Acidente vascular encefálico: características do paciente e qualidade de vida de cuidadores

Caregiver burden, hopelessness, and anxiety: Association between sociodemographic and clinical profiles of patients with stroke

OBJECTIVES

This study aimed to evaluate the association between the sociodemographic characteristics of caregivers and patients with stroke, clinical data on stroke, and disability with caregiver burden, hopelessness, and anxiety.

MATERIALS AND METHODS

This cross-sectional study included patients with stroke of either sex, aged >18 years. Data were collected between January 2020 and July 2021. Patient demographic included age, sex, stroke type, severity, etiology, topography, treatment, and stroke recurrence. Stroke disability was assessed using the modified Rankin Scale and Barthel Index at 90 days post-discharge. Additionally, caregiver burden, hopelessness, and anxiety were evaluated during patient consultations using the Zarit Burden Interview (ZBI), Beck Hopelessness Scale (BHS), and Beck Anxiety Inventory (BAI).

RESULTS

We included 104 patients with stroke and their caregivers. Overall caregiver burden was moderate (ZBI: 24 [25]), with mild hopelessness (BHS: 4 [4]) and minimal to mild anxiety (BAI: 8 [13]). The linear regression model presented in Table 3 showed that female caregivers scored up to 11 points higher on the Zarit Burden Interview (p = 0.011). Additionally, increased patient age was associated with a higher caregiver burden (p = 0.002) on the Zarit Burden Interview. Posterior circulation stroke and total anterior circulation stroke were also associated with higher Zarit Burden Interview scores compared to lacunar stroke (p = 0.017). Age was not associated with caregiver burden in the entire sample. However, an association between age and caregiver burden was found only in the female group. Furthermore, women aged 65 years and older experienced a more severe burden than women aged 18 to 64 years (p<0.001). Stroke disability was not associated with caregiver burden.

CONCLUSIONS

Older female caregivers were significantly affected when caring for stroke patients. Total anterior circulation stroke and Posterior circulation stroke increased Zarit Burden Interview scores. However, no association was observed between stroke disability and the caregiver burden.

e-Health as a tool to improve the quality of life of informal caregivers dealing with stroke patients: Systematic review with meta-analysis

OBJECTIVE

The objective of this review was to elucidate the evidence related to utilizing e-Health as a tool in improving the quality of life of informal caregivers of dependent patients due to cerebrovascular accident (CVA).

METHODS

This systematic review with meta-analysis includes 13 studies. For these studies, seven databases were searched between 2009 and 2019. A random-effects model was adopted for overall estimation and to explain the heterogeneity.

RESULTS

A random-effects model was adopted for overall estimation and to explain heterogeneity. The results did not demonstrate statistical significance (p<0.05) and low heterogeneity (I²  = 0).

CONCLUSIONS

There is a tendency toward improvement in psychological health, solving care-related problems, as well as better prevention of problems arising from the burden. Therefore, new studies with larger sample size and primarily to conduct them for more than 6 months for the accuracy.

CLINICAL RELEVANCE

This study reflects a trend toward improving psychological health, solving care-related problems, as well as improved the prevention of problems arising from the burden.

Theoretically Based Factors Affecting Stroke Family Caregiver Health: An Integrative Review

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.

A scoping review on studies about the quality of life of informal caregivers of stroke survivors

PURPOSE

To assess the available evidence regarding the quality of life (QoL) of informal caregivers of stroke survivors, by identifying the instruments used to assess QoL, and its associated characteristics.

METHODS

A scoping review was performed, following PRISMA-ScR guidelines. The electronic databases PubMed, ISI Web of Science, PsycINFO, and SciELO were searched for empirical, peer-reviewed, original, and full-length studies on the characteristics influencing the QoL of informal caregivers of stroke survivors. Eligibility and data extraction were conducted by two independent researchers. The main quantitative findings were synthesized, and qualitative data were explored by thematic content analysis.

RESULTS

The included studies, 56 quantitative, 1 qualitative, and 1 mixed methods, were published between 1999 and 2020. A high heterogeneity was found regarding the assessment of QoL, and the characteristics influencing it. Only one study used an instrument specifically designed to assess the stroke caregivers' QoL. The QoL of informal caregivers was inversely associated with physical and mental health of stroke survivors and caregivers, while stroke characteristics with a better prognosis, caregivers' positive relationships, and a more supportive and participative social context were positively associated to QoL.

