The effects of a family-focused dyadic psychoeducational intervention for stroke survivors and their family caregivers: A randomised controlled trial

From Hospital to Home: A Qualitative-Multidimensional Analysis of Stroke Survivors' Perspectives During the Transition from Hospital to Home

BACKGROUND

Stroke recovery is a complex process, with the transition from hospital to home representing a critical yet underexplored phase in patient care.

AIM

Our aim was to explore stroke survivors' perspectives during transition from hospital to home.

METHODS

A qualitative study was conducted. Interviews with stroke survivors were collected to explore their transition experiences. Data were analyzed using an innovative multimethod approach, which combines quantitative statistics and informatic software to categorize themes and visualize relationships among latent dimensions.

FINDINGS

Four key themes emerged from the data: "experience," "predischarge preparedness," "support," and "challenges." Participants expressed mixed feelings of relief and anxiety, highlighting the need for structured discharge planning and comprehensive support. Predischarge preparedness was identified as essential for reducing stress and facilitating reintegration into daily life. Support from family and healthcare providers was critical for emotional and physical recovery, with continuous support enhancing quality of life. Participants faced challenges, including mobility issues, pain, and emotional distress, impacting their ability to perform daily tasks and leading to feelings of dependence.

CONCLUSIONS

This study underscored the importance of a multidisciplinary approach that integrates effective predischarge preparation, continuous medical care, and emotional support to improve quality of life for stroke survivors. Our findings highlighted the need to develop targeted care strategies that address the multifaceted needs of stroke survivors during their transition from hospital to home.

'Shared efforts, brighter smiles': a protocol for a randomised controlled study on the effectiveness of a parent-child orofacial myofunctional therapy programme post-adenoidectomy

INTRODUCTION

Adenoid hypertrophy has a high prevalence in children, often causing early orofacial muscle dysfunction that worsens facial deformities over time. While adenoidectomy (AT) alleviates airway obstruction, it only partially addresses the condition, leaving persistent neuromuscular habits. Orofacial myofunctional therapy is necessary for post-AT recovery but faces challenges such as poor adherence and ineffective parent-child communication. Dyadic interventions, which actively involve both parents and children, have shown advantages in improving treatment adherence and enhancing orofacial muscle function. Evidence suggests that dyadic intervention addresses both the child's recovery needs and the caregiving capacity of parents, offering a more comprehensive solution for long-term intervention. Therefore, our team developed a parent-child dyadic orofacial myofunctional therapy (PCD-OMT) programme, offering insights into its potential application in paediatric healthcare to support comprehensive family-centred care.

METHOD AND ANALYSIS

This two-arm, parallel-design, randomised controlled trial will recruit 80 dyads whose children performed AT from two hospitals in Qingdao, China. Dyads will be randomly allocated to two arms. Dyads randomly assigned to the intervention group will receive the PCD-OMT programme. Dyads randomly assigned to the control group will receive regular care. The primary outcomes are orofacial myofunction in children and parental care abilities. The secondary outcomes are children's engagement and parental functioning. A feasibility and acceptability process will be employed to evaluate the viability in clinical practice. Outcomes will be collected at three checkpoints: baseline (T0), postintervention (T1) and after a 12-week follow-up phase (T2).

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee of Medical College of Qingdao University (QDU-HEC-2023216). The results will be published in peer-reviewed publications and presented in international conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2400091466.

The impact of dyadic interventions on psycho-social outcomes for stroke patients and their caregivers: a systematic review and meta-analysis

Aims

To describe the details of dyadic interventions and summarize the current evidence on supporting dyadic interventions for psycho-social outcomes of stroke patients and their caregivers.

Design

A systematic review and meta-analysis based on PRISMA guidelines.

Data sources

Five English databases (PubMed, Web of Science, CINAHL, Embase and Cochrane Library) were searched to identify eligible studies published from the inception to October 15, 2024.

