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Denham AMJ, Haracz K, Bird ML, Bonevski B, Spratt NJ, Turner A, Chow WZ, Larkin M, Mabotuwana N, Janssen H. Non-pharmacological interventions to improve mental health outcomes among female carers of people living with a neurological condition: a systematic review. Disabil Rehabil 2024:1-18. [PMID: 38859798 DOI: 10.1080/09638288.2024.2360648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 05/22/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE This systematic review aims to examine the effectiveness of non-pharmacological interventions for improving mental health outcomes among female carers of people living with a neurological condition. MATERIALS AND METHODS A narrative synthesis of English-language randomized controlled trials was undertaken. RESULTS 18 unique studies were included. Intervention components that were found to have improved mental health outcomes were: delivered in person, to groups, on an intermittent schedule with ≥10 sessions; had a duration between 3-6 months; and were facilitated by research staff or allied health professionals. As the review had few robust studies, results of mental health outcomes reported in studies assessed as low risk of bias were highlighted in the review. Psychoeducation interventions, cognitive behavioural interventions, and support group interventions were found to improve depression. Psychoeducation interventions were also found to improve burden. CONCLUSIONS There is a clear need for adequately powered, high-quality randomised controlled trials to determine the effectiveness of non-pharmacological interventions for female carers of people living with a neurological condition.
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Affiliation(s)
- A M J Denham
- School of Health Sciences, University of Newcastle, Callaghan, Australia
| | - K Haracz
- School of Health Sciences, University of Newcastle, Callaghan, Australia
| | - M L Bird
- School of Health Sciences, University of Tasmania, Hobart, Australia
| | - B Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - N J Spratt
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, Australia
- Department of Neurology, John Hunter Hospital, Newcastle, Australia
| | - A Turner
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - W Z Chow
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | - M Larkin
- School of Health, Wellbeing & Social Care, The Open University, Milton Keynes, UK
| | - N Mabotuwana
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
| | - H Janssen
- School of Health Sciences, University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, Australia
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Chou A, Beach SR, Lutz BJ, Rodakowski J, Terhorst L, Freburger JK. Moderating Effects of Informal Care on the Relationship Between ADL Limitations and Adverse Outcomes in Stroke Survivors. Stroke 2024; 55:1554-1561. [PMID: 38660796 DOI: 10.1161/strokeaha.123.045427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Stroke survivors with limitations in activities of daily living (ADL) have a greater risk of experiencing falls, hospitalizations, or physical function decline. We examined how informal caregiving received in hours per week by stroke survivors moderated the relationship between ADL limitations and adverse outcomes. METHODS In this retrospective cohort, community-dwelling participants were extracted from the National Health and Aging Trends Study (2011-2020; n=277) and included if they had at least 1 formal or informal caregiver and reported an incident stroke in the prior year. Participants reported the amount of informal caregiving received in the month prior (low [<5.8], moderate [5.8-27.1], and high [27.2-350.4] hours per week) and their number of ADL limitations (ranging from 0 to 7). Participants were surveyed 1 year later to determine the number of adverse outcomes (ie, falls, hospitalizations, and physical function decline) experienced over the year. Poisson regression coefficients were converted to average marginal effects and estimated the moderating effects of informal caregiving hours per week on the relationship between ADL limitations and adverse outcomes. RESULTS Stroke survivors were 69.7% White, 54.5% female, with an average age of 80.5 (SD, 7.6) years and 1.2 adverse outcomes at 2 years after the incident stroke. The relationships between informal caregiving hours and adverse outcomes and between ADL limitations and adverse outcomes were positive. The interaction between informal caregiving hours per week and ADL limitations indicated that those who received the lowest amount of informal caregiving had a rate of 0.12 more adverse outcomes per ADL (average marginal effect, 0.12 [95% CI, 0.005-0.23]; P=0.041) than those who received the highest amounts. CONCLUSIONS Informal caregiving hours moderated the relationship between ADL limitations and adverse outcomes in this sample of community-based stroke survivors. Higher amounts relative to lower amounts of informal caregiving hours per week may be protective by decreasing the rate of adverse outcomes per ADL limitation.
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Affiliation(s)
- Aileen Chou
- Departments of Physical Therapy (A.C., J.K.F.), University of Pittsburgh, PA
| | | | - Barbara J Lutz
- School of Nursing, College of Health and Human Services, University of North Carolina-Wilmington, NC (B.J.L.)
| | | | - Lauren Terhorst
- Occupational Therapy (J.R., L.T.), University of Pittsburgh, PA
| | - Janet K Freburger
- Departments of Physical Therapy (A.C., J.K.F.), University of Pittsburgh, PA
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Mirhosseini S, Hosseini Nezhad FS, Haji Mohammad Rahim A, Basirinezhad MH, Bakhshiarab A, Saeedi M, Ebrahimi H. Care burden and the predictive role of spiritual well-being and religious coping: A cross sectional study among Iranian family caregivers of patients with stroke. Health Sci Rep 2024; 7:e2155. [PMID: 38841117 PMCID: PMC11150275 DOI: 10.1002/hsr2.2155] [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: 10/18/2023] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024] Open
Abstract
Background and Aims The burden of care after a stroke is gaining recognition as a significant healthcare issue. Factors like religion and spirituality, encompassing religious coping and spiritual health, prove to be influential in anticipating the challenges faced by caregivers. The present study aimed to determine the relationship between care burden, spiritual health, and religious coping among caregivers of stroke patients. Methods This cross-sectional research was conducted with the participation of 129 caregivers of stroke patients. The data was collected using the Ellison and Paloutzian spiritual well-being instruments, Pargament Religious Coping (RCOPE) brief version, and the Zarit burden interview (ZBI). Through a census, participants were recruited for the investigation. Data were analyzed using descriptive and inferential statistics (multivariate linear regression analysis). Results The study results indicate a strong and statistically significant relationship between the burden of caring and spiritual health (p < 0.001, β = 0.33). Furthermore, specific variables were identified as indicators of an increased burden of care, including positive religious coping (p = 0.04, β = 0.63), the familial relationship between the caregiver and patient, specifically as a child (p = 0.001, β = 29.26), and a sister (p < 0.001, β = 35.93). Conclusion It is advisable to consider adopting and implementing appropriate support measures for coping strategies rooted in religion and spirituality. So, it is recommended to enhance the provision of comprehensive support, including psychological and religious interventions. This can be achieved through the collaborative efforts of support groups comprising psychiatric nurses, psychiatrists, psychologists, and religious experts.
