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Domeisen Benedetti F, Hechinger M, Fringer A. Self-Assessment Instruments for Supporting Family Caregivers: An Integrative Review. Healthcare (Basel) 2024; 12:1016. [PMID: 38786426 PMCID: PMC11120749 DOI: 10.3390/healthcare12101016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
Family caregivers take on a variety of tasks when caring for relatives in need of care. Depending on the situation and the intensity of care, they may experience multidimensional burdens, such as physical, psychological, social, or financial stress. The aim of the present study was to identify and appraise self-assessment instruments (SAIs) that capture the dimensions of family caregivers' burdens and that support family caregivers in easily identifying their caregiving role, activities, burden, and needs. We performed an integrative review with a broad-based strategy. A literature search was conducted on PubMed, Google Scholar, Google, and mobile app stores in March 2020. After screening the records based on the eligibility criteria, we appraised the tools we found for their usefulness for family care and nursing practice. From a total of 2654 hits, 45 suitable SAIs from 274 records were identified and analyzed in this way. Finally, nine SAIs were identified and analyzed in detail based on further criteria such as their psychometric properties, advantages, and disadvantages. They are presented in multi-page vignettes with additional information for healthcare professionals. These SAIs have proven useful in assessing the dimensions of caregiver burden and can be recommended for application in family care and nursing practice.
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Affiliation(s)
- Franzisca Domeisen Benedetti
- School of Health Professions, Institute of Nursing, ZHAW—Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401 Winterthur, Switzerland (A.F.)
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Lee JW, Sohn MK, Lee J, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Han J, Ahn J, Kim YH, Song MK, Chang WH. Predictors of Burden for First-Ever Stroke Survivor's Long-Term Caregivers: A Study of KOSCO. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:559. [PMID: 38674206 PMCID: PMC11052313 DOI: 10.3390/medicina60040559] [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: 02/27/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024]
Abstract
Long-term changes in caregiver burden should be clarified considering that extended post-stroke disability can increase caregiver stress. We assessed long-term changes in caregiver burden severity and its predictors. This study was a retrospective analysis of the Korean Stroke Cohort for Functioning and Rehabilitation. Patients with an acute first-ever stroke were enrolled from August 2012 to May 2015. Data were collected at 6 months and 6 years after stroke onset. The caregiver burden was measured with a subjective caregiver burden questionnaire based on the Korean version of the Caregiver Burden Inventory. The caregivers' characteristics and patients' clinical and functional status were also examined at each follow-up. A high caregiver burden, which suggests a risk of burnout, was reported by 37.9% and 51.7% of caregivers at 6 months and 6 years post-stroke, respectively. Both the caregiver burden total score and proportion of caregivers at risk of burnout did not decrease between 6 months and 6 years. The patients' disability (OR = 11.60; 95% CI 1.58-85.08; p = 0.016), caregivers' self-rated stress (OR = 0.03; 95% CI 0.00-0.47; p = 0.013), and caregivers' quality of life (OR = 0.76; 95% CI 0.59-0.99; p = 0.042) were burden predictors at 6 months. At 6 years, only the patients' disability (OR = 5.88; 95% CI 2.19-15.82; p < 0.001) and caregivers' psychosocial stress (OR = 1.26; 95% CI 1.10-1.44; p = 0.001) showed significance. Nearly half of the caregivers were at risk of burnout, which lasted for 6 years after stroke onset. The patients' disability and caregivers' stress were burden predictors in both subacute and chronic phases of stroke. The findings suggest that consistent interventions, such as emotional support or counseling on stress relief strategies for caregivers of stroke survivors, may reduce caregiver burden. Further research is needed to establish specific strategies appropriate for Korean caregivers to alleviate their burden in caring for stroke patients.
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Grants
- 3300-3334-300-260-00, 2013-E33017-00, 2013E-33017-01, 2013E-33017-02, 2016-E33003-00, 2016-E33003-01, 2016-E33003-02, 2019-E3202-00, 2019-E3202-01, 2019-E3202-02, and 2022-11-006 Korea Disease Control and Prevention Agency
- NRF-2022R1A2C1091592 National Research Foundation of Korea
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Affiliation(s)
- Jin-Won Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul 05029, Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju City 63243, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon 24252, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06355, Republic of Korea
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Liu J, Dong J, Guo J. The effects of nutrition supplement on rehabilitation for patients with stroke: Analysis based on 16 randomized controlled trials. Medicine (Baltimore) 2022; 101:e29651. [PMID: 36123946 PMCID: PMC9478301 DOI: 10.1097/md.0000000000029651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Malnutrition is a relatively common and often unrecognized condition in stroke survivors, which may negatively affect functional recovery and survival. Though previous studies have indicated significant role of nutrition supplement for rehabilitation of patients with stroke, the results still remain controversy. OBJECTIVE The present analysis was designed to systematically review effective evidence of nutrition supplement on rehabilitation for patients with stroke. METHODS A systematic search of PubMed, EMBASE, the Cochrane Library, and Web of Science up to August 1, 2021 was performed to find relevant studies that analyzed the effect of nutrition supplement on rehabilitation of patients with stroke. The primary outcome was functional outcomes and activities of daily living (ADL). The secondary outcomes included disability, all-cause mortality, infections, pneumonia, walking ability, stroke recurrence, and laboratory results indicating nutrition status of patients. All statistical analyses were performed using standard statistical procedures with Review Manager 5.2. RESULTS Ultimately, 16 studies including 7547 patients were identified. Our pooled results found no significant difference in total, cognitive and motor FIM score between nutrition supplement and placebo groups, with pooled MDs of 7.64 (95% CI - 1.67 to 16.94; P = .11), 0.74 (95% CI - 1.33 to 2.81; P = .48), 1.11 (95% CI - 1.68 to 3.90; P = .44), respectively. However, our result showed that nutritional interventions had significant effect on ADL for patients with stroke (MD 3.26; 95% CI 0.59 to 5.93; P = .02). In addition, nutrition supplement reduced the incidence of infections for patients with stroke, with a pooled RR of 0.65 (95% CI 0.51 to 0.84; P = .0008). No significant results were found in disabilities, complication and laboratory outcomes. CONCLUSIONS The present meta-analysis indicated no statistically significant effect of nutrition supplement on functional outcomes as well as disabilities, complication and laboratory outcomes for patients with stroke. However, it increased ADL and reduced the incidence of infections.
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Affiliation(s)
- Jianhua Liu
- Department of Physical Therapy, Beijing Bo’ai Hospital, Chinese Rehabilitation Research Centre, Beijing, China
| | - Jige Dong
- Department of Rehabilitation and Treatment, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
| | - Jiangzhou Guo
- Department of Rehabilitation and Treatment, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing, China
- *Correspondence: Jiangzhou Guo, Department of Rehabilitation and Treatment, Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Huajiadi Street, Chaoyang District, Beijing 100102, China (e-mail: )
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Aravind G, Bashir K, Cameron JI, Howe JA, Jaglal SB, Bayley MT, Teasell RW, Moineddin R, Zee J, Wodchis WP, Tee A, Hunter S, Salbach NM. Community-based exercise programs incorporating healthcare-community partnerships to improve function post-stroke: feasibility of a 2-group randomized controlled trial. Pilot Feasibility Stud 2022; 8:88. [PMID: 35459194 PMCID: PMC9028093 DOI: 10.1186/s40814-022-01037-9] [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: 06/06/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the potential for community-based exercise programs supported through healthcare-community partnerships (CBEP-HCPs) to improve function post-stroke, insufficient trial evidence limits widespread program implementation and funding. We evaluated the feasibility and acceptability of a CBEP-HCP compared to a waitlist control group to improve everyday function among people post-stroke. Methods We conducted a 3-site, pilot randomized trial with blinded follow-up evaluations at 3, 6, and 10 months. Community-dwelling adults able to walk 10 m were stratified by site and gait speed and randomized (1:1) to a CBEP-HCP or waitlist control group. The CBEP-HCP involved a 1-h, group exercise class, with repetitive and progressive practice of functional balance and mobility tasks, twice a week for 12 weeks. We offered the exercise program to the waitlist group at 10 months. We interviewed 13 participants and 9 caregivers post-intervention and triangulated quantitative and qualitative results. Study outcomes included feasibility of recruitment, interventions, retention, and data collection, and potential effect on everyday function. Results Thirty-three people with stroke were randomized to the intervention (n = 16) or waitlist group (n = 17). We recruited 1–2 participants/month at each site. Participants preferred being recruited by a familiar healthcare professional. Participants described a 10- or 12-month wait in the control group as too long. The exercise program was implemented per protocol across sites. Five participants (31%) in the intervention group attended fewer than 50% of classes for health reasons. In the intervention and waitlist group, retention was 88% and 82%, respectively, and attendance at 10-month evaluations was 63% and 71%, respectively. Participants described inclement weather, availability of transportation, and long commutes as barriers to attending exercise classes and evaluations. Among participants in the CBEP-HCP who attended ≥ 50% of classes, quantitative and qualitative results suggested an immediate effect of the intervention on balance, balance self-efficacy, lower limb strength, everyday function, and overall health. Conclusion The CBEP-HCP appears feasible and potentially beneficial. Findings will inform protocol revisions to optimize recruitment, and program and evaluation attendance in a future trial. Trial registration ClinicalTrials.gov, NCT03122626. Registered April 21, 2017 — retrospectively registered.