Methods

Two reviewers independently screened the literature in accordance with the selection criteria. The risk of bias of the included studies was assessed using Cochrane RoB 2.0. Relevant information was extracted, narrative synthesis was conducted and the meta-analysis was carried out using Review Manager 5.4 soft.

Results

A total of 28 literature were identified and included in this review. These interventions focused mainly on the provision of stroke related knowledge, promotion of family relationships and relief of negative emotions by a face-to-face mode. The outcome indicators can be grouped into three dimensions based on the developmental contextual coping model: dyadic appraisal, dyadic coping and dyadic adjustments. The results of meta-analysis showed that dyadic interventions significantly improved quality of life and coping capacity of patients, promoted family function of caregivers and alleviated caregiver-related burden.

Conclusion

These findings highlighted the positive outcomes of dyadic interventions that focused on patients and their caregivers coping with stroke. However, the effectiveness of interventions is not absolute, the evaluation system of intervention effect needs to be improved and demand-driven interventions need to be developed urgently. Therefore, further large-scale randomized controlled trials with a high-quality design are warranted.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, CRD42024621297.

Research hotspots and trends of post-stroke depression rehabilitation: a bibliometric analysis from 2003 to 2024

Background

Post-stroke depression (PSD) is a common complication of stroke and is associated with stroke prognosis. Rehabilitation plays an essential role in the comprehensive treatment of PSD. However, there are few bibliometric analyses of studies on PSD rehabilitation. This study aimed to comprehensively sort out the network of PSD rehabilitation through bibliometric analyses, analyze the research trends, focus on the hotspots related to PSD rehabilitation, and provide new research perspectives and guidance for future studies.

Methods

The Web of Science Core Collection (WoSCC) database was searched for studies about depression rehabilitation after a stroke. The search covered the period from January 1, 2003, to October 31, 2024. We analyzed countries, institutions, journals, authors and keywords using CiteSpace and VOSviewer software to create visualizations and perform a bibliometric analysis.

Results

A total of 2,227 papers were analyzed, with an increasing trend in the number of papers published each year. The United States had the highest number of published articles (458 publications), and Maastricht University and Utrecht University were the most published institutions (56 articles). Archives of Physical Medicine and Rehabilitation is the journal with the most cited publications (5,913 citations). Johanna M. A. is the most prolific author (24 publications).

Conclusion

Using bibliometric methods, relevant studies on PSD rehabilitation were reviewed. The hotspots of future research on PSD rehabilitation will center on the brain plasticity mechanism of PSD rehabilitation, PSD assessment, and new techniques of PSD rehabilitation. This article provides systematic information to support and guide future research in this area.

Health Professional Support for Friends and Family Members of Older People Discharged from Hospital After a Fracture: A Survey Study

Background/Objectives: Friends and family members of people who are discharged from hospital after a fracture often take on caring roles, since these patients have reduced independence during recovery. Previous literature suggests that these individuals are rarely supported in their adoption of these roles. No studies have previously explored the use of carer training interventions to support friends/family members by health professionals in this setting. This survey study aimed to address this. Methods: A cross-sectional online survey was conducted among health professionals who treat people in hospital following fractures. Respondents were asked about the use of care training for friends/family members of people discharged from hospital after fracture, and whether a clinical trial would be useful to test such carer training interventions. Results: A total of 114 health professionals accessed the survey. Fifty respondents (44%) reported that carer training was not offered in their practice. When it was offered, respondents reported this was not consistently provided. Less than 12% of respondents reported offering carer training to most of their patients following a fracture. What was offered in these instances was largely based on education provision (69%), practical skills in exercise prescription (55%) and manual handling (51%). Ninety-eight percent of respondents reported that a clinical trial would be, or would potentially be, valuable to aid a change in practice to include carer training in routine clinical care. Conclusions: Carer training programmes are not routinely provided in clinical practice for people following a fracture. The results indicate that health professionals see a potential value in these programmes, but further research is recommended to provide an evidence base for these interventions.