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Affiliation(s)
- Seyedmohammad Mirhosseini
- Department of Nursing, School of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
| | | | - Ali Haji Mohammad Rahim
- Student Research Committee, School of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
| | - Mohammad Hasan Basirinezhad
- Department of Epidemiology and Biostatistics, School of Public HealthShahid Sadoughi University of Medical SciencesYazdIran
| | - Amirheidar Bakhshiarab
- Department of Nursing, School of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
| | - Maryam Saeedi
- Department of Clinical Sciences, School of MedicineShahroud University of Medical SciencesIran
| | - Hossein Ebrahimi
- Center for Health Related Social and Behavioral Sciences ResearchShahroud University of Medical SciencesShahroudIran
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Kum C, Jones HJ, Miller EL, Kreitzer N, Bakas T. Theoretically Based Factors Associated With Stroke Family Caregiver Health. Rehabil Nurs 2024; 49:86-94. [PMID: 38696434 PMCID: PMC11068090 DOI: 10.1097/rnj.0000000000000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
PURPOSE Most persons who have had strokes are cared for at home by family members-many of whom experience depressive symptoms and quality of life changes as a result of providing care. The objective of this study is to determine theoretically based factors associated with unhealthy days in stroke family caregivers. RESEARCH DESIGN AND METHODS Secondary data analysis was conducted using baseline data from a large randomized controlled clinical trial testing the Telephone Assessment and Skill-Building Kit program with 254 family caregivers of persons who have had strokes. Guided by a conceptual model derived from Lazarus' transactional approach to stress, data were analyzed using multiple regression with unhealthy days as the dependent variable and theoretically based factors as independent variables. RESULTS Caregivers were mostly female (78%), White (71%), spouses (47%), or adult children (29%). Caregivers reported nine unhealthy days on average within the past month. A total of 37.8% of the variance in unhealthy days was explained by caregiver task difficulty, level of optimism, threat appraisal, depressive symptoms, and life changes with depressive symptoms being the strongest individual predictor because of shared variance. CLINICAL RELEVANCE Unhealthy days is an important part of stroke family caregiver health. Factors associated with unhealthy days in this study provide areas to consider in future intervention development.
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Affiliation(s)
- Cleopatra Kum
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Holly J Jones
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Elaine L Miller
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Natalie Kreitzer
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tamilyn Bakas
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
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Kringle EA, Kersey J, Lewis MA, Gibbs BB, Skidmore ER. Similarities and differences in factors associated with high and low sedentary behavior after stroke: a mixed methods study. Disabil Rehabil 2024:1-9. [PMID: 38632899 DOI: 10.1080/09638288.2024.2341867] [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: 05/14/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To identify similarities and differences in factors affecting activity engagement between adults with stroke who are more and less sedentary. MATERIALS AND METHODS Data were pooled from two studies of adults with stroke (N = 36). Sedentary time was measured activPAL micro3. Participants completed activPAL interviews, which were analyzed using framework analysis. Participants were stratified into more and less sedentary groups based on activPAL data. Between-group similarities and differences were identified. RESULTS Adults with stroke (mean [SD] age = 65.8 [13.6] years, stroke chronicity = 40.5 [SD = 38.3] months, 36.1% female) were more sedentary (785.5 [64.7] sedentary minutes/day) and less sedentary (583.6 [87.4] sedentary minutes/day). Those who were more sedentary: engaged in basic activities of daily living, avoided activities, received assistance from other people, and did not use strategies to overcome barriers. Those who were less sedentary: engaged in instrumental and community activities, embraced new strategies, did activities with other people, and used strategies to overcome environmental barriers. CONCLUSIONS Factors affecting activity engagement differed between people who are more and less sedentary. Interventions that aim to reduce post-stroke sedentary behavior should consider the: (1) types of activities, (2) role of other people, and (2) application of strategies to overcome activity and environment-related barriers.