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Affiliation(s)
- Gayatri Aravind
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kainat Bashir
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Jo-Anne Howe
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.,Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Susan B Jaglal
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Mark T Bayley
- Toronto Rehabilitation Institute, University Health Network, University of Toronto, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.,Department of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, London, ON, M5S 3H2, Canada
| | - Robert W Teasell
- Schulich School of Medicine and Dentistry, Western University, St Joseph's Health Care London - Parkwood Institute, 550 Wellington Rd, London, ON, N6C 0A7, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, 160‑500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Joanne Zee
- Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Alda Tee
- Central East Stroke Network, Royal Victoria Regional Health Centre, 201 Georgian Drive, Barrie, ON, L4M6M2, Canada
| | - Susan Hunter
- School of Physical Therapy, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada. .,The KITE Research Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
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Handlery R, Regan E, Lewis AF, Larsen C, Handlery K, Flach A, Fritz S. Active Participation of Care Partners in a Physical Activity Intervention Alongside People with Stroke: A Feasibility Study. Physiother Can 2022; 74:97-110. [PMID: 35185254 PMCID: PMC8816353 DOI: 10.3138/ptc-2020-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/20/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023]
Abstract
Purpose: This study investigated the feasibility of a physical activity intervention for people with stroke and their care partners and the role social support plays in physical activity adherence. Method: The study used a single-group, pretest-posttest design with follow-up. Participants were adults with chronic stroke and their care partners. The intervention consisted of 8 weeks of structured, group-based physical activity classes, followed by 19 weeks of self-directed physical activity. Recruitment, adherence, safety, and retention were assessed. Familial social support was assessed before and after the 8-week structured portion and again 19 weeks later. Results: A total of 21 participants (15 people with stroke, 6 care partners), mean age 67.6 (SD 11.6) years, were recruited; 19 (90.5%) completed the 19-week assessment. No adverse events were experienced during the programme. Attendance during the 8-week portion was better than during the 19-week portion (mean difference 0.95; p < 0.001; 95% CI: 0.71, 1.19 visits/wk). No relationship was found between social support and physical activity adherence (p > 0.05). Conclusions: Involvement of care partners in a physical activity intervention is feasible and safe. Both people with stroke and their care partners may require ongoing support to participate in long-term physical activity. The relationship between social support and physical activity adherence requires further study.
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Affiliation(s)
- Reed Handlery
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Elizabeth Regan
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Allison Foster Lewis
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Chelsea Larsen
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Kaci Handlery
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Alicia Flach
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
| | - Stacy Fritz
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina, United States
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Okonkwo UP, Agbo CF, Ibeneme SC, Igwe ES, Akosile CO, Onwuakagba IU, Emmanuel OC, Maduagwu SM, Ezenwankwo EF, Ekechukwu EN. The Burden and Quality of life of Caregivers of Stroke Survivors with Cognitive Impairment in Selected Healthcare Facilities in Anambra State, Nigeria. Gerontol Geriatr Med 2022; 8:23337214221126329. [PMID: 36189374 PMCID: PMC9520178 DOI: 10.1177/23337214221126329] [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: 05/24/2022] [Revised: 08/27/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the burden and quality of life of caregivers of stroke survivors with cognitive impairment in selected healthcare facilities in Anambra State, Nigeria. Methods: This was a cross-sectional survey using the World Health Organization QOL-BREF and Caregiver Strain Index (CSI) as instruments. Descriptive statistics of frequency, percentage counts, mean and standard deviation were used to summarize the socio-demographics. Spearman’s ranked order correlation; Mann–Whitney U test assessed the correlation and gender and age difference in QoL and caregiver’s burden. Alpha level was set at 0.05. Results: Physical health domain of QOL was slightly moderate (53.29 ± 15.19), psychological health was low (46.33 ± 16.96), social relationship was slightly moderate (51.16 ± 0.31), environmental health was slightly moderate (51.22 ± 15.88), the burden of caregivers was high (6.35 ± 1.29). Conclusion: The quality of life of the caregivers of stroke survivors with cognitive impairment was moderate, and the caregivers’ stress was high in the sample of the population studied.
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Fluck D, Fry CH, Gulli G, Affley B, Robin J, Kakar P, Sharma P, Han TS. Association of risk of malnutrition with adverse outcomes and early support on discharge in acute stroke patients without prestroke disability: A multicenter, registry-based cohort study. Nutr Clin Pract 2021; 37:1233-1241. [PMID: 34664741 DOI: 10.1002/ncp.10790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Malnutrition in hospitals remains highly prevalent. As part of quality improvement initiatives, the Royal College of Physicians recommends nutrition screening for all patients admitted with acute stroke. We aimed to examine the associations of patients at risk of malnutrition with poststroke outcomes. METHODS We analyzed prospectively collected data from four hyperacute stroke units (HASUs) (2014-2016). Nutrition status was screened in 2962 acute stroke patients without prestroke disability (1515 men, [mean ± SD] 73.5 years ± 13.1; 1447 women, 79.2 ± 13.0 years). The risk of malnutrition was tested against stroke outcomes and adjusted for age, sex, and comorbidities. RESULTS Risk of malnutrition was identified in 25.8% of patients). Compared with well-nourished patients, those at risk of malnutrition had, within 7 days of admission, increased risk of stay on the HASU of >14 days (odds ratio [OR]: 9.9 [7.3-11.5]), disability on discharge (OR: 8.1 [6.6-10.0]), worst level of consciousness in the first 7 days (score ≥ 1) (OR: 7.5 [6.1-9.3]), mortality (OR: 5.2 [4.0-6.6], pneumonia (OR: 5.1 [3.9-6.7]), and urinary tract infection (OR: 1.5 [1.1-2.0]). They also required palliative care (OR: 12.3 [8.5-17.8]), discharge to new care home (OR: 3.07 [2.18-4.3]), activities of daily living support (OR: 1.8 [1.5-2.3]), planned joint care (OR: 1.5 [1.2-1.8]), and weekly visits (OR: 1.4 [1.1-1.8]). CONCLUSION Patients at risk of malnutrition more commonly have multiple adverse outcomes after acute stroke and greater need for early support on discharge.
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Affiliation(s)
- David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Giosue Gulli
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK.,Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK
| | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
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Hughes AK, Cummings CE. Grief and Loss Associated With Stroke Recovery: A Qualitative Study of Stroke Survivors and Their Spousal Caregivers. J Patient Exp 2020; 7:1219-1226. [PMID: 33457568 PMCID: PMC7786670 DOI: 10.1177/2374373520967796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite a focus on physical and cognitive outcomes, stroke survivors are also impacted by emotional and mental health challenges. Additionally, their caregivers may experience decreased well-being due to increased burden and role adjustment. A small body of literature characterizes this experience as a form of grief and loss. This study seeks to explore experiences of grief and loss reported by stroke survivors and caregivers, using Holbrook's 4-stage bereavement model. This cross-sectional, qualitative study was conducted among adult stroke survivors (n = 9) and their spousal caregivers (n = 5). Focus groups on experiences of recent hospitalizations and transitions home were transcribed, coded, and thematic analysis was conducted, identifying a major theme of loss. Data were reanalyzed guided by Holbrook's model. Common themes were losses and changes experienced by patients/caregivers, disbelief, and lack of understanding. Subthemes of denial and confusion were present. Less prevalent themes were loss of existing support systems and silver lining. Stroke survivors and caregivers experienced a range of negative emotions, impacting behaviors, self-perception, roles, and social support. Awareness of these issues can improve practice with those affected by stroke.
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Affiliation(s)
- Anne K Hughes
- School of Social Work, Michigan State University, East Lansing, MI, USA
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9
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Sabbouh T, Torbey MT. Malnutrition in Stroke Patients: Risk Factors, Assessment, and Management. Neurocrit Care 2019; 29:374-384. [PMID: 28799021 DOI: 10.1007/s12028-017-0436-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Toni Sabbouh
- Cerebrovascular and Neurocritical Care Division, Department of Neurology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Michel T Torbey
- Cerebrovascular and Neurocritical Care Division, Department of Neurology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA. .,Department of Neurosurgery, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, Columbus, OH, 43210, USA.
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10
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The relationship between plasma amino acids and circulating albumin and haemoglobin in postabsorptive stroke patients. PLoS One 2019; 14:e0219756. [PMID: 31412042 PMCID: PMC6693779 DOI: 10.1371/journal.pone.0219756] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 07/01/2019] [Indexed: 01/15/2023] Open
Abstract
Background This retrospective study had two main aims: (1) to document possible correlations between plasma Amino Acids (AAs) and circulating Albumin (Alb) and Haemoglobin (Hb); and (2) to identify which AAs were predictors of Alb and Hb. Methods The study considered 125 stroke subjects (ST) (61.6% males; 65.6 +/- 14.9 years) who met the eligibility criteria (absence of co morbidities associated with altered plasma AAs and presence of plasma AAs determined after overnight fasting). Fifteen matched healthy subjects with measured plasma AAs served as controls. Results The best correlations of Alb were with tryptophan (Trp) and histidine (His) (r = + 0.53; p < 0.0001), and those of Hb were with histidine (r = +0.47) and Essential AAs (r = +0.47) (both p<0.0001). In multivariate analysis, Trp (p< 0.0001) and His (p = 0.01) were shown to be the best positive predictors of Alb, whereas glutamine (p = 0.006) was the best positive predictor of Hb. Conclusions The study shows that the majority of plasma AAs were positively correlated with Alb and Hb. The best predictors of circulating Alb and Hb were the levels of tryptophan and glutamine, respectively.