Effects of dyadic psychoeducational interventions for haemodialysis patients and their family caregivers: a randomised controlled trial

BACKGROUND

Haemodialysis may affect the changes in the patient's relationship with the family, and eventually cause some psychological distress to the patient and affect the health-related quality of life. This study examines the effectiveness of the dyadic psychoeducational intervention on patients' quality of life and psychosocial health, as well as caregiver burden and psychosocial outcomes among caregivers.

METHODS

This is a parallel, two-arm, assessor-blind, randomised controlled trial with a repeated-measures design. A total of 80 haemodialysis dyads (patient and family caregivers) randomly assigned to the intervention group or control group with usual care (N = 40 dyads per group). The intervention included 4-week dyadic psychoeducational intervention. At before intervention (T0), immediately after intervention (T1), 1 month after intervention (T2) and 3 months after intervention (T3), patients' quality of life ana caregiver burden (primary outcomes), and other secondary outcomes (i.e., dyads' coping, depression and anxiety symptoms, and social support) were evaluated. Generalized Estimated Equation was used to test the intervention effect of the dyadic psychoeducation intervention, and intentional-to-treat analysis was used for all analyses.

RESULTS

Effects of dyadic psychoeducational intervention: The result of adjusting the GEE model shows that dyadic psychoeducational intervention can effectively improve patients' quality of life (T1: β = 8.51, p < 0.001; T2: β = 9.03, p < 0.001; T3: β = 8.82, p < 0.001), patients' anxiety (T1: β = -2.35, p = 0.022; T2: β = -2.84, p = 0.002; T3: β = -2.85, p = 0.001) and caregivers' anxiety (T2: β = -1.67, p = 0.012; T3: β = -2.57, p = 0.004), patients' depression (T2: β = -2.39, p = 0.017; T3: β = -2.71, p = 0.006), caregiver burden (T2: β = -6.95, p = 0.007; T3: β = -6.34, p = 0.008), caregiver depression (T2: β = -2.01, p = 0.015; T3: β = -1.85, p = 0.015).

CONCLUSIONS

The dyadic psychoeducational intervention can improve the psychosocial outcomes of haemodialysis dyads. This intervention provides effective ways and measures for the relevant psychological education intervention and provides new ideas and evidence for clinical nursing research.

TRIAL REGISTRATION

This study was retrospectively registered as a randomized controlled trial in the ClinicalTrials Registry. Registration Date: April 16, 2024.

REGISTRATION NUMBER

NCT06203730.

Effectiveness of e-share intervention for caregivers of elderly people after stroke: a pragmatic randomized trial

OBJECTIVE

to analyse the effectiveness of a virtual educational intervention for family caregivers on the burden and ability to care for elderly people after stroke.

METHOD

randomized pragmatic trial with 58 caregivers of elderly survivors of stroke. The intervention group received access to an online course for caregiver education. Caregiver training was assessed using the Scale of Capabilities of Informal Caregivers for Dependent Elderly People due to Stroke and burden through the Caregiver Burden Scale before and three months after hospital discharge, both adapted and validated for use in Brazil. The Generalized Estimating Equations model complemented by the Least Significant Difference was adopted.

RESULTS

the sample was homogeneous and the groups differed statistically only in relation to kinship (p=0.034), with a higher proportion of children observed in the control group. There was an effect of the intervention on improving medication administration (p=0.006) and reducing disappointment (p=0.011) in the intervention group.

CONCLUSION

the intervention benefited the caregivers who received it in terms of improving medication administration and reducing disappointment. This is the first study in Brazil that proposes the use of digital educational technologies for this group, representing an important advance in Nursing. Clinicaltrial.gov registration: NCT05553340.

BACKGROUND

(1)First study in Brazil that proposes a MOOC for caregivers of elderly people after stroke. (2)Advances in Nursing in the construction of digital educational technologies. (3)E-share helped caregivers improve medication administration. (4)E-share helped caregivers reduce overload in the disappointment domain. (5)Digital tools contribute to the use of nurses' work.