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Affiliation(s)
- Emily A Kringle
- School of Kinesiology, University of MN, Minneapolis, MN, USA
| | - Jessica Kersey
- Program in Occupational Therapy, School of Medicine, WA University, St. Louis, MO, USA
| | | | - Bethany Barone Gibbs
- Department of Epidemiology and Biostatistics, West VA University, Morgantown, WV, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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Bartoli D, Petrizzo A, Vellone E, Alvaro R, Pucciarelli G. Impact of telehealth on stroke survivor-caregiver dyad in at-home rehabilitation: A systematic review. J Adv Nurs 2024. [PMID: 38563582 DOI: 10.1111/jan.16177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/19/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
AIM To examine studies involving the impact of telerehabilitation (TLR), tele-training and tele-support on the dyad stroke survivor and caregiver in relation to psychological, physical, social and health dimensions. DESIGN A systematic review was conducted. DATA SOURCES The following electronic databases were consulted until September 2023: PsycInfo, CINAHL, Eric, Ovid, PubMed, Scopus, Cochrane Central and Web of Science. REVIEW METHODS It was conducted and reported following the checklists for Reviews of PRISMA 2020 Checklist. Critical evaluation of the quality of the studies included in the review was performed with the Joanna Briggs Institute Checklists. DATA SYNTHESIS A total of 2290 records were identified after removing duplicates, 501 articles were selected by title and abstract and only 21 met the inclusion criteria. It included 4 quasi-experimental studies, 7 RCTs, 1 cohort study and 9 qualitative studies. The total number of participants between caregivers and stroke survivors was 1697, including 858 stroke survivors and 839 caregivers recruited from 2002 to 2022. For a total of 884 participants who carried out TLR activities in the experimental groups,11 impact domains were identified: cognitive/functional, psychological, caregiver burden, social, general health and self-efficacy, family function, quality of life, healthcare utilization, preparedness, quality of care and relationship with technology. CONCLUSIONS The results support the application of telehealth in the discharge phase of hospitals and rehabilitation centres for stroke survivors and caregivers. TLR could be considered a substitute for traditional rehabilitation only if it is supported by a tele-learning programme for the caregiver and ongoing technical, computer and health support to satisfy the dyad's needs. IMPACT Designing a comprehensive telemedicine programme upon the return home of the dyad involved in the stroke improves the quality of life, functional, psychological, social, family status, self-efficacy, use of health systems and the dyad's preparation for managing the stroke. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Davide Bartoli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Antonello Petrizzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Wang W, Pucciarelli G, Mei Y, Zhang Z, Vellone E. The dyadic self-care experience of stroke survivors and their caregivers: A qualitative descriptive study. Health Expect 2023; 26:2325-2339. [PMID: 37497863 PMCID: PMC10632628 DOI: 10.1111/hex.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/11/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Promoting self-care is the core response strategy of the global health system to the burden of stroke. Although self-care in stroke represents a dyadic phenomenon, the dyadic self-care experience of stroke survivors and their caregivers is often overlooked in clinical practice. OBJECTIVES The aim of this study was to explore the dyadic self-care experience of stroke survivors and their caregivers. DESIGN A descriptive qualitative design was used to conduct the study. RESULTS The Consolidated Criteria for Reporting Qualitative Research was used for study reporting. A total of 21 stroke survivor-caregiver dyads were recruited for this study between May 2022 and September 2022. Data were collected through semistructured interviews and analyzed using thematic analysis. In this study, four themes were identified: (1) poor relationship quality of the dyads, (2) dyadic incongruence in managing stroke, (3) a slow and tiring dyadic self-care process and (4) happy cooperation in coping with dyadic self-care. DISCUSSION AND CONCLUSION Healthcare professionals should give greater consideration to the contradictions and disparities that may arise between stroke survivors and caregivers during the self-care process. It is crucial for them to provide personalized and tailored support and interventions that can assist these individuals in achieving a more optimal balance in their dyadic self-care. PATIENT/PUBLIC CONTRIBUTION Patients were involved in the formulation of interview questions for this study. No members of the public were involved in this study.
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Affiliation(s)
- Wenna Wang
- Academy of Medical SciencesZhengzhou UniversityZhengzhouHenanChina
- School of Nursing and HealthZhengzhou UniversityZhengzhouHenanChina
| | - Gianluca Pucciarelli
- Department of Biomedicine and PreventionUniversity of Rome “Tor Vergata”RomeItaly
| | - Yongxia Mei
- School of Nursing and HealthZhengzhou UniversityZhengzhouHenanChina
| | - Zhenxiang Zhang
- School of Nursing and HealthZhengzhou UniversityZhengzhouHenanChina
| | - Ercole Vellone
- Department of Biomedicine and PreventionUniversity of Rome “Tor Vergata”RomeItaly
- Department of Nursing and ObstetricsWroclaw Medical UniversityWrocławPoland
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Blanton S, Cotsonis G, Brennan K, Song R, Zajac-Cox L, Caston S, Stewart H, Jayaraman A, Reisman D, Clark PC, Kesar T. Evaluation of a carepartner-integrated telehealth gait rehabilitation program for persons with stroke: study protocol for a feasibility study. Pilot Feasibility Stud 2023; 9:192. [PMID: 38001523 PMCID: PMC10668368 DOI: 10.1186/s40814-023-01411-1] [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: 03/13/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Despite family carepartners of individuals post-stroke experiencing high levels of strain and reduced quality of life, stroke rehabilitation interventions rarely address carepartner well-being or offer training to support their engagement in therapeutic activities. Our group has developed creative intervention approaches to support families during stroke recovery, thereby improving physical and psychosocial outcomes for both carepartners and stroke survivors. The purpose of this study is to test the feasibility of an adapted, home-based intervention (Carepartner Collaborative Integrative Therapy for Gait-CARE-CITE-Gait) designed to facilitate positive carepartner involvement during home-based training targeting gait and mobility. METHODS This two-phased design will determine the feasibility of CARE-CITE-Gait, a novel intervention that leverages principles from our previous carepartner-focused upper extremity intervention. During the 4-week CARE-CITE-Gait intervention, carepartners review online video-based modules designed to illustrate strategies for an autonomy-supportive environment during functional mobility task practice, and the study team completes two 2-h home visits for dyad collaborative goal setting. In phase I, content validity, usability, and acceptability of the CARE-CITE-Gait modules will be evaluated by stroke rehabilitation content experts and carepartners. In phase II, feasibility (based on measures of recruitment, retention, intervention adherence, and safety) will be measured. Preliminary effects of the CARE-CITE-Gait will be gathered using a single-group, quasi-experimental design with repeated measures (two baseline visits 1 week apart, posttest, and 1-month follow-up) with 15 carepartner and stroke survivor dyads. Outcome data collectors will be blinded. Outcomes include psychosocial variables (family conflict surrounding stroke recovery, strain, autonomy support, and quality of life) collected from carepartners and measures of functional mobility, gait speed, stepping activity, and health-related quality of life collected from stroke survivors. DISCUSSION The findings of the feasibility testing and preliminary data on the effects of CARE-CITE-Gait will provide justification and information to guide a future definitive randomized clinical trial. The knowledge gained from this study will enhance our understanding of and aid the development of rehabilitation approaches that address both carepartner and stroke survivor needs during the stroke recovery process. TRIAL REGISTRATION ClinicalTrials.gov, NCT05257928. Registered 25 February 2022. TRIAL STATUS This trial was registered on ClinicalTrials.gov (NCT05257928) on March 25, 2022. Recruitment of participants was initiated on May 18, 2022.