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Condon L, Benford P, Kontou E, Thomas S, Walker M. The use of carer perspectives and expert consensus to define key components of a biopsychosocial support intervention for stroke carers. Top Stroke Rehabil 2019; 26:440-447. [PMID: 31170035 DOI: 10.1080/10749357.2019.1623472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To identify the key components of a biopsychosocial support intervention to improve mental wellbeing for informal stroke carers within the first year post-stroke based on the combined perspectives of experts in the field of psychological care after stroke and informal stroke carers themselves. Methods: After reviewing the existing literature a cross-sectional mixed-methods design was adopted comprising 1) focus groups with informal stroke carers about their psychological support needs, and 2) nominal group technique with academic and clinical stroke care experts to reach consensus on intervention priorities. Transcripts were thematically analyzed and combined with the ranked priorities from the nominal group to identify key components for intervention content. Results: Key themes for informal stroke carers were associated with: 1) changes in relationships, roles, and dynamics; 2) emotional impact and acceptance; 3) drawing on inner resources; 4) looking for information, solutions, and explanations; 5) support from others. The expert nominal group placed priority on eight ranked areas: 1) acknowledging "normal" emotions; 2) education about the effects of a stroke; 3) reactions to loss and adjustment; 4) recognizing signs and symptoms of not coping; 5) knowing how and when to access practical and emotional support; 6) strategies for taking care of own health; 7) dealing with difficult emotions; and 8) problem solving skills. Conclusions: Themes from the informal carer focus groups, and ranked priority areas will inform the development of a biopsychosocial support intervention for stroke carers to be tested in a feasibility randomized controlled trial.
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Affiliation(s)
- Laura Condon
- a Division of Rehabilitation and Ageing, University of Nottingham, B Floor, The Medical School, Queens Medical Centre , Nottingham , England
| | - Penny Benford
- a Division of Rehabilitation and Ageing, University of Nottingham, B Floor, The Medical School, Queens Medical Centre , Nottingham , England
| | - Eirini Kontou
- a Division of Rehabilitation and Ageing, University of Nottingham, B Floor, The Medical School, Queens Medical Centre , Nottingham , England
| | - Shirley Thomas
- a Division of Rehabilitation and Ageing, University of Nottingham, B Floor, The Medical School, Queens Medical Centre , Nottingham , England
| | - Marion Walker
- a Division of Rehabilitation and Ageing, University of Nottingham, B Floor, The Medical School, Queens Medical Centre , Nottingham , England
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Wu CY, Skidmore ER, Rodakowski J. Relationship Consensus and Caregiver Burden in Adults with Cognitive Impairments 6 Months Following Stroke. PM R 2019; 11:597-603. [PMID: 30844137 DOI: 10.1002/pmrj.12009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/01/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Caregiver burden is commonly experienced in caregivers of adults with cognitive impairment after stroke. This burden can be associated with caregiver-centered factors, including caregiver-perceived relationship quality. OBJECTIVE To examine the role of caregiver-perceived relationship quality on caregiver burden at 6 months following stroke. DESIGN Prospective observational study. SETTING Community settings. PARTICIPANTS Adults enrolled in two randomized controlled trials after stroke (n = 60) and their caregivers (n = 60). METHODS Three constructs of relationship quality (relationship consensus, cohesion, and satisfaction) were examined as predictors of caregiver burden (the Abbreviated Dyadic Adjustment Scale). A hierarchical logistic regression and a Poisson regression with robust standard errors were used to examine the effect of relationship quality on caregiver burden while controlling for characteristics of stroke survivors and caregivers. MAIN OUTCOME MEASUREMENTS Caregiver burden was measured with the abridged version of the Zarit Burden Interview. RESULTS Poor relationship consensus (odds ratio [OR] = 1.48; 95% confidence interval [CI] = 1.06-2.07; P = .02) increased the odds of high caregiver burden after controlling for characteristics of stroke survivors (age, comorbidity, cognitive fluency) and caregivers (gender, self-reported health). Relationship cohesion (OR = 1.03; 95% CI = .84-1.25; P = .81) and relationship satisfaction (OR = 1.53; 95% CI = .75-3.10; P = .24) did not predict caregiver burden. CONCLUSION Meaningful and agreeable goals and expectations between dyads are essential to reduce caregiver burden after stroke. Collaborative goal-setting between stroke survivors and their caregivers may be a promising intervention strategy to increase relationship consensus and reduce caregiver burden. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Chao-Yi Wu
- Department of Occupational Therapy, University of Pittsburgh, 5055 Forbes Tower, Pittsburgh, PA 15260
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, Clinical and Translational Institute, Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Juleen Rodakowski
- Department of Occupational Therapy, Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
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Optimizing Participation of Older Adults with Cognitive Deficits Post-stroke: Types of Help and Caregiver Burden. Can J Aging 2019; 38:222-235. [DOI: 10.1017/s0714980818000521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RÉSUMÉCette étude a examiné les types d’aide fournis par des proches aidants qui visaient à optimiser la participation de personnes aînées ayant des déficits cognitifs (personnes aidées) consécutifs à un accident vasculaire cérébral (AVC), et la façon dont ces types d’aide différaient selon le niveau de fardeau des proches aidants. Un devis longitudinal mixte a été utilisé. Douze proches aidants d’aînés ayant subi un AVC ont complété un questionnaire sur le fardeau du proche aidant et ont participé à des entrevues semi-structurées qui ont été réalisées trois semaines, trois mois et six mois suivant le congé de l’hôpital (soins aigus), de l’unité de réadaptation fonctionnelle intensive ou de l’hôpital de jour. Les personnes aidées ont passé des tests cognitifs et ont rempli un questionnaire sur la participation sociale. Les types d’aide fournis par les proches aidants ont différé selon la quantité d’aide apportée, selon le niveau de préoccupation associé au bien-être de la personne aidée et selon l’impact sur la vie sociale du proche aidant. Il est intéressant de constater que les types d’aide favorisant la participation, l’estime de soi et le maintien des capacités n’étaient pas associés à un impact négatif sur la vie sociale des proches aidants. Une meilleure compréhension des relations entre les différents types d’aide et le fardeau des proches aidants permettrait d’optimiser le soutien fourni pour la participation sociale d’aînés ayant subi un AVC sans augmenter le fardeau de leurs proches aidants.
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Zhu W, Jiang Y. A Meta-analytic Study of Predictors for Informal Caregiver Burden in Patients With Stroke. J Stroke Cerebrovasc Dis 2018; 27:3636-3646. [PMID: 30268368 DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/13/2018] [Accepted: 08/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several studies have reported on predictors for caregiver burden in patients with stroke, but the magnitude of the impact of these variables remains unclear. The aim of the study was to determine the magnitude of relationship between each predictor and caregiver burden. METHODS Articles related to this filed were search in PUBMED, MEDLINE and Cochrane Library electronic database from the upset to May 2018. Of the 812 articles identified, 22 were included in the final analysis (3025 patients and 2887 caregivers). Weighted correlation coefficient (r-index) was computed as effect size for each predictor. RESULTS Of predictor variables of patients, the activity of daily living and anxiety had moderate to large effect sizes; gender, neurological function and depression had the small to moderate effect sizes. Of caregivers' predictors, depression, anxiety, and sense of coherence had large effect sizes; gender, daughter in law, physical health and employment status had small to moderate effect sizes. CONCLUSIONS The most powerful predictors of caregiver burden using meta-analysis were identified to direct future research and evidence-based practice.
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Affiliation(s)
- Wei Zhu
- West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Yan Jiang
- West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China.
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Pont W, Groeneveld I, Arwert H, Meesters J, Mishre RR, Vliet Vlieland T, Goossens P. Caregiver burden after stroke: changes over time? Disabil Rehabil 2018; 42:360-367. [DOI: 10.1080/09638288.2018.1499047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Winke Pont
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Sophia Rehabilitation, The Hague, The Netherlands
| | - Iris Groeneveld
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Henk Arwert
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Rehabilitation Medicine, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Jorit Meesters
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Radha Rambaran Mishre
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Rehabilitation Medicine, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Thea Vliet Vlieland
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Paulien Goossens
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
- Sophia Rehabilitation, The Hague, The Netherlands
- Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Centre, Leiden, The Netherlands
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Han TS, Fry CH, Fluck D, Affley B, Gulli G, Barrett C, Kakar P, Patel T, Sharma S, Sharma P. Anticoagulation therapy in patients with stroke and atrial fibrillation: a registry-based study of acute stroke care in Surrey, UK. BMJ Open 2018; 8:e022558. [PMID: 29997144 PMCID: PMC6089275 DOI: 10.1136/bmjopen-2018-022558] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Because of their high risk of stroke, anticoagulation therapy is recommended for most patients with atrial fibrillation (AF). The present study evaluated the use of anticoagulants in the community and in a hospital setting for patients with AF and its associations with stroke. METHODS Patients admitted with stroke to four major hospitals in County of Surrey, England were surveyed in the 2014-2016 Sentinel Stroke National Audit Programme. Descriptive statistics was used to summarise subject characteristics and χ² test to assess differences between categorical variables. RESULTS A total of 3309 patients, 1656 men (mean age: 73.1 years±SD 13.2) and 1653 women (79.3 years±13.0) were admitted with stroke (83.3% with ischaemic, 15.7% haemorrhagic stroke and 1% unspecified). AF occurred more frequently (χ2=62.4; p<0.001) among patients admitted with recurrent (30.2%) rather than with first stroke (17.1%). There were 666 (20.1%) patients admitted with a history of AF, among whom 304 (45.3%) were anticoagulated, 279 (41.9%) were untreated and 85 (12.8%) deemed unsuitable for anticoagulation. Of the 453 patients with history of AF admitted with a first ischaemic stroke, 138 (37.2%) were on anticoagulation and 41 (49.6%) were not (χ2 = 6.3; p<0.043) and thrombolysis was given more frequently for those without prior anticoagulation treatment (16.1%) or unsuitable for anticoagulation (23.6%) compared with those already on anticoagulation treatment (8.3%; χ2=10.0; p=0.007). Of 2643 patients without a previous history of AF, 171 (6.5%) were identified with AF during hospitalisation. Of patients with AF who presented with ischaemic stroke who were not anticoagulated or deemed unsuitable for anticoagulation prior to admission, 91.8% and 75.0%, respectively, were anticoagulated on discharge. CONCLUSIONS The study highlights an existing burden for patients with stroke and reflects inadequate treatment of AF which results in an increased stroke burden. There is significant scope to improve the rates of anticoagulation.
