Burden on caregivers of patients with sequelae of cerebrovascular accident

Enhancing the role of the social network in activity (re)engagement post-stroke: a focus group study with rehabilitation professionals

BACKGROUND

People post-stroke are at risk of not being able to participate in valued activities. It is important that rehabilitation professionals prepare people post-stroke for the transition home and provide needed support when they live at home. Several authors have suggested that members of the broad social network should play an active role in rehabilitation. This includes informing them about the importance of activity (re)engagement post-stroke and learning strategies to provide support. It is not clear when and how the broad social network can best be equipped to provide adequate activity support. This study aimed to explore stroke professionals' perspectives on strategies that establish a social network that supports activity (re)engagement of people post-stroke, when strategies are best implemented, and the factors that influence the implementation of these strategies.

METHODS

Two focus groups were executed. Content analysis was used to analyze the transcripts of the recorded conversations.

RESULTS

Eighteen professionals with various professional backgrounds and roles in treating people post-stroke participated. Strategies to establish a supportive social network included identifying, expanding, informing, and actively engaging network members. Working with the network in the immediate post-stroke phase was regarded as important for improving long-term activity outcomes. Participants expressed that most strategies to equip the social network to support people post-stroke need to take place within community care. However, the participants experienced difficulties in implementing network strategies. Perceived barriers included interprofessional collaboration, professional knowledge, self-efficacy, and financial structures.

CONCLUSIONS

Strategies to involve the social network of people post-stroke are not fully implemented. Although identifying members of a social network should begin during inpatient rehabilitation, the main part of actively engaging the network will have to take place when the people post-stroke return home. Implementing social network strategies requires a systematic process focusing on collaboration, knowledge, attitude, and skill development.

Craniocerebral Magnetic Resonance Imaging Features of Benign Paroxysmal Positional Vertigo under Artificial Intelligence Algorithm and the Correlation with Cerebrovascular Disease

This research aimed to discuss the characteristics of benign paroxysmal positional vertigo (BPPV) and the correlation with cerebrovascular disease. An artificial intelligence algorithm under a parallel dual-domain concatenated convolutional neural network (PDDC-CNN) was proposed to process the images of magnetic resonance imaging (MRI). MRI, magnetic resonance angiography (MRA), and susceptibility weighted imaging (SWI) were performed on all 60 research objects with a 3.0 MRI scanner. The number of cases with cerebral microbleeds (CMBs), SWI image display of small veins, the number of lacunar infarctions, vertebral artery dominance, and vertebrobasilar morphology were observed in the two groups. The number of lacunar infarctions was 2.400 ± 3.358 and 0.672 ± 0.251, respectively, in the BBPV group with 30 cases and the control group with the other 30 cases. The positive rates of CMBs on SWI images were 48% and 27% in the BBPV group and the control group, respectively, and the average CMBs were counted as 1.670 ± 2.326 and 0.487 ± 0.865. CMBs were shown as round or oval lesions of conventional sequence deletion in the images with a diameter of less than 1.5 cm. SWI images of the BBPV group showed a significant increase in intracerebral small veins compared to those of the control group. The curvature of the vertebrobasilar artery in the BBPV group was significantly higher than that in the control group, and the curvature of the basilar artery was slightly higher than that in the control group. In conclusion, the MRI features of BPPV patients were related to their own microvascular lesions closely, and it was speculated that the cerebrovascular factors might play a dominant role in the early onset of BPPV.

Qualidade de vida e sobrecarga de cuidadores informais de indivíduos acometidos por Acidente Vascular Encefálico