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Affiliation(s)
- Sarah Blanton
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Room 213, Atlanta, GA, 30322, USA.
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, GA, 30322, USA
| | | | - Robert Song
- Emory Rehabilitation Hospital, Atlanta, GA, USA
| | - Laura Zajac-Cox
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Room 213, Atlanta, GA, 30322, USA
| | - Sarah Caston
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Room 213, Atlanta, GA, 30322, USA
| | | | - Arun Jayaraman
- Technology & Innovation Hub (tiHUB), Department of Physical Medicine and Rehabilitation, Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Max Näder Center for Rehabilitation Technologies & Outcomes Research, Northwestern University, Chicago, IL, 60611, USA
| | - Darcy Reisman
- Department of Physical Therapy and Graduate Program in Biomechanics and Movement Science, Neurologic and Older Adult Clinic, University of Delaware, Newark, DE, USA
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA, USA
| | - Trisha Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road NE, Room 213, Atlanta, GA, 30322, USA
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Kreitzer N, Adeoye O, Wade SL, Kurowki BG, Thomas S, Gillespie L, Bakas T. Iterative Development of the Caregiver Wellness After Traumatic Brain Injury Program (CG-Well). J Head Trauma Rehabil 2023; 38:E424-E436. [PMID: 36951450 PMCID: PMC10517076 DOI: 10.1097/htr.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVES (1) To iteratively design a web/phone-based intervention to support caregivers of adults acutely following traumatic brain injury (TBI), Caregiver Wellness (CG-Well), and (2) to obtain qualitative and quantitative feedback on CG-Well from experts and caregivers to refine the intervention. SETTING A level I trauma and tertiary medical center. PARTICIPANTS Convenience sample of a total of 19 caregivers and 25 experts. DESIGN Multistep prospective study with iterative changes to CG-Well: (1) developed intervention content based on qualitative feedback from a prior study and literature review; (2) obtained qualitative feedback from 10 experts; (3) refined content using a modified Delphi approach involving 4 caregivers and 6 experts followed by qualitative interviews with 9 caregivers; (4) designed CG-Well website and videos; and (5) obtained feedback on program acceptability, appropriateness, and feasibility from 6 caregivers and 9 experts. INTERVENTIONS CG-Well included content on TBI, self-care and support, and skill-building strategies delivered through a website and telephone calls. MAIN OUTCOME MEASURES Qualitative data were analyzed using content analysis. Caregivers and experts completed Likert-type scales to rate module relevance, clarity, accuracy, utility and website acceptability, appropriateness, and feasibility (1 = strongly disagree to 5 = strongly agree). Means and standard deviations (SD) characterized ratings. RESULTS Qualitative findings were instrumental in designing and refining CG-Well. Ratings were positive for modules (means and SD for relevant [4.9, 0.33], clear [4.6, 0.53], accurate [4.9, 0.33], and useful [5, 0]) and the website (means and SD for acceptable [4.8, 0.36], appropriate [4.8, 0.35], and feasible [4.8, 0.36]). CONCLUSIONS The iterative design process for CG-Well resulted in a highly acceptable program. An early-stage randomized controlled trial is underway to estimate treatment effects for a future well-powered clinical trial.
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Affiliation(s)
- Natalie Kreitzer
- Department of Emergency Medicine (Drs Kreitzer and Gillespie and Ms Thomas) and College of Nursing (Dr Bakas), University of Cincinnati, Cincinnati, Ohio; Department of Emergency Medicine, Washington University, St Louis, Missouri (Dr Adeoye); Departments of Pediatrics (Dr Wade) and Pediatrics and Neurology and Rehabilitation Medicine (Dr Kurowki), Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Kurowki)
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Terrill AL, Reblin M, MacKenzie JJ, Baucom BRW, Einerson J, Cardell B, Richards L, Majersik JJ. Promoting Resilience After Stroke in Dyads (ReStoreD): A Supplemental Analysis. Arch Phys Med Rehabil 2023; 104:1580-1587. [PMID: 37075965 PMCID: PMC10543397 DOI: 10.1016/j.apmr.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To examine preliminary effects of ReStoreD (Resilience after Stroke in Dyads) on resilience in couples coping with stroke-related challenges. DESIGN Supplemental analysis of prospective pilot trial with pre-/post-assessments and 3-month follow-up. SETTING Community. PARTICIPANTS Thirty-four cohabitating stroke-care partner dyads (N=34); at least 3 months post-stroke. INTERVENTIONS 8-week self-administered dyadic intervention (ReStoreD) consisting of activities completed individually and as a couple. MAIN OUTCOME MEASURES 10-item Connor-Davidson Resilience Scale. RESULTS Care partner baseline resilience scores were significantly higher than persons with stroke scores. Repeated-measures analysis of variance suggest significant pre-post improvement in resilience for persons with stroke (mean difference [I - J]=-2.42, SE=.91, P=.04, 95% CI [-4.75, -0.08]) with a large effect size (η2=.34), which was maintained at 3-month follow-up. Care partners showed no significant change over time. CONCLUSIONS This study provides preliminary evidence that ReStoreD improves resilience in persons with stroke. More research is needed to address resilience in care partners. These findings represent a promising first step to address the mental health needs in this population.