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Affiliation(s)
- Thang S Han
- Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK
| | - Christopher Henry Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Brendan Affley
- Department of Stroke, Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
| | - Giosue Gulli
- Department of Stroke, Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
| | | | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, UK
| | - Tasmin Patel
- Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK
| | - Sapna Sharma
- Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK
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17
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Lee MJ, Yoon S, Kang JJ, Kim J, Kim JM, Han JY. Efficacy and Safety of Caregiver-Mediated Exercise in Post-stroke Rehabilitation. Ann Rehabil Med 2018; 42:406-415. [PMID: 29961738 PMCID: PMC6058591 DOI: 10.5535/arm.2018.42.3.406] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/04/2017] [Indexed: 01/19/2023] Open
Abstract
Objective To assess the efficacy and safety of our 4-week caregiver-mediated exercise (CME) in improving trunk control capacity, gait, and balance and in decreasing concerns about post-stroke falls when there is an increase in its efficacy. Methods Acute or subacute stroke survivors were assigned to either the trial group (n=35) or the control group (n=37). Changes in Modified Barthel Index (MBI), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), and Trunk Impairment Scale (TIS) scores at 4 weeks from baseline served as primary outcome measures. Correlations of primary outcome measures with changes in Fall Efficacy Scale-International (FES-I) scores at 4 weeks from baseline in the trial group served as secondary outcome measures. Treatment-emergent adverse events (TEAEs) served as safety outcome measures. Results There were significant differences in changes in MBI, FAC, BBS, TIS-T, TIS-D, TIS-C, and FES-I scores at 4 weeks from baseline between the two groups (all p<0.0001). There were no significant (p=0.0755) differences in changes in TIS-S scores at 4 weeks from baseline between the two groups. MBI, FAC, BBS, and TIS scores showed significantly inverse correlations with FES-I scores in patients receiving CME. There were no TEAEs in our series. Conclusion CME was effective and safe in improving the degree of independence, ambulation status, dynamic and static balance, trunk function, and concerns about post-stroke falls in stroke survivors.
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Affiliation(s)
- Min Jun Lee
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Seihee Yoon
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jung Joong Kang
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jungin Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jong Moon Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jun Young Han
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju, Korea
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Chander RJ, Lim L, Handa S, Hiu S, Choong A, Lin X, Singh R, Oh D, Kandiah N. Atrial Fibrillation is Independently Associated with Cognitive Impairment after Ischemic Stroke. J Alzheimers Dis 2018; 60:867-875. [PMID: 28922154 DOI: 10.3233/jad-170313] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND While atrial fibrillation (AF) is an important risk factor for ischemic strokes and mild cognitive impairment (MCI) in Alzheimer's disease, the association between AF and post-stroke cognitive impairment (PSCI), and the factors mediating this association, is unclear. OBJECTIVE To investigate the role of AF in PSCI, especially in relation to other markers of cerebrovascular disease. METHODS 445 subjects with mild ischemic stroke without pre-stroke cognitive decline were assessed 3-6 months post-stroke for cognitive deficits. MRIs were reviewed by trained raters for acute infarct characteristics, global cortical atrophy, white matter hyperintensities, cerebral microbleeds, and intracranial stenosis. Logistic regression analysis was used to identify factors independently associated with PSCI. Subjects were also categorized according to paroxysmal (pAF) or persistent/chronic AF (p/cAF), and presence or absence of AF or large cortical infarcts (LCI) to study cognitive trends. RESULTS 80 (18.0%) subjects had AF. 76.3% of AF subjects and 42.7% of subjects without AF had PSCI. The odds ratio (OR) of AF in developing PSCI was 2.31 (95% CI: 1.12-4.75; p = 0.035), after correcting for other risk factors. pAF subjects and AF subjects with LCIs had higher ORs for PSCI. AF subjects performed worse in neuropsychological tasks associated with global cognition, episodic memory, and executive function. CONCLUSION AF is a significant risk factor for PSCI, even after correcting for AF-related infarcts. Other mechanisms, such as hypoperfusion, microhemorrhages, and neuroinflammation, may be at play. All stroke patients with AF, regardless of the type of infarction, should be closely monitored for PSCI.
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Affiliation(s)
| | - Levinia Lim
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Sagarika Handa
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Shaun Hiu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Angeline Choong
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Xuling Lin
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Daniel Oh
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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19
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Kitt-Lewis E, Strauss S, Penrod J. A Discourse Analysis: One Caregiver's Voice in End-of-Life Care. QUALITATIVE HEALTH RESEARCH 2018; 28:346-356. [PMID: 28891387 PMCID: PMC7875470 DOI: 10.1177/1049732317728916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Informal family caregivers make a significant contribution to the U.S. health care system, and the need for caregivers will likely increase. Gaining deeper insights into the caregiver experience will provide essential knowledge needed to support the future caregiver workforce delivering care. Discourse analysis is a viable approach in analyzing textual caregiver data that focuses on the end-of-life caregiving experience. The purpose of this study was to conduct an in-depth discourse analytic examination of 13 hours of caregiver interview data, which reveal the multiplicity of shifting stances and perceptions of one caregiver in the midst of end-of-life care, specifically with regard to his perceptions of self (caregiver) and other (care recipient). By isolating a specific but limited set of reference terms used throughout the discourse, we gained systematic glimpses into the mind and perceptions of this single caregiver in relation to his role as caregiver for his terminally ill wife.
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Affiliation(s)
- Erin Kitt-Lewis
- The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Susan Strauss
- The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Janice Penrod
- The Pennsylvania State University, University Park, Pennsylvania, USA
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20
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Bunketorp-Käll L, Lundgren-Nilsson Å, Nilsson M, Blomstrand C. Multimodal rehabilitation in the late phase after stroke enhances the life situation of informal caregivers. Top Stroke Rehabil 2017; 25:161-167. [PMID: 29237339 DOI: 10.1080/10749357.2017.1413761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Purpose The burden of caregiving for stroke survivors is well known, but the effect of late stroke rehabilitation on the life situation of informal caregivers is unknown. Here, we assessed changes in the life situation of informal caregivers of stroke survivors enrolled in a multimodal intervention trial. Methods This controlled study was a questionnaire-based survey accompanying a three-armed randomized controlled trial of 123 stroke survivors. The care recipients of 106 caregivers who chose to participate were assigned to rhythm-and-music-based therapy (R-MT; n = 37), horse-riding therapy (H-RT; n = 37), or delayed intervention (control group, n = 32). Perceived changes in the life situation of the caregivers were evaluated with the Life Situation among Spouses after the Stroke Event (LISS) questionnaire before randomization, after the 12-week intervention, and 3 and 6 months later. Results After the intervention, the change in the median LISS score was significantly higher among intervention caregivers (1.5 [interquartile range (IQR) 8.8]) than controls (1.5 [IQR 8.8] vs. 0.0 [IQR 12.0], p = 0.036). The improvement was maintained at 3 months (1.5 [IQR 9.0] vs. 0.0 [IQR 10.5], p = 0.039) but not at 6 months (p = 0.284). Conclusion Engaging stroke survivors in multimodal interventions late after stroke appears to have potential to produce gains also in the general life situation of informal caregivers.