Resumo Introdução A assistência ao indivíduo pós-acidente vascular encefálico (AVE) geralmente é prestada por cuidadores familiares, mas com grande sobrecarga e impacto negativo em sua qualidade de vida (QV). Objetivo Identificar a população que atualmente cuida de maneira informal de indivíduos com sequelas decorrentes de AVE em Araranguá/SC (Brasil) e avaliar a relação entre a QV e o nível de sobrecarga nessa população. Método Estudo transversal que avaliou 60 indivíduos: 30 cuidadores informais de 30 indivíduos pós-AVE crônicos inscritos nas Unidades Básicas de Saúde de Araranguá, SC. Os seguintes instrumentos de avaliação foram utilizados: Escala Zarit Burden Interview para avaliar a sobrecarga e Questionário World Health Organization Quality of Life (WHOQOL-BREF) para avaliar a QV do cuidador; Medida de Independência Funcional (MIF) para avaliar a independência funcional e a Escala de Rankin Modificada para avaliar o nível de incapacidade do indivíduo pós-AVE. Resultados Foi observado algum nível de sobrecarga em 71,67% dos cuidadores avaliados, sendo que a maioria (46,67%) apresentou sobrecarga leve a moderada. A QV dos cuidadores mostrou-se alterada, com menores índice de satisfação com os domínios físico e meio ambiente. Foi observada correlação significativa entre a sobrecarga e a QV (ρ=-0,60; p<0,01) dos cuidadores. Conclusão A população de cuidadores de indivíduos pós-AVE residentes em Araranguá mostrou-se sobrecarregada com a função de cuidar, com alteração na sua QV. Os achados sugerem a necessidade de intervenções de saúde dirigidas não só aos indivíduos pós-AVE, mas também a seus cuidadores familiares.

Quality of life and burden of informal caregivers of post-stroke individuals

Abstract Introduction Assistance to post-stroke individuals is usually provided by family caregivers, but with a great burden and negative impact on their quality of life (QoL). Objective To identify the population that currently takes care informally for individuals with sequelae resulting from stroke in Araranguá/SC (Brazil) and to assess the relationship between QoL and the level of burden in this population. Method A cross-sectional study that evaluated 60 individuals: 30 informal caregivers of 30 chronic post-stroke individuals enrolled in Basic Health Units in Araranguá, SC. The following assessment instruments were used: Zarit Burden Interview Scale to assess burden and World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) to assess caregiver QoL; Functional Independence Measure (FIM) to assess functional independence and the Modified Rankin Scale to assess the individual's level of disability post-stroke. Results Some level of burden was observed in 71.67% of the caregivers evaluated, with the majority (46.67%) having mild to moderate burden. The caregivers' QoL was altered, with lower levels of satisfaction on the physical and environment domains. A significant correlation was observed between burden and QoL (ρ=-0.60; p<0.01) of caregivers. Conclusion The population of caregivers of post-stroke individuals residing in Araranguá proved to be overloaded with the care function, with changes in their QoL. The findings suggest the need for health interventions aimed not only at post-stroke individuals, but also at their family caregivers.

The effect of a supportive home care program on caregiver burden with stroke patients in Iran: an experimental study

Background

Stroke can impose a heavy burden on caregivers. Caring for stroke patients at home is more challenging than in hospitals with facilities. The purpose of this study was to evaluate the effect of a supportive home care program on caregiver burden with stroke patients.

Methods

This was an experimental study. One hundred sixteen caregivers of stroke patients were recruited using convenience sampling from two university-affiliated hospitals in Tehran from June 2019 to February 2020. They were randomly allocated into two groups (supportive home care program and routine hospital education program) using a randomized block design. The supportive home care program included eight educational sessions delivered in the hospital before discharge, and with home visits after hospital discharge. Caregiver burden was measured using Caregiver Burden Inventory. The data were analyzed using independent samples t-test and Analysis of Covariance.

Results

Caregiver burden in the routine education group increased significantly after 2 weeks, from 52.27 ± 23.95 to 62.63 ± 22.68. The mean of caregiver burden scores in the supportive home care program decreased from 44.75 ± 17.21 to 40.46 ± 17.28. The difference between the scores of the two groups before the intervention was not significantly different (t = 1.941, df = 114, p = 0.055). There was a significant difference between the two groups regarding caregiver burden scores after the intervention period (η² = 0.305, P < 0.001).

Conclusions

Caregiver burden increased significantly after the discharge without proper interventions in the caregivers of stroke patients. Providing support for home care providers can help to decrease or prevent the intensification of caregiver burden.