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Affiliation(s)
- Alexandra L Terrill
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, UT.
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, Burlington, VT
| | - Justin J MacKenzie
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, UT
| | - Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Jackie Einerson
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, UT
| | - Beth Cardell
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, UT
| | - Lorie Richards
- Department of Occupational & Recreational Therapies, University of Utah, Salt Lake City, UT
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Klinjun N, Suwanno J, Srisomthrong K, Suwanno J, Kelly M. A psychometrics evaluation of the Thai version of Caregiver Contribution to Self-Care of Chronic Illness Inventory Version 2 in stroke caregivers. Int J Nurs Sci 2023; 10:456-467. [PMID: 38020839 PMCID: PMC10667295 DOI: 10.1016/j.ijnss.2023.09.021] [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: 06/25/2023] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives To evaluate the psychometric characteristics of the Thai version of Caregiver Contribution to Self-Care (CC-SC) of Chronic Illness Inventory version 2 (CC-SC-CII-v2) in stroke caregivers. Methods We conducted a multicenter, cross-sectional study following the COSMIN guidelines, evaluating validity and reliability of three separate scales, CC-SC Maintenance, CC-SC Monitoring, and CC-SC Management, as well as overall CC-SC-CII-v2. From September to December 2022, we enrolled 422 stroke caregivers from primary care centers in southern Thailand. Structural validity was assessed through confirmatory factor analysis (CFA), while concurrent validity was evaluated using Pearson's correlation r coefficients between CC-SC-CII-v2 and the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale (CSE-CSC). Internal coherence reliability was assessed using Cronbach's α coefficient, the composite reliability index, and the McDonald's ω coefficient. Additionally, test-retest reliability was assessed with intraclass correlation coefficients (ICCs). Results The study included mostly middle-aged women who cared for their parent. CFA supported the two-factor structure of the CC-SC Maintenance and Management scales and the one-factor structure of the CC-SC Monitoring scale. A simultaneous CFA on the combined set of items supported the more general model. The concurrent validity of CC-SC-CII-v2 with CSE-CSC was established (r ranging 0.47-0.65, all P < 0.001). Reliability estimates supported adequate Cronbach's α coefficient (ranging 0.83-0.89), composite reliability (ranging 0.84-0.85), McDonald's ω coefficients (ranging 0.83-0.85), and ICCs (ranging 0.86-0.90) across the three scales. Conclusions The Thai CC-SC-CII-v2 demonstrated strong psychometric properties among stroke caregivers. It can be a valuable instrument to investigate the role of caregivers in contributing to stroke patients' self-care in diverse cultural contexts like Thailand.
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Affiliation(s)
- Nuntaporn Klinjun
- Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand
| | - Jom Suwanno
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- The Excellent Center of Community Health Promotion, Walailak University, Thailand
| | - Kannika Srisomthrong
- School of Nursing, Walailak University, Nakhon Si Thammarat, Thailand
- The Excellent Center of Community Health Promotion, Walailak University, Thailand
| | - Juk Suwanno
- Stroke Care Center, Hat Yai Hospital, Songkhla, Thailand
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
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12
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McCarthy MJ, Garcia YE, Cassady M, Mall NS, Bosch PR, Barger SD. Barriers and strategies for engagement and retention of rural Latino and Native American dyads in psychosocial interventions after stroke. PATIENT EDUCATION AND COUNSELING 2023; 115:107869. [PMID: 37473605 DOI: 10.1016/j.pec.2023.107869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Michael J McCarthy
- Department of Social Work, Northern Arizona University, 19 W McConnell Dr, Flagstaff, AZ 86011, USA.
| | - Y Evie Garcia
- Department of Educational Psychology, Northern Arizona University, Flagstaff, AZ, USA
| | - Mara Cassady
- Department of Communication Sciences and Disorders, Northern Arizona University, Flagstaff, AZ, USA
| | - Neshay S Mall
- Department of Educational Psychology, Northern Arizona University, Flagstaff, AZ, USA
| | - Pamela R Bosch
- Department of Physical Therapy and Athletic Training, Northern Arizona University Phoenix Bioscience Core, Phoenix, AZ, USA
| | - Steven D Barger
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, AZ, USA
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13
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Zhang XY, Sha KH, Ma XY, Li XM, Zhang MH. Dyadic psycho-social interventions for stroke survivors and family caregivers: A systematic review and meta-analysis of randomized controlled trials. J Adv Nurs 2023; 79:3707-3726. [PMID: 37439492 DOI: 10.1111/jan.15781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
AIMS AND OBJECTIVES To describe dyadic psycho-social intervention measures and to evaluate their influence on stroke survivors and caregiver's functional independence, quality of life, depression, anxiety, self-efficacy and coping ability. BACKGROUND Because of the importance of dyadic intervention and the seriousness of the psycho-social problems of stroke survivors and caregivers, understanding the influence of dyadic psycho-social interventions is vital. DESIGN A systematic review and meta-analysis based on PRISMA guidelines. DATA SOURCES Nine databases were systematically searched for randomized controlled trials submitted from 1910 to 4 July 2022. METHODS The included papers were evaluated for quality, and quantitative data were standardly extracted and analysed by meta-analysis, followed by synthesis. The meta-analysis was carried out using Review Manager 5.4 software. RESULTS Fifteen randomized controlled trials were included (n = 2190 for patients, and n = 1933 for caregivers). Study results showed that dyadic psycho-social interventions significantly alleviated the depressive symptoms of patients, obviously improved the ability to function independently of patients and more quickly alleviated the care burden of caregivers. CONCLUSIONS This study provided moderate support for the benefits of dyadic psycho-social intervention in improving survivor and caregiver's functional independence, quality of life, depression, anxiety, self-efficacy and care burden. Nevertheless, due to limitations of the study, it was deemed necessary that this topic is studied further. RELEVANCE TO CLINICAL PRACTICE This review suggests that dyadic psycho-social interventions should be considered as effective strategies for decreasing psycho-social problems of stroke survivors and caregivers, and provides evidence for the formulation of targeted intervention programs. The personalized implementation of such interventions should be the focus of clinical practice. NO PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution.