Supporting Long-Term Meaningful Outcomes in Stroke Rehabilitation

PURPOSE OF REVIEW

Rehabilitation is the mainstay of recovery after stroke, but key recommendations focused on delivering 'as much therapy as possible' and stroke survivor outcome measures have remained relatively unchanged for decades. Traditional therapy approaches focus on maximum improvement of physical impairments while a stroke survivor is in hospital to ensure that community discharge can be deemed 'safe'. This narrow approach sidelines the outcomes that are meaningful to the stroke survivor in the long term and the challenges they may face within their social context. In this article, we highlight the importance of the whole-person approach and review recent research introducing novel considerations to optimise outcomes after stroke.

RECENT FINDINGS

Psychosocial well-being is a major component of health but is poorly acknowledged and managed for stroke survivors. Evidence supports the use of self-management interventions, peer befriending, and culturally - responsive methods, including deep engagement with Indigenous and cultural knowledge. Cultural safety and involvement of a stroke survivor's important personal connections are also vital for achieving truly person-centred care and equity in rehabilitation outcomes. Outcomes in rehabilitation will be optimised if we shift our mindsets from a sole focus on improving physical impairments to a broader scope of delivering whole-person care.

The interactivity and independence of Recovery challenges and coping strategies for ICU survivors and their caregivers: a systematic review and Meta-synthesis

BACKGROUND

The post-ICU home recovery period requires patients and caregivers to confront recovery challenges and adopt coping strategies as a family dyad, necessitating effective dyadic interaction patterns. Existing qualitative research shows that the dyads face interactive or independent challenges and employs varying coping strategies, which may include strong communication or, conversely, avoidance. However, a single qualitative study alone might offer limited generalizability, and there is a lack of broader, more nuanced understanding about the recovery challenge and copings among ICU survivors and caregivers. This meta-synthesis aims to figure out the interactivity and independence of challenges and coping strategies during the recovery process for ICU survivors and caregivers.

METHODS

This is a meta-synthesis of qualitative studies, which was guided by the Stress and Coping Framework. We systematically reviewed six electronic databases, including PubMed, Medline, the Cochrane Library, CINAHL, PsycArticles, and PsycInfo, for relevant qualitative studies published from inception to January, 2024. We utilized a content analysis approach for data analysis. Presentation of this synthesis adhered to the PRISMA guideline and the ENTREQ guideline.

RESULTS

After full-text screening, 49 studies were included. Four themes with 16 sub-themes emerged from this synthesis including, interactivity of recovery challenges for ICU survivors and caregivers (subthemes: Life was turned upside down, Situational overstrain, Isolation without compassion, Empowerment conflicts, Marginalized support), independence of recovery challenges for ICU survivors and caregivers (subthemes: Recovery means silent suffering, Gap in memory, Sacrificing to caregiving), interactivity of recovery coping strategies for ICU survivors and caregivers (subthemes: Reorientation of mindset, Cultivating inner power, Sharing burden with an open-ear, Going through thick and thin together, Negotiating care level), and independence of recovery coping strategies for ICU survivors and caregivers (subthemes: Wearing a faked smile, Developing daily routine, Seeking respite).

CONCLUSIONS

The findings suggest that ICU survivors and caregivers experience overlapping yet distinct challenges during recovery, often involving shared coping strategies, alongside a need for individual space. These results support the presence of both interactivity and independence in recovery challenges and coping strategies for ICU survivors and their caregivers. Therefore, we call for future dyadic or family interventions to target both ICU survivors and caregivers, taking advantage of their interactivity and desire for gradual independence, so that fostered individualized coping strategies adapted to flexible contexts.

Family resilience and social support as mediators of caregiver burden and capacity in stroke caregivers: a cross-sectional study

Introduction

Caring for stroke survivors poses significant challenges to survivors and caregivers; understanding these relationships can inform targeted interventions and support systems.

Aim

This study investigates the influencing factors of caregiver burden and the potential mediating roles of family resilience and perceived social support between caregiver burden and caregiver capacity.