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Affiliation(s)
- Lina Bunketorp-Käll
- a Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience , Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Åsa Lundgren-Nilsson
- a Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience , Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.,b Stroke Center West, Department of Clinical Neuroscience , Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
| | - Michael Nilsson
- a Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience , Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.,c Hunter Medical Research Institute (HMRI) and University of Newcastle , Newcastle , Australia
| | - Christian Blomstrand
- a Center for Brain Repair and Rehabilitation, Department of Clinical Neuroscience , Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden.,b Stroke Center West, Department of Clinical Neuroscience , Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
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21
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Imarhiagbe FA, Asemota AU, Oripelaye BA, Akpekpe JE, Owolabi AA, Abidakun AO, Akemokwe FM, Ogundare VO, Azeez AL, Osakue JO. Burden of informal caregivers of stroke survivors: Validation of the Zarit burden interview in an African population. Ann Afr Med 2017; 16:46-51. [PMID: 28469116 PMCID: PMC5452708 DOI: 10.4103/aam.aam_213_16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Informal care giving can be burdensome particularly where the option of institutionalized informal care scarcely exist. Objective: To look at the burden of informal caregivers of stroke survivors using the Zarit burden interview (ZBI). Method: 64 stroke survivors were assessed for demographics of age, gender, duration of follow-up since discharged from in-patient care, modified Rankin score at the time of discharge and at the time of evaluation for this study and the most important informal care giver at home was also assessed for whether care giving was telling on their health or life in any negative way. All the caregivers were subsequently assessed with the ZBI. Results: Mean age of most important informal care givers was 40.67 ± 14.27 years and the sex distribution was 33(51.6%) female and 29(45.4%) males. 21(32.8%) reported that caregiving was a health burden. Mean ZBI scores were significantly higher (30.19 ± 14.81 vs 20.30 ± 12.96, P < 0.01) in those that reported that caregiving was telling on their health. ZBI overall rating of burden of caregiving was also significantly associated with whether caregiving was telling on the health of caregiver (P = 0.01) and also symmetrically agreed with whether the burden of caregiving was telling on health (k = 0.33, P < 0.01). The sensitivity and specificity of ZBI were 70% and 68.4% respectively on ROC statistics (AUC = 0.67, P = 0.017). Conclusion: Reported burden of informal caregiving of about 33% is in our opinion huge. The moderate sensitivity and specificity of the ZBI means it could be safely used in the population studied.
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Affiliation(s)
| | - A U Asemota
- Department of Medicine, Neurology Unit, University of Benin Teaching Hospital, Benin City, Nigeria
| | - B A Oripelaye
- Department of Medicine, Neurology Unit, University of Benin Teaching Hospital, Benin City, Nigeria
| | - J E Akpekpe
- Department of Medicine, Neurology Unit, University of Benin Teaching Hospital, Benin City, Nigeria
| | - A A Owolabi
- Department of Medicine, Neurology Unit, University of Benin Teaching Hospital, Benin City, Nigeria
| | - A O Abidakun
- Department of Medicine, Neurology Unit, University of Benin Teaching Hospital, Benin City, Nigeria
| | - F M Akemokwe
- Department of Medicine, Neurology Unit, University of Benin Teaching Hospital, Benin City, Nigeria
| | - V O Ogundare
- Department of Medicine, Neurology Unit, University of Benin Teaching Hospital, Benin City, Nigeria
| | - A L Azeez
- Department of Surgery, Division of Neurological Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
| | - J O Osakue
- Department of Surgery, Division of Neurological Surgery, University of Benin Teaching Hospital, Benin City, Nigeria
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Usefulness of the prediction method based on a logarithmic model for functional recovery in stroke patients: in case of using the motor-Functional Independence Measure score. Int J Rehabil Res 2017; 40:134-137. [DOI: 10.1097/mrr.0000000000000219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Em S, Bozkurt M, Caglayan M, Ceylan Cevik F, Kaya C, Oktayoglu P, Nas K. Psychological health of caregivers and association with functional status of stroke patients. Top Stroke Rehabil 2017; 24:323-329. [PMID: 28317472 DOI: 10.1080/10749357.2017.1280901] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Stroke does not only affect the physical state of patients but also the emotional state of their relatives, most effectively their caregivers. The study aims to examine the mood of caregivers experienced with care for patients with stroke who are highly dependent on the assistance and also to establish the relationship between the emotional state of caregivers and the severity of disability of the patients. METHODS This study contained a total of 76 patients with sufficient cognitive functions and severe physical disabilities with hemiplegia caused by a cerebrovascular accident and their caregivers and 94 controls. The functional state of patients was assessed by the Barthel Index (BI). Furthermore, emotional state of the caregivers was assessed by the Hospital Anxiety and Depression Scale (HADS) and their life quality was assessed by the SF36 Health Survey. RESULTS The mean anxiety (9.73 ± 4.88) and depression rates (9.81 ± 5.05) in the caregivers were significantly higher than those in controls (p<0.001, respectively). Significant impairments were observed in both their mental and physical health. Regression analysis also showed a significant negative correlation between the BI scores and the HADS scores. CONCLUSION Caregivers had an impaired emotional state and the level of their anxiety was associated with the severity of functional disability of the patients. Therefore, the support provided to the caregiver might be influential on the functional recovery of the patients.
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Affiliation(s)
- Serda Em
- a Faculty of Medicine, Department of Physical Medicine and Rehabilitation , Dicle University , Diyarbakir , Turkey
| | - Mehtap Bozkurt
- a Faculty of Medicine, Department of Physical Medicine and Rehabilitation , Dicle University , Diyarbakir , Turkey
| | - Mehmet Caglayan
- a Faculty of Medicine, Department of Physical Medicine and Rehabilitation , Dicle University , Diyarbakir , Turkey
| | - Figen Ceylan Cevik
- b Department of Physical Medicine and Rehabilitation , Diyarbakır Training and Research Hospital , Diyarbakır , Turkey
| | - Cemal Kaya
- c Faculty of Medicine, Department of Psychiatry , Dicle University , Diyarbakir , Turkey
| | - Pelin Oktayoglu
- a Faculty of Medicine, Department of Physical Medicine and Rehabilitation , Dicle University , Diyarbakir , Turkey
| | - Kemal Nas
- d Faculty of Medicine, Department of Physical Medicine and Rehabilitation , Sakarya University , Sakarya , Turkey
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Pai HC, Wu MH, Chang MY. Determinants of Health-Related Quality of Life in Taiwanese Middle-Aged Women Stroke Survivors. Rehabil Nurs 2017; 42:80-89. [DOI: 10.1002/rnj.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Determinants of caregiving burden and quality of life of informal caregivers of African stroke survivors: literature review. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/ijdhd-2016-0041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractBackground:The involvement of informal caregivers (CGs) in the provision of care for stroke survivors always ensures the success of stroke rehabilitation.Aims:The aim of this review was to find the determinants of caregiving burden and quality of life (QOL) of CGs of African stroke survivors.Methods:The literature was searched in Google Scholar and PUBMED, AJOL and Cochrane Databases using selected search strategies without date restriction.Results:A total of eight African studies met the inclusion criteria. There were more female stroke CGs (55.6%) than their male counterparts. The determinants of CG QOL were duration and burden of caregiving, the CG’s age and functional status of the stroke survivors. The determinants of caregiving burden were functional status of stroke survivors and having intimate relationship with them.Conclusion:Impairment of physical function in African stroke survivors was the consistent determinant of increased caregiving burden and deterioration of CG QOL. CG education and training is needed in order to enhance their ability to cope effectively with the burden of providing care to stroke survivors who have impairment of physical function and this may help to improve CG QOL.
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Chuluunbaatar E, Pu C, Chou YJ. Changes in caregiver burden among informal caregivers of stroke patients in Mongolia. Top Stroke Rehabil 2017; 24:314-321. [DOI: 10.1080/10749357.2016.1277479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Enkhzaya Chuluunbaatar
- Institute of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Christy Pu
- Institute of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan
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van Wijnen HGFM, Rasquin SMC, van Heugten CM, Verbunt JA, Moulaert VRM. The impact of cardiac arrest on the long-term wellbeing and caregiver burden of family caregivers: a prospective cohort study. Clin Rehabil 2017; 31:1267-1275. [DOI: 10.1177/0269215516686155] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The purpose was to gain insight in the functioning of caregivers of cardiac arrest survivors at 12 months after a cardiac arrest. Secondly, the course of the wellbeing of the caregivers during the first year was studied. Finally, factors that are associated with a higher care burden at 12 months after the cardiac arrest were investigated. Subjects: A total of 195 family caregivers of cardiac arrest survivors were included. Main measures: Quality of life (SF-36, EuroQol-VAS), caregiver strain (CSI) and emotional functioning (HADS, IES) were measured at two weeks, three months and one year after the cardiac arrest. Thereby, the caregiver was asked to fill out the cognitive failure questionnaire (CFQ) to evaluate their view on the cognitive status of the patient. Results: Caregiver strain was high in 16 (15%) of the caregivers at 12 months. Anxiety was present in 33 (25%) caregivers and depression in 18 (14%) caregivers at 12 months. The repeated measures MANOVA showed that during the first year the following variables improved significantly: SF-36 domains social and mental health, role physical, role emotional and vitality, caregiver strain, HADS and IES ( P<0.001). At 12 months caregiver strain correlated significantly (explained variance 63%, P=0.03) with caregiver HADS ( P=0.01), EuroQol-VAS ( P=0.02), and the CFQ ( P<0.001), all measured at 12 months after the cardiac arrest. Conclusions: Overall wellbeing of the caregivers improves during the first year up to normal levels, but caregivers with emotional problems or perceived cognitive problems at 12 months are at risk for developing a higher care burden.
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Affiliation(s)
- Helena GFM van Wijnen
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Sascha MC Rasquin
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Jeanine A Verbunt
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- CAPHRI School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
| | - Véronique RM Moulaert
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- CAPHRI School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
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28
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Correlates of well-being among caregivers of long-term community-dwelling stroke survivors. Int J Rehabil Res 2016; 39:326-330. [DOI: 10.1097/mrr.0000000000000192] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Verma S, Sayal A, Vijayan VK, Rizvi SM, Talwar A. Caregiver's burden in pulmonary arterial hypertension: a clinical review. J Exerc Rehabil 2016; 12:386-392. [PMID: 27807515 PMCID: PMC5091052 DOI: 10.12965/jer.1632708.354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/20/2016] [Indexed: 11/22/2022] Open
Abstract
Caregiver’s burden is a multidimensional phenomenon affecting care-givers physically, emotionally and socially. It is critical to examine the burden of caregivers, because of the complex responsibility they have with their partners. There are relatively few studies that have examined factors linked with psychological burden amongst caregivers of pulmonary arterial hypertension (PAH) patients. Hence, it is pertinent to develop a good understanding of these factors and develop appropriate management strategies, modified to assist PAH caregivers.