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Affiliation(s)
- Xin-Yue Zhang
- School of Nursing, Binzhou Medical University, Binzhou, Shandong, China
| | - Kai-Hui Sha
- School of Nursing, Binzhou Medical University, Binzhou, Shandong, China
| | - Xue-Ying Ma
- The Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, China
| | - Xue-Mei Li
- The Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, China
| | - Ming-Hui Zhang
- School of Nursing, Binzhou Medical University, Binzhou, Shandong, China
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14
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Takashi N, McCarthy MJ, Ono-Kihara M, Kihara M, Nakayama T. Disagreement about perceptions of patient disability between the stroke patient and caregiver: a cross sectional study exploring the association to patient and caregiver quality of life. Aging Ment Health 2023; 27:1729-1737. [PMID: 36036267 PMCID: PMC9339023 DOI: 10.1080/13607863.2022.2116400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/21/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study explored the association of disagreement in the perception of patient disability between patients and family caregivers with physical and psychological quality of life (QOL) in both parties. METHODS A cross-sectional analysis of data collected from male stroke patients and family caregivers was conducted. Physical and psychological QOL in patients and caregivers were measured using the WHOQOL BREF. Perceptions of patient disability were measured using the 12-item WHO Disability Assessment Schedule 2.0 (DAS). Using DAS scores reported independently by patients and caregivers, dyads were categorized into one of four groups representing agreement or disagreement about patient disability. Generalized estimating equations were used to examine the associations between WHOQOL scores in patients and caregivers and these four groups. RESULTS Among 56 dyads enrolled, approximately 52% were categorized into 'agreement' groups and 48% were categorized into 'disagreement' groups. The disagreement in perception about patient disability were significantly associated with poor patient physical QOL. However, the disagreement in perception were not significantly associated with caregiver QOL. CONCLUSION Findings suggest the association of disagreement with QOL differs between patients and caregivers. Further research is needed to carefully appraise the relationship and interaction between patient and caregiver.
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Affiliation(s)
- Naoki Takashi
- Graduate School of Medicine, School of Public Health, Department of Health Informatics, Kyoto University, Kyoto, Japan
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Tokyo, Japan
| | - Michael J McCarthy
- College of Social and Behavioral Sciences, Department of Social Work, Northern Arizona University, Flagstaff, AZ, USA
| | - Masako Ono-Kihara
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
| | - Masahiro Kihara
- Global Health Interdisciplinary Unit, Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
- International Institute of Socio-epidemiology, Kyoto, Japan
| | - Takeo Nakayama
- Graduate School of Medicine, School of Public Health, Department of Health Informatics, Kyoto University, Kyoto, Japan
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15
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Quinn EB, LeLaurin JH, Eliazar-Macke ND, Orozco T, Montague M, Freytes IM, Uphold CR. Effect of a telephone and web-based problem-solving intervention for stroke caregivers on stroke patient activities of daily living: A randomized controlled trial. Clin Rehabil 2023; 37:1062-1073. [PMID: 36847253 DOI: 10.1177/02692155231157301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To test for effects of a problem-solving intervention for stroke caregivers on stroke survivor activities of daily living. DESIGN Two-arm parallel randomized clinical trial with repeated measures at 11 weeks and 19 weeks. SETTING Medical centers for US military Veterans. SUBJECTS Caregivers of stroke survivors. INTERVENTION A registered nurse guided caregivers in using problem-solving strategies emphasizing creative thinking, optimism, planning, and expert information to address challenges associated with caregiving. Caregivers in the intervention completed one telephone orientation session followed by eight online, asynchronous messaging center sessions. The messaging center sessions involved (a) education on the Resources and Education for Stroke Caregivers' Understanding and Empowerment website (https://www.stroke.cindrr.research.va.gov/en/), (b) supportive communication between the nurse and caregiver, (c) nurse and caregiver interactions to improve problem-solving, and (d) maintain adherence to discharge planning instructions. MAIN OUTCOME The Barthel Index was used to measure activities of daily living. RESULTS 174 participants (standard care n = 88, intervention n = 86) were enrolled at baseline. There were no significant differences between groups at baseline. Change scores in activities of daily living between baseline and 11 weeks were significantly higher in the intervention group than the standard care group (group difference = 6.43, 95% confidence interval: 1.28, 11.58). Group differences in change scores between baseline and 19 weeks were not statistically significant (group difference = 3.89, 95% confidence interval: -3.58, 11.36). CONCLUSIONS This web-based caregiver intervention improved stroke survivor activities of daily living by 11 weeks, but intervention effects were undetectable after 19 weeks.