CONCLUSION

There is a need for standardizing the assessment of the QoL of informal caregivers of stroke survivors, as well as for investing in cross-country/cultural studies with robust mixed methods designs to allow a deeper understanding of the experiences of caregivers. Further research, policies, and practices should consider the diversity and complexity of the characteristics influencing QoL, to empower informal caregivers and improve their QoL.

Family quality of life: an integrative review on the family of people with disabilities

The objective of this integrative revision is to understand the Brazilian scientific production of the thematic focus on the family quality of life (FQoL) of people with disabilities, as well as the participating population, referential theory, and instruments used in the studies. The data survey was done in the BVS, Scielo, and PubMed databases, and in the Capes' Periodic portal, whose inclusion criteria were articles published from 2007 to 2018, available fully online, in Portuguese or English. These articles portrayed the theme of life quality of families of people with disabilities and articles from research done in Brazilian contexts. The results showed that only three of the 19 selected articles to the study analyzed the theme of FQoL directly including the aspects related to the construct. They also pointed out that WHOQOL-Bref was the most used instrument to evaluate the FQoL (n=11), followed by semi structured interviews (n=5) and that only 10,5%, i.e., two articles used the appropriated definition of the FQoL. The research determined that the thematic research is still in the beginning stage in the scientific national production, large use of individual constructs of life quality, and sparse presence of specific measures instruments to measure FQoL.

Quality of life perceptions of family caregivers of older adults stroke survivors: A longitudinal study

BACKGROUND

There are few formal outreach and out-patient support services to help family caring for older adults who have had a stroke in developing countries. Family caregivers experience negative changes in their quality of life.

AIM

To assess quality of life perceptions of spouse and non-spouse caregivers of older adult stroke survivors.

METHODS

A longitudinal survey study. A convenience sample of forty-eight family caregivers was recruited from the Special Care Stroke Unit at a University Hospital in South Brazil. Quality of life was measured using the World Health Organization's Quality of Life BREF survey upon discharge from the hospital (Time 1) and two months after (Time 2).

RESULTS

Non-spouse caregivers had the lowest Social Relationship scores at Time 1 (p < .001) and at Time 2 (p = .005), both in terms of personal relationship, the quality of their sex lives and support received from others.

CONCLUSION

Unfortunately, formal community support programs for family caregivers in Brazil are lacking. Post-stroke caregiving is largely a family affair. Quality of Life assessments among family caregivers of older adult stroke survivors are crucial, particularly after discharge.

Burden of Care and Quality of Life in Home Caregivers of Patients With Stroke in Iran

The purpose of this study was to investigate the relationship between Burden of Care and Quality of Life in informal home caregivers of stroke patients in Iran. Also we were trying to explore the factors that affect the burden of care. In this cross-sectional study, we have selected 62 informal home caregivers of the patients admitted to “the stroke outpatient unit of the neurology clinic” of the central hospital in Semnan province, Iran, to take part in the investigation. We interviewed them using the Caregiver Burden Inventory and SF-36 Questionnaire for assessing their quality of life. There was a negative and significant correlation between different aspects of quality of life and burden of care. In the bivariate regression model, being married and having lower levels of education (minimum years of schooling) were associated with higher levels of the burden. Our study shows that increasing burden of care in informal home caregivers reduces the quality of life in all domains. Thus, the results of this study indicate that an increase in the burden of caregiving on caregivers lowers their quality of life in all aspects; especially, caregivers who provide care to their spouses encountered more burden. Therefore, these caregivers must be in the center of interest while planning to reduce the burden of care.

Effects of aquatic walking exercise using a walker in a chronic stroke patient

[Purpose] The aim of this study was to examine the usefulness of aquatic walking exercise using a walker for chronic stroke patients. We also examined the psychological effects on the study subject and the primary caregiver before and after aquatic walking exercise. [Subject and Methods] The subject was a 60-year-old male with bilateral paralysis after a cerebrovascular accident. The Fugl-Meyer Assessment (FMA) total score was 116 on the right and 115 on the left. The intervention combined aquatic and land walking exercise. A U-shaped walker was used for both water and land exercise. Continuous walking distance was the measure used to evaluate land walking ability. The psychological effects on the study subject and the primary caregiver were examined with the questionnaire. [Results] In aquatic walking, the mean time to walk 5 m showed an increase from the intervention after two months. After the aquatic walking and land walking combination, continuous walking distance also showed a prolonged trend. In the survey given to the main caregivers, improvements were observed. [Conclusion] Aquatic walking practice using a walker improved motivation in a chronic stroke patient, leading to improved walking ability, with a positive psychological influence on the participant and family caregiver.