affected individuals. Available literature for post stroke HRQOL and the associated factors are mainly from high income countries. Therefore, we conducted this study to identify the factors associated with HRQOL of stroke survivors using a stroke specific measure. METHODS A longitudinal study was conducted with the participation of 257 stroke survivors. Participants were followed up after 3 months at the neurology and medical clinics in the Teaching Hospital, Karapitiya, Sri Lanka. Health related quality of life was assessed using the validated version of Stroke Aphasia Quality of Life (SAQOL)-39 generic scale. Pearson correlation, independent sample t-test, one-way ANOVA and regression analysis were used to identify the factors associated with quality of life. RESULTS Mean age of the participants with stroke was 66.1 (SD 11.7) years. The mean overall HRQOL was 3.15 (SD 0.96) as measured by the SAQOL-39 g. The socio-demographic factors which had significant associations with HRQOL were; gender, level of education, marital status, occupation and monthly income (p < 0.05). The clinical factors which had significant associations with HRQOL were; level of dependence and disability, type of stroke, side of the lesion, type of aphasia, level of language impairment, receiving physiotherapy and speech therapy and follow up care (p < 0.05). The results of regression indicated six independent predictors [F (6,234) = 42.6, p < 0.05], with an R2 of 0.52. The HRQOL was significantly predicted by the level of dependence (β = .43, p < .01), level of language impairment (β = .20, p < .01), age (β = -.23, p < .01), type of stroke (β = -.19, p < .01), side of the lesion (β = .17, p < .01) and the level of education (β = .12, p < .05). CONCLUSION Severe degree of dependence, severe level of language impairment, older age, hemorrhagic stroke, and lesions in the left side were associated with lower HRQOL. Higher education level was associated with higher HRQOL scores.
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Affiliation(s)
| | | | - Don Chandana Hewage
- Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Sri Lanka
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