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Affiliation(s)
- Edward B Quinn
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Department of Anthropology, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, USA
| | - Jennifer H LeLaurin
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Tatiana Orozco
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Magda Montague
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - I Magaly Freytes
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Constance R Uphold
- Research Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
- Department of Aging & Geriatrics, College of Medicine, University of Florida, Gainesville, FL, USA
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16
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Blanton S, Cotsonis G, Brenan K, Song R, Zajac-Cox L, Caston S, Stewart H, Jayaraman A, Reisman D, Clark PC, Kesar T. Evaluation of a Carepartner-Integrated Telehealth Gait Rehabilitation Program for Persons with Stroke : Study Protocol for a Feasibility Study. RESEARCH SQUARE 2023:rs.3.rs-2689016. [PMID: 37090566 PMCID: PMC10120785 DOI: 10.21203/rs.3.rs-2689016/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Background Despite family carepartners of individuals post-stroke experiencing high levels of strain and reduced quality of life, stroke rehabilitation interventions rarely address carepartner well-being or offer training to support their engagement in therapeutic activities. Our group has developed creative intervention approaches to support families during stroke recovery, thereby improving physical and psychosocial outcomes for both carepartners and stroke survivors. The purpose of this preliminary clinical trial is to test the feasibility of an adapted, home-based intervention (Carepartner Collaborative Integrative Therapy for Gait-CARE-CITE-Gait) designed to facilitate positive carepartner involvement during home-based training targeting gait and mobility. Methods This two-phased study will determine the feasibility of CARE-CITE-Gait, a novel intervention developed by our team that leverages principles from our previous carepartner-focused upper extremity intervention. During the 4-week CARE-CITE-Gait intervention, carepartners review online video-based modules designed to illustrate strategies for an autonomy-supportive environment during functional mobility task practice, and the study team completes two 2-hour (home-based) visits for dyad collaborative goal setting. In Phase I, the usability and acceptability of the CARE-CITE-Gait modules will be evaluated by stroke rehabilitation content experts and carepartners. In Phase II, feasibility (based on measures of recruitment, retention, and intervention adherence) will be measured. Preliminary effects of the CARE-CITE-Gait will be gathered using a single-group, evaluator blinded, quasi-experimental design with repeated measures (two baseline visits one week apart, post-test, and one-month follow-up) with 15 carepartner and stroke survivor dyads. Outcomes include psychosocial variables (strain, family conflict surrounding stroke recovery, autonomy support and life changes) collected from carepartners, and measures of functional mobility, gait speed, stepping activity, and health-related quality of life collected from stroke survivors. Discussion The findings of the feasibility testing and preliminary data on the effects of CARE-CITE-Gait will provide justification and information to guide a future definitive randomized clinical trial. The knowledge gained from this study will enhance our understanding of and aid the development of rehabilitation approaches that address both carepartner and stroke survivor needs during the stroke recovery process. Trial Registration ClinicalTrials.gov, NCT05257928. Registered 25 February 2022, https://clinicaltrials.gov/ct2/show/NCT05257928.
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Affiliation(s)
| | | | | | | | | | | | | | - Arun Jayaraman
- Northwestern University Department of Physical Medicine and Rehabilitation
| | - Darcy Reisman
- University of Delaware Department of Physical Therapy
| | - Patricia C Clark
- Georgia State University Byrdine F Lewis School of Nursing and Health Professions
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17
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Bin Suliman MA, Hanis TM, Kamdi MKA, Ibrahim MI, Musa KI. A Bibliometric Analysis of Stroke Caregiver Research from 1989 to 2022. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4642. [PMID: 36901652 PMCID: PMC10001807 DOI: 10.3390/ijerph20054642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Many stroke survivors suffer with varying degrees of disability and require assistance. Family members commonly act as informal caregivers, caring for these stroke survivors and ensuring care adherence. However, many caregivers reported a poor quality of life and physical and psychological distress. Due to these issues, multiple studies have been conducted to understand the experience of caregivers, the outcomes of caregiving, and interventional studies among caregivers. This study aims to explore the intellectual landscape of studies on stroke caregivers using bibliometric analysis. Studies with "stroke" and "caregiver" terms in the title were extracted from the Web of Sciences (WOS) database. The resulting publications were analysed using the 'bibliometrix' package in R. There were 678 publications analysed, dating from 1989 to 2022. The USA has the highest number of publications (28.6%), followed by China (12.1%) and Canada (6.1%). The most productive institution, journal and author were The University of Toronto (9.5%), 'Topics in Stroke Rehabilitation' journal (5.8%) and Tamilyn Bakas (3.1%), respectively. Co-occurrences keywords analysis revealed mainstream research on stroke survivors, burden, quality of life, depression, care, and rehabilitation, reflecting the timeless hotspot in the field. This bibliometric analysis helps us understand the current state of stroke caregiver research and its recent developments. This study can be used to evaluate research policies and promote international cooperation.