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Affiliation(s)
- Sameer Verma
- Department of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA; Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Abhineet Sayal
- Department of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA
| | - V K Vijayan
- Indian Council of Medical Research (ICMR), Bhopal Memorial Hospital and Research Centre (ICMR) & National Institute for Research in Environmental Health (ICMR), Bhopal, India
| | - Syed M Rizvi
- Touro College, New York School of Career and Applied Studies, New York, NY, USA
| | - Arunabh Talwar
- Department of Pulmonary, Critical Care and Sleep Medicine, Northwell Health, New Hyde Park, NY, USA; Feinstein Institute for Medical Research, Manhasset, NY, USA
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Mancuso M, Varalta V, Sardella L, Capitani D, Zoccolotti P, Antonucci G. Italian normative data for a stroke specific cognitive screening tool: the Oxford Cognitive Screen (OCS). Neurol Sci 2016; 37:1713-21. [PMID: 27395388 DOI: 10.1007/s10072-016-2650-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/27/2016] [Indexed: 12/18/2022]
Abstract
Cognitive deficits occur in most stroke patients and cognitive impairment is an important predictor of adverse long term outcome. However, current screening measures, such as the Mini Mental State Examination or the Montreal Cognitive Assessment, do not provide information tuned for evaluating the impact of cognitive impairment in the early phase after stroke. The Oxford Cognitive Screen (OCS) represents an important new development in this regard. The OCS is now available for assessment of Italian individuals and the aim of this study is to standardize the OCS on a large sample of healthy Italian participants stratified for age, gender and education level. Results confirmed the influence of these factors in several of the OCS tasks. Age-, education- and gender-adjusted norms are provided for the ten sub-tests of the test. The availability of normative data represents an important prerequite for the reliable use of OCS with stroke patients.
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Affiliation(s)
- M Mancuso
- Rehabilitation Center, Terranuova Bracciolini, Arezzo, Italy.
| | - V Varalta
- Department of Neuroscience Biomedicine and Movement, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy
| | - L Sardella
- Rehabilitation Center, Terranuova Bracciolini, Arezzo, Italy
| | - D Capitani
- ESTAR Sud Est, ICT-Department, Grosseto, Italy
| | - P Zoccolotti
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Neuropsychology Centre, IRCCS Santa Lucia Foundation, Rome, Italy
| | - G Antonucci
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Neuropsychology Centre, IRCCS Santa Lucia Foundation, Rome, Italy
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van Exel NJA, Scholte op Reimer WJM, Brouwer WBF, van den Berg B, Koopmanschap MA, van den Bos GAM. Instruments for assessing the burden of informal caregiving for stroke patients in clinical practice: a comparison of CSI, CRA, SCQ and self-rated burden. Clin Rehabil 2016; 18:203-14. [PMID: 15053130 DOI: 10.1191/0269215504cr723oa] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compare the feasibility, convergent and clinical validity of three commonly used burden scales: Caregiver Strain Index (CSI), Caregiver Reaction Assessment (CRA) and Sense of Competence Questionnaire (SCQ), with a self-developed single question on self-rated burden (SRB). Subjects: Stroke patients receiving support from an informal caregiver ( n=148) and their caregivers were followed up to six months after stroke. Intervention: Feasibility was assessed with several measures of missing values. Convergent validity was assessed on the basis of the correlation patterns between the burden scales, and clinical validity through evaluation of expected associations between levels of burden and explanatory patients' and caregivers' characteristics. Results: Missing values were less often observed on CSI and SRB than SCQ and CRA. Significant correlation coefficients ( p<0.05) could be demonstrated between all burden scales, except for one subscale of CRA. Evidence for clinical validity was strongest for CSI and SRB, based on associations between higher burden scores and patients' disability, and patients' and caregivers' poor level of health-related quality of life (all p<0.05). Conclusions: A concise and simple measure would facilitate early detection of caregivers at risk in clinical practice and research. CSI and SRB are more feasible and at least as valid instruments for assessment of caregiver burden in stroke than the longer and more complex SCQ and CRA. SRB could be used for quick screening of caregivers at risk. CSI is indicated for further diagnosis of the burden of informal caregivers.
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Affiliation(s)
- N Job A van Exel
- Institute for Medical Technology Assessment (iMTA) and Department of Health Policy and Management (iBMG), Erasmus University Rotterdam, The Netherlands.
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Visser-Meily JMA, Post MWM, Riphagen II, Lindeman E. Measures used to assess burden among caregivers of stroke patients: a review. Clin Rehabil 2016; 18:601-23. [PMID: 15473113 DOI: 10.1191/0269215504cr776oa] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: To describe measures used to evaluate the burden of caregiving experienced by caregivers of stroke patients and their clinimetric properties. Design: A review of the literature was conducted to examine burden scales with regard to concept, feasibility, internal consistency, validity, reliability and responsiveness. Results: The literature search resulted in 45 measures of caregiver outcomes, including 16 different measures of caregiver burden. About half of the scales were used only once and were not further described. Nearly all instruments measure the various dimensions of burden (competency, negative feelings, social relations, participation problems, physical and mental health and economic aspects), but not in the same proportions. Most measures showed good internal consistency, and validity was demonstrated for all measures except one. However, not much is known about the reliability and responsiveness of these measures. Conclusions: No measure has proven superiority above others. Future research should focus on comparisons between existing instruments and on their reliability and responsiveness.
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Affiliation(s)
- J M Anne Visser-Meily
- Rehabilitation Centre De Hoogstraat, Rembrandtkade 10, 3583 TM Utrecht, The Netherlands.
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Forsberg-Wärleby G, Möller A, Blomstrand C. Psychological well-being of spouses of stroke patients during the first year after stroke. Clin Rehabil 2016; 18:430-7. [PMID: 15180127 DOI: 10.1191/0269215504cr740oa] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate whether spouses' psychological well-being changed between the first weeks after their partner's stroke and four months and one year later, and to study the relationship between spouses’ psychological well-being and objective characteristics of the stroke patients. Design: Prospective, longitudinal study. Setting: Hospital care and follow-ups. Subjects: Sixty-seven consecutively enrolled spouses to first-ever stroke patients B/ 75 years. Main measures: The Psychological General Well-Being (PGWB) Index. Clinical examination of the stroke patients. The Barthel Index. Results: The spouses' psychological well-being was significantly lower in the first weeks after their partner's stroke as compared with norms. At four months, it had increased significantly. Between four months and one year, individual changes were observed in both positive and negative directions; thus, the mean level of the group remained constant. The spouses’ psychological well-being in the first weeks was significantly related to the patients’ sensorimotor impairments, while it was related at four months to cognitive impairment and the patients’ abilities in self-care. At one year, psychological well-being was related to remaining sensorimotor and cognitive impairments. A significant relationship was also seen between the spouses’ and the stroke patients’ emotional health. Conclusions: The spouses' psychological well-being increased after the first chaotic weeks. The presence of visible impairments initially seemed to affect spouses’ emotional health, while cognitive and emotional impairments became more evident in everyday life. In the long term, however, the spouses’ individual life situations and coping abilities seem to be of relatively increasing importance for their continued well-being.
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Affiliation(s)
- Gunilla Forsberg-Wärleby
- Institute of Clinical Neuroscience, The Sahlgrenska Academy at Göteborg University and Department of Occupational Therapy, Sahlgrenska University Hospital, Göteborg, Sweden.
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Edwards DF, Hahn MG, Baum CM, Perlmutter MS, Sheedy C, Dromerick AW. Screening Patients with Stroke for Rehabilitation Needs: Validation of the Post-Stroke Rehabilitation Guidelines. Neurorehabil Neural Repair 2016; 20:42-8. [PMID: 16467277 DOI: 10.1177/1545968305283038] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The authors assessed patients with acute stroke to determine whether the systematic use of brief screening measures would more efficiently detect cognitive and sensory impairment than standard clinical practice. Methods. Fifty-three patients admitted to an acute stroke unit were assessed within 10 days of stroke onset. Performance on the screening measures was compared to information obtained from review of the patient’s chart at discharge. Cognition, language, visual acuity, visual-spatial neglect, hearing, and depression were evaluated. Results. Formal screening detected significantly more impairments than were noted in patient charts in every domain. Only 3 patients had no impairments identified on screening; all remaining patients had at least 1 impairment detected by screening that was not documented in the chart. Thirty-five percent had 3 or more undetected impairments. Memory impairment was most likely to be noted in the chart; for all other domains tested, undocumented impairment ranged from 61% (neglect) to 97% (anomia). Conclusion. Many acute stroke patients had cognitive and perceptual deficits that were not documented in their charts. These data support the Post-Stroke Rehabilitation Guidelines for systematic assessment even when deficits are not immediately apparent. Systematic screening may improve discharge planning, rehabilitation treatment, and long-term outcome of persons with stroke.
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Affiliation(s)
- Dorothy F Edwards
- Program in Occupational Therapy, Washington University School of Medicine, and Barnes Jewish Hospital, St. Louis, MO 63108, USA.
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Abstract
We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer’s disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking) are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the short and long term, and great efforts should be oriented toward a multidisciplinary approach, including quality-of-life assessment and support of caregivers.