Design

This is a cross-sectional study.

Methods

The participants in this study included 462 stroke survivors and their primary caregivers from Ningbo Lihuili Hospital in Zhejiang Province, China. Primary caregivers completed several assessments, including the Shortened Chinese Version of the Family Resilience Assessment Scale (FRAS), the Perceived Social Support Scale (PSSS), the Zarit Caregiver Burden Interview (ZCBI), and the Family Caregiver Task Inventory (FCTI). The ZCBI was used to evaluate caregiver burden, while the activities of daily living (ADL) were assessed for stroke survivors to measure their actual level of dependence. The mediating effect of family resilience was estimated using the bootstrap method through Jamovi version 2.3.0 with the mediation plug-in, while controlling for sociodemographic variables.

Results

The results showed that caregiver burden was influenced by stroke survivors' level of dependence on activities of daily living (ADL), caregiver education level, caregiver health status, and average daily care time. The family resilience mediated the relationship between caregiver burden and caregiver capacity (b = 0.141; 95% confidence interval: 0.091 to 0.176). Additionally, perceived social support mediated the relationship between caregiver burden and caregiver capacity (b = 0.080; 95% confidence interval: 0.041 to 0.110).

Conclusion

These findings indicate that enhancing family resilience and perceived social support can be strategies for alleviating caregiver burden. Clinical practitioners should actively assess the family resilience and social support of stroke survivors, and implement interventions that promote resilience and strengthen social support, thereby reducing caregiver burden and improving the health outcomes of stroke survivors.

Development and validation of a nomogram for sleep disorders among stroke patients

BACKGROUND

Precisely identifying high-risk sleep disorder patients and implementing suitable measures are important for decreasing the incidence of sleep disorders. In this study, a nomogram method was adopted to construct a tool to predict sleep disorders in stroke based on four factors: individual characteristics, treatment-related factors, psychological factors, and family-related factors.

METHODS

A total of 450 stroke patients were continuously diagnosed at the Affiliated Hospital of Nantong University, and the data on participants were randomly distributed into a training set (n = 315) and a validation set (n = 135). Within the training set, using LASSO regression and random forest methods, five optimal predictors of sleep disorders were identified. Five optimal predictors were used to develop a model. The calibration, discrimination, generalization, and clinical applicability of the model were evaluated using calibration curves, receiver operating characteristic (ROC) curves, internal validation, and decision curve analysis (DCA).

RESULTS

We found that the place of residence, average daily infusion time, the Hospital Anxiety and Depression Scale (HADS), the Type D Personality Scale-14 (DS14), and the Fatigue Severity Scale (FSS) were crucial factors associated with sleep disorders. The validation data showed an area under the curve (AUC) of 0.903 compared to 0.899 in the training set. There was an approach to the diagonal in the calibration curve of this model, and the results of DCA noted that it is clinically beneficial across a range of thresholds from 5 % to 99 %.

CONCLUSION

A model was developed to predict sleep disorders among stroke patients to help hospital staff evaluate the risk among patients and screen high-risk patients.

Effectiveness of a Patient-Family Carer Partnership Intervention on Blood Pressure Control for People with Hypertension in Rural Communities: A Randomised Controlled Trial

Objectives

To examine the effectiveness of a patient-family (carer) partnership intervention on the BP control, self-care and self-efficacy for hypertensive people, and dyadic-relationship quality, depressive and anxiety symptoms, and health-related quality of life for the family dyads (hypertensive people and family carers) in rural communities of mainland China.

Design

A randomised controlled trial.

Methods

A total of 110 family dyads were randomly recruited from village clinics and randomly allocated to the intervention group (n = 55) or control group (n = 55). Family dyads in the control group received usual care. In addition to the usual care, family dyads in the intervention group received the individual-based, five-session patient-family (carer) partnership intervention. The primary outcomes included SBP, DBP, and the proportion of people with normal controlled BP. EuroQol five-dimensional-five-level (EQ-5D-5L) was adopted to evaluate participants' health-related quality of life. Data were collected at the baseline (T0), one-month (T1), and three-month postintervention (T2). Generalised estimating equation model was adopted to test the study hypotheses on all study outcomes.