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18
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Beauchamp JES, Sharrief A, Chaoul A, Casameni Montiel T, Love MF, Cron S, Prossin A, Selvaraj S, Dishman D, Savitz SI. Feasibility of a meditation intervention for stroke survivors and informal caregivers: a randomized controlled trial. BMC Psychol 2023; 11:9. [PMID: 36635775 PMCID: PMC9838004 DOI: 10.1186/s40359-022-01031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Depressive symptoms are a significant psychological complication of stroke, impacting both survivors and informal caregivers of survivors. Randomized controlled trials are needed to determine optimal non-pharmacological strategies to prevent or ameliorate depressive symptoms in stroke survivors and their informal caregivers. METHODS A prospective, randomized, parallel-group, single-center, feasibility study. Participants were assigned to a 4-week meditation intervention or expressive writing control group. The intervention comprised four facilitator-led group meditation sessions, one session per week and building upon prior session(s). Descriptive statistics were used to examine the proportion of eligible individuals who enrolled, retention and adherence rates, and the proportion of questionnaires completed. Data were collected at baseline, immediately after the 4-week intervention period, and 4 and 8 weeks after the intervention period. Secondary analysis tested for changes in symptoms of depression (Center for Epidemiologic Studies-Depression [CES-D]), anxiety [State-Trait Anxiety Inventory for Adults (STAI)], and pain (Brief Pain Inventory-Short Form) in the intervention group via paired t tests. Linear mixed models were used to compare longitudinal changes in the measures between the groups. Intervention and trial design acceptability were preliminary explored. RESULTS Seventy-one (77%) individuals enrolled and 26 (37%) completed the study (baseline and 8-week post-intervention visits completed). Forty-two (66%) participants completed baseline and immediate post-intervention visits. Mean questionnaire completion rate was 95%. The median meditation group session attendance rate for the intervention group was 75.0%, and the mean attendance rate was 55%. Non-significant reductions in CES-D scores were found. Paired t tests for stroke survivors indicated a significant reduction from baseline through week 8 in BPI-sf severity scores (p = 0.0270). Repeated measures analysis with linear mixed models for informal caregivers indicated a significant reduction in in STAI-Trait scores (F [3,16.2] = 3.28, p = 0.0479) and paired t test showed a significant reduction from baseline to week 4 in STAI-Trait scores (mean = - 9.1250, 95% CI [- 16.8060 to 1.4440], p = 0.0262). No between-group differences were found. CONCLUSIONS Future trials will require strategies to optimize retention and adherence before definitive efficacy testing of the meditation intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03239132. Registration date: 03/08/2017.
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Affiliation(s)
- Jennifer E. S. Beauchamp
- grid.267308.80000 0000 9206 2401Cizik School of Nursing Department of Research and the Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center at Houston, 6901 Bertner Avenue, Suite 580D, Houston, TX 77030 USA
| | - Anjail Sharrief
- grid.267308.80000 0000 9206 2401McGovern Medical School Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center at Houston, 6410 Fannin St, Suite 1014, Houston, TX 77030 USA
| | - Alejandro Chaoul
- Mind Body Spirit Institute, The Jung Center of Houston, 5200 Montrose Ave., Houston, TX 77006 USA
| | - Tahani Casameni Montiel
- grid.267308.80000 0000 9206 2401Cizik School of Nursing Department of Research, The University of Texas Health Science Center at Houston, 6901 Bertner Avenue, Suite 582, Houston, TX 77030 USA
| | - Mary F. Love
- grid.266436.30000 0004 1569 9707College of Nursing, University of Houston, 14000 University Boulevard, #367G, Sugar Land, Houston, TX 77479 USA
| | - Stanley Cron
- grid.267308.80000 0000 9206 2401Cizik School of Nursing, University of Texas Health Science Center at Houston, 6901 Bertner Avenue, Suite SON 561, Houston, TX 77030 USA
| | - Alan Prossin
- grid.267308.80000 0000 9206 2401McGovern Medical School Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, 1941 East Road, Suite BBS 2310, Houston, TX 77054 USA
| | - Sudhakar Selvaraj
- grid.267308.80000 0000 9206 2401Louis Faillace Department of Psychiatry and Behavioral Science, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Road, Suite BBS 3152, Houston, TX 77054 USA
| | - Deniz Dishman
- grid.267308.80000 0000 9206 2401Cizik School of Nursing Department of Research, The University of Texas Health Science Center at Houston, 6901 Bertner Avenue, Suite SON580C, Houston, TX 77030 USA
| | - Sean I. Savitz
- grid.267308.80000 0000 9206 2401McGovern Medical School Department of Neurology and the Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center at Houston, 6431 Fannin, Suite MSB-7.128, Houston, TX 77030-1503 USA
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Chou A, Lutz BJ, Beach SR, Freburger JK. Informal caregiver training to address functional mobility limitations of stroke survivors: a scoping review. Top Stroke Rehabil 2022:1-14. [PMID: 36403145 DOI: 10.1080/10749357.2022.2145761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Informal caregivers of stroke survivors often report the need for training on how to care for a loved one with functional mobility limitations. Evidence on training interventions to help informal caregivers with issues related to mobility is varied. The objective of this scoping review was to examine the literature including skill-based training interventions that educate caregivers on functional mobility for stroke survivors. RESEARCH DESIGN AND METHODS We extracted studies from OVID Medline, Cochrane, ISI Web of Knowledge, and Embase published between 1990 and 2021. At every stage of assessment, data extraction forms were used to reach consensus among at least three out of four authors. We followed PRISMA-ScR guidelines and Arskey and O'Malley's framework to chart information into several tables based on research questions and summarized with descriptive statistics. RESULTS Most studies were conducted outside the US focused on training in mobility and activities of daily living. The stroke survivor, on average, was an older individual (mean age 64.8 [SD = 5.3] years). The informal caregiver was predominately a younger female spouse (mean age 54.2 [SD = 6.3]). More than a third of the studies reported improvement in the stroke survivors' physical function post-intervention, with a mean follow-up time of 4.4 months. Effective studies tended to include stroke survivors with less cognitive and functional mobility limitations at higher training dosages. DISCUSSION AND IMPLICATIONS Gaps in our understanding of informal caregiver training for those caring for stroke survivors are identified, and recommendations are provided for future research.
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Affiliation(s)
- Aileen Chou
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Barbara J. Lutz
- School of Nursing, University of North Carolina-Wilmington