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Affiliation(s)
- Daniele Lo Coco
- Neurology and Stroke Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Gianluca Lopez
- Neurology and Stroke Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Salvatore Corrao
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy; Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M.), Di.Bi.M.I.S., University of Palermo, Palermo, Italy
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Mees M, Klein J, Yperzeele L, Vanacker P, Cras P. Predicting discharge destination after stroke: A systematic review. Clin Neurol Neurosurg 2016; 142:15-21. [DOI: 10.1016/j.clineuro.2016.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/19/2015] [Accepted: 01/03/2016] [Indexed: 10/22/2022]
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Mugisha JO, Schatz E, Seeley J, Kowal P. Gender perspectives in care provision and care receipt among older people infected and affected by HIV in Uganda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2016. [PMID: 26223333 DOI: 10.2989/16085906.2015.1040805] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this study was to examine gender roles in the provision and receipt of care among older Ugandans. Survey data on care work were collected in 2009-2010 from 510 older people infected or affected by HIV/AIDS, at one rural and one semi-urban site. The questionnaire was adapted from the WHO Study on global AGEing and adult health survey. The type of care work done by older men and women for children in their households differs, yet, both men and women are taking on various types of care work. Women were more likely to report taking part in health/personal and physical care, whereas men were more likely to report providing financial assistance. Some older people, particularly women, were providing care at the same time as needing care. The finding on reciprocity of care suggests the need for further studies focused on how the reciprocity of care may affect health and well-being in older age.
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Affiliation(s)
- Joseph O Mugisha
- a Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Uganda Research Unit on AIDS , Entebbe
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Ratmansky M, Levy A, Messinger A, Birg A, Front L, Treger I. The Effects of Acupuncture on Cerebral Blood Flow in Post-Stroke Patients: A Randomized Controlled Trial. J Altern Complement Med 2015; 22:33-7. [PMID: 26569545 DOI: 10.1089/acm.2015.0066] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND/OBJECTIVE Stroke is a major cause of disability and death in the Western world. Studies have shown a direct relationship between specific mental and motor activity and changes in cerebral blood flow. Acupuncture is often used in post-stroke patients, but there is a lack of sham-controlled studies evaluating the effects of acupuncture on cerebral blood flow following a stroke. This pilot concept-assessment study sought to evaluate the effects of true acupuncture on cerebral blood flow velocity compared with sham acupuncture and lay a foundation for future work in this field. METHODS Seventeen inpatients (age range, 44-79 years) 1-3 months post-stroke were allocated to acupuncture at true acupuncture (TA) points or at sham acupuncture (SA) points. The treatment was 20 minutes long. Transcranial Doppler ultrasonography was used to measure mean flow velocity (MFV) and peak flow velocity (PFV) at both healthy and damaged hemispheres before (T0), in the middle of (T15), and 5 minutes after (T25) treatment. Blood pressure was measured at T0 and T25. RESULTS A statistically significant (p < 0.04) MFV increase in both hemispheres was found during and after TA; this increase was higher than that seen with SA (p < 0.035). Acupuncture had no significant effect on PFV. Systolic blood pressure significantly decreased after acupuncture (p < 0.005) in a similar manner for both TA and SA. National Institutes of Health Stroke Scale score was negatively correlated with MFV at T15 (r = -0.825; p < 0.05). CONCLUSION This pilot study showed a significant influence on cerebral blood flow velocity by TA. This study lays a foundation for larger-scale studies that may prove acupuncture to be a useful tool for cerebral blood flow enhancement during post-stroke rehabilitation.
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Affiliation(s)
- Motti Ratmansky
- 1 Pain Clinic, Loewenstein Rehabilitation Hospital , Raanana, Israel
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Adi Levy
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
- 3 Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center , Jerusalem, Israel
| | - Aviv Messinger
- 4 Complementary Medicine Services, Sheba Medical Center , Tel Hashomer, Israel
| | - Alla Birg
- 1 Pain Clinic, Loewenstein Rehabilitation Hospital , Raanana, Israel
| | - Lilach Front
- 1 Pain Clinic, Loewenstein Rehabilitation Hospital , Raanana, Israel
| | - Iuly Treger
- 1 Pain Clinic, Loewenstein Rehabilitation Hospital , Raanana, Israel
- 2 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
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Abstract
Stroke is a leading cause of long-term disability. A large proportion of geriatric stroke survivors receive informal care. The assessment and monetary valuation of informal care should therefore constitute an essential part of any health economic analysis, but it is hardly measured in stroke caregiver studies. The aim of the current research was to estimate the amount of informal care provided by caregivers of stroke survivors aged 60 years and older and to calculate its economic value. Information about caregiving time in activities of daily living (ADL), instrumental activities of daily living (IADL), and supervision during the last 3 months was obtained from 122 caregivers by means of structured interviews. The proxy good method was applied for the monetary valuation of time. About 63 % of the stroke survivors in our sample were moderately cognitively impaired. The results showed that the majority of the main caregivers assisted in ADL and IADL. Supervision was delivered by 45.9 %. The median amount of help in ADL was 13.9, in IADL 22.2, and in supervision 13.9 h/week. The median overall amount of care was 42.8 h/week. Fifty percent were supported by additional persons (2.7 h/week). The mean overall costs of informal care were calculated at 2252 €/month. Our results reveal the high social and economic costs of informal care. The main burden of caregiving appears to be carried by the primary caregiver. Consequently, support and counseling of this group is important. Furthermore, caregiver interventions should be aimed at the mobilization of informal resources.
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Lee JE, Shin DW, Cho J, Yang HK, Kim SY, Yoo HS, Jho HJ, Shin JY, Cho B, Park K, Park JH. Caregiver burden, patients' self-perceived burden, and preference for palliative care among cancer patients and caregivers. Psychooncology 2015; 24:1545-51. [DOI: 10.1002/pon.3827] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 02/11/2015] [Accepted: 03/20/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Ji Eun Lee
- Department of Family Medicine/Cancer Survivorship Clinic; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
| | - Dong Wook Shin
- Department of Family Medicine/Cancer Survivorship Clinic; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
| | - Juhee Cho
- Cancer Education Center; Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
- Departments of Health, Behavior and Society, and Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
- Department of Health Sciences and Technology, SAIHST; Sungkyunkwan University; Seoul Korea
| | - Hyung Kook Yang
- Division of Cancer Policy, National Cancer Control Institute; National Cancer Center; Goyang-si Korea
| | - So Young Kim
- Division of Cancer Policy, National Cancer Control Institute; National Cancer Center; Goyang-si Korea
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju-si Korea
| | - Hyo Sang Yoo
- Department of Family Medicine/Cancer Survivorship Clinic; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
| | - Hyun Jung Jho
- Hospice and Palliative Care Branch, National Cancer Control Institute; National Cancer Center; Goyang-si Korea
| | - Joo Yeon Shin
- Department of Counseling Psychology; Hanyang Cyber University; Seoul Korea
| | - Belong Cho
- Department of Family Medicine/Cancer Survivorship Clinic; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
| | - Keeho Park
- Division of Cancer Policy, National Cancer Control Institute; National Cancer Center; Goyang-si Korea
| | - Jong-Hyock Park
- Division of Cancer Policy, National Cancer Control Institute; National Cancer Center; Goyang-si Korea
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju-si Korea
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Chenoweth L, Gietzelt D, Jeon YH. Perceived Needs of Stroke Survivors from Non-English-Speaking Backgrounds and Their Family Carers. Top Stroke Rehabil 2015; 9:67-79. [PMID: 14523723 DOI: 10.1310/d392-nul6-2j35-5egm] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this article is to discuss current findings in the research literature on the experiences and needs of stroke survivors and their family carers and to provide suggestions for future research. Based on this critical review, knowledge gaps and issues in stroke management in the community indicate that the needs of people surviving a stroke, particularly people from non-English speaking backgrounds, are not being adequately met by community-based health services. There is a critical need for changes in practices to meet the needs of this specific population.
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Affiliation(s)
- Lynn Chenoweth
- Health & Ageing Research Unit, South Eastern Sydney Area Health Service, Sydney, Australia
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Mitchell K. Assessment of Stroke Survivors: Assisting Families of Stroke Survivors on Acute Rehabilitation Units. Top Stroke Rehabil 2015; 16:420-4. [DOI: 10.1310/tsr1606-420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tellier M, Rochette A. Falling Through the Cracks: A Literature Review to Understand the Reality of Mild Stroke Survivors. Top Stroke Rehabil 2015; 16:454-62. [DOI: 10.1310/tsr1606-454] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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El Masry Y, Mullan B, Hackett M. Psychosocial Experiences and Needs of Australian Caregivers of People with Stroke: Prognosis Messages, Caregiver Resilience, and Relationships. Top Stroke Rehabil 2015; 20:356-68. [DOI: 10.1310/tsr2004-356] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lutz BJ, Chumbler NR, Roland K. Care Coordination/Home-Telehealth for Veterans with Stroke and Their Caregivers: Addressing an Unmet Need. Top Stroke Rehabil 2014; 14:32-42. [PMID: 17517572 DOI: 10.1310/tsr1402-32] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Stroke is a life-disrupting, costly event for many stroke patients and their families. An estimated 4.8 million stroke survivors are living in the community with some level of disability, and the incidence of stroke is expected to rise with correspondingly higher costs, both in dollars and other forms of burden for families of patients with stroke. Approximately 80,000 veterans have experienced a stroke, leaving approximately 40% with moderate residual impairments and 15%-30% with severe residual disability. PURPOSE The purpose of this study was to identify postdischarge needs of veterans with stroke and their caregivers and to identify how to design a care coordination/home-telehealth (CC/HT) program to address these needs. METHOD Veterans and their caregivers (N = 22) were interviewed about their experiences with stroke, their postdischarge stroke recovery needs, and their experiences with the Veterans Administration's existing Care Coordination/Home-Telehealth (CC/HT) program. Data were analyzed using the process of grounded dimensional analysis. RESULTS Core concepts identified were (a) assessing and managing the residual effects of stroke, and (b) shifting roles and responsibilities. CONCLUSION The findings suggest that a comprehensive care coordination program that includes home telehealth could aid veterans and their caregivers in managing stroke recovery across the continuum of care at home and within the community. The results of the study can provide elements to be included in the CC/HT program.