Results

Compared with the control group, hypertensive people in the intervention group had a greater reduction in SBP by 10.10 mmHg and DBP by 4.66 mmHg and a larger proportion of people with normal BP at T2, as well as statistically significant improvements at T1 and T2 in dyadic relationship, self-care, antihypertensive drug-titration rate, anxiety symptoms, and health-related quality of life. The intervention also had statistically significant positive effects on family carer's dyadic relationship and health-related quality of life at T1 and T2.

Conclusion

The patient-family (carer) partnership intervention has the potential to improve hypertensive people's BP control and family dyad's dyadic-relationship quality and mental health at short-to-medium term follow-ups. Implications for the Profession and/or Patient Care. This study provided evidence and direction to support healthcare providers in developing and implementing patient-family (carer) partnership intervention for hypertension care in rural areas. This trial is registered with ChiCTR1900027087.

A study on the effect of using the video teach-back method in continuous nursing care of stroke patients

Objective

To explore the effect of a video teach-back method on continuous family nursing care of stroke patients.

Methods

Stroke patients hospitalized in our hospital between March 2020 and March 2023 who met the inclusion criteria were randomly divided into an intervention group (n = 45), who received routine health education plus video teach-back training of caregivers, and a control group (n = 45), who received routine health education only. The effects on nursing-related variables were compared between the two groups.

Results

Total scores representing the caring ability of caregivers in the intervention group increased significantly over time relative to baseline and were higher than those of the control group. Scores representing the care burden of caregivers in the intervention group decreased significantly over time and were lower than those of the control group.

Conclusion

The teach-back method combined with video education improves the nursing ability of family caregivers and can improve the self-care ability of stroke patients.

Effects of the family customised online FOCUS programme on patients with heart failure and their informal caregivers: a multicentre, single-blind, randomised clinical trial

Background

Living with heart failure can severely affect the physical and mental health of patients with heart failure and their caregivers. Available dyadic self-care interventions for heart failure are scarce, especially in China. We aimed to develop and test the family FOCUS programme.

Methods

This single-blind, randomised, controlled study was conducted at four hospitals in Tianjin, China. Patients with heart failure (aged at least 18 years) and their caregiver (dyads) were randomly assigned to either the intervention (n = 71) or control (n = 71) group in a 1:1 ratio. The primary outcomes of this study were patient self-care, with three specific dimensions (self-care maintenance, symptom perception, and self-care management), and caregiver contribution to self-care, mirroring these three dimensions. The outcomes were assessed at baseline (T0) and 4 (T1), 12 (T2), and 24 (T3) weeks post-discharge, respectively. This work is registered on ChiCTR, ChiCTR2100053168.

Findings

Between May 20, 2022, and September 30, 2022, 142 dyads with heart failure were enrolled. The intervention group exhibited dropout rates of 6%, 8.5%, and 18.3% at 4, 12, and 24 weeks after discharge, while the control group showed 9.9%, 12.3%, and 25.4%. Compared with the control group, patients in the intervention group reported improved self-care maintenance (β: 8.5, 95% CI: 0.7, 16.4) and management (β: 7.2, 95% CI: 0.1, 14.3) at T1, as well as improved symptom perception at both T1 (β: 9.7, 95% CI: 1.5, 17.9) and T2 (β: 9.6, 95% CI: 0.6, 18.6). Furthermore, caregiver contributions to self-care maintenance, self-care management, and symptom perception (excluding T3) exhibited significant improvements at all timepoints.

Interpretation

Although the significant improvements in patients' self-care were not long-lasting, this study suggested that the family FOCUS programme consistently enhanced caregivers' contributions to self-care. Future work could explore the effect of the family FOCUS programme on families with multiple chronic conditions.

Funding

The National Natural Science Foundation of China.