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Affiliation(s)
- Barbara J Lutz
- College of Nursing, University of Florida, Gainesville, Florida, USA
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Van Heugten CM, Walton L, Hentschel U. Can we forget the Mini-Mental State Examination? A systematic review of the validity of cognitive screening instruments within one month after stroke. Clin Rehabil 2014; 29:694-704. [PMID: 25381346 DOI: 10.1177/0269215514553012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/04/2014] [Indexed: 11/15/2022]
Abstract
Objective: To review systematically studies investigating the convergent, criterion, and predictive validity of multi-domain cognitive screening instruments in the first four weeks after stroke. Data sources: Electronic databases (Pubmed, PsycINFO, CINAHL, Embase) were searched until June 2014. Review methods: Studies concerning screening for cognitive dysfunction in stroke patients using multi-domain instruments, within four weeks postinfarct or haemorrhagic stroke, using tests taking no longer than one hour. Convergent, criterion, and predictive validity were examined. Results: A total of 51 studies investigating 16 cognitive screening instruments were identified. None of the instruments covered all of the most affected cognitive domains. Only one study investigated the convergent validity of a multi-domain test during the (sub)acute phase after stroke. A total of 15 studies examined the criterion validity of cognitive measurements during the acute phase after stroke. The Montreal Cognitive Assessment and Higher Cortical Function Deficit Test had good criterion validity. A total of 24 studies examined the predictive ability of multi-domain cognitive instruments applied in the acute phase after stroke. The Cognistat, Montreal Cognitive Assessment, and Functional Independence Measure-cognitive showed good predictive validity. The Mini-Mental State Examination is the most widely used cognitive screening instrument, but shows insufficient criterion validity. Conclusion: None of the existing instruments fulfils all criteria. The Montreal Cognitive Assessment is the best candidate at present, provided items measuring speed of information processing are added, and further studies investigating the optimal cut-offs are conducted.
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Affiliation(s)
- Caroline M Van Heugten
- Department Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - L Walton
- Department Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - U Hentschel
- Department Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
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Nightingale CL, Lagorio L, Carnaby G. A prospective pilot study of psychosocial functioning in head and neck cancer patient-caregiver dyads. J Psychosoc Oncol 2014; 32:477-92. [PMID: 24988320 DOI: 10.1080/07347332.2014.936649] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study explored the psychosocial functioning of 10 head and neck cancer patient-caregiver dyads over the radiation/chemoradiation (radiation or combined chemoradiation) treatment period, including the interdependence in patient-caregiver quality of life (QOL). Dyads were recruited prior to or at the initiation of radiation/chemoradiation treatment. Patient QOL decreased across the treatment trajectory, and many caregiver QOL subscales decreased during the middle of treatment. Caregiver burden increased over the treatment trajectory with levels remaining relatively low. Patients and caregivers demonstrated interdependence in QOL toward the middle and conclusion of treatment. Patients demonstrated more depression than caregivers at all time points. Results suggest that both members of the dyad should be targeted for psychosocial interventions during radiation/chemoradiation treatment period.
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Affiliation(s)
- Chandylen L Nightingale
- a Department of Behavioral Science and Community Health, College of Public Health and Health Professions , University of Florida , Gainesville , FL , USA
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Gloede TD, Halbach SM, Thrift AG, Dewey HM, Pfaff H, Cadilhac DA. Long-Term Costs of Stroke Using 10-Year Longitudinal Data From the North East Melbourne Stroke Incidence Study. Stroke 2014; 45:3389-94. [DOI: 10.1161/strokeaha.114.006200] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Stroke is costly, although little is known about the long-term costs of survivors of stroke. In previous cost-of-illness studies, lifetime costs have been modeled based on estimates to 5 years after stroke. Building on previous work from the North East Melbourne Stroke Incidence Study (NEMESIS), we aimed to describe resource use at 10 years and recalculate the lifetime societal costs of ischemic and hemorrhagic (intracerebral hemorrhage) stroke.
Methods—
Ten-year patient-level resource use data were obtained and updated prices and population demographic statistics for 2010 were applied to our cost-of-illness models. We incorporated incidence data from a larger study region of NEMESIS than that used in the previous model and new 10-year survival and recurrent stroke rates. One-way sensitivity and probabilistic multivariable uncertainty analyses were undertaken.
Results—
For ischemic stroke, the overall average annual direct costs at 10 years (US dollars [USD] 5207) were comparable to those for survivors between 3 and 5 years (USD5438). However, the contribution of some costs varied (eg, medications contributed 13% at 5 years and 20% at 10 years). For intracerebral hemorrhage, annual direct costs were considerably (24%) greater at 10 years than estimated using 3 to 5 year data. Greater average lifetime costs per case were found using the updated models (ischemic stroke: previous model USD51806 and current USD68 769; intracerebral hemorrhage: previous model USD43 786 and current USD54 956 per case). Following sensitivity and multivariable uncertainty analyses, the findings were robust.
Conclusions—
Costs to 10 years after stroke have not previously been reported. Our findings demonstrate the importance of estimating resource use over longer periods for forecasting lifetime estimates.
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Affiliation(s)
- Tristan D. Gloede
- From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A
| | - Sarah M. Halbach
- From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A
| | - Amanda G. Thrift
- From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A
| | - Helen M. Dewey
- From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A
| | - Holger Pfaff
- From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A
| | - Dominique A. Cadilhac
- From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A
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Abstract
The purposes of this study were to develop and validate a measure of unmet resource needs of the caregivers of survivors of stroke and to describe the caregivers' unmet needs during 1 year. A longitudinal, descriptive design was used to test the reliability and validity of the Unmet Resource Needs (URN) measure. Item development was based on literature review and preliminary study findings. A stress and coping conceptual model framed the hypotheses. Psychometric testing was based on 6-month postdischarge data (n = 166). Content and structural construct validity, internal consistency reliability through 1 year, and concurrent validity were tested. Change in URN over time was examined. Content validity was supported by floor and ceiling effects less than 5%. Principal axis factoring yielded a 12-item, two-factor solution reflecting general and technology unmet needs. Internal consistency reliability was satisfactory for the total scale and subscales at all times, excepting the baseline three-item technology scale (α = .56). Concurrent validity was supported by significant correlations with model constructs (threat, positive problem solving, depression, preparedness; p < .01) in the expected direction. Functional status and resource use were not associated with the URN. Repeated measures analysis of variance (n = 123) indicated a significant decrease in unmet needs from baseline to 3, 6, and 12 months postdischarge (p < .001). Nevertheless, 42% reported one or more unmet needs at year 1. Assessment and counseling on unmet needs is indicated throughout the caregiving trajectory to reduce negative outcomes.
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van Middelaar T, Nederkoorn PJ, van der Worp HB, Stam J, Richard E. Quality of Life after Surgical Decompression for Space-Occupying Middle Cerebral Artery Infarction: Systematic Review. Int J Stroke 2014; 10:170-6. [DOI: 10.1111/ijs.12329] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 05/20/2014] [Indexed: 01/05/2023]
Abstract
Background and Purpose In patients with space-occupying middle cerebral artery infarction, surgical decompression strongly reduces risk of death and increases the chance of a favorable outcome. This comes at the expense of an increase in the risk of survival with (moderately) severe disability. We assessed quality of life, depression, and caregiver burden in these patients. Summary of Review We systematically reviewed the literature by searching MEDLINE, EMBASE, and PsycINFO up to March 2014. We included randomized controlled trials, cohort studies, case–control studies, and case series with quality of life, depression, or caregiver burden as primary or secondary outcome. Seventeen articles reporting on 459 patients were included. At final follow-up at 7 to 51 months, 1344 patients (30%) had died, and 34 (11%) were lost to follow up. Data on 291 patients were available, of whom 81 of 213 survivors (39%) achieved good functional outcome at final follow-up (modified Rankin Scale ⩽3). Mean quality of life was 46% to 67% of the best possible score when based on questionnaires or visual analogue scales. At final follow-up, 143 of 189 patients (76%) would in retrospect again choose for surgical decompression. Severe depressive symptoms were present in 14 of 113 patients (16%). Three studies investigated caregiver burden and reported substantial burden. Patients more than 60 years old had a lower quality of life in comparison with younger patients. Conclusions Most patients treated with surgical decompression for space-occupying infarction have a reasonable quality of life at long-term follow-up and are satisfied with the treatment received. Severe depressive symptoms are uncommon.
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Affiliation(s)
- Tessa van Middelaar
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Paul J. Nederkoorn
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - H. Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Stam
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Edo Richard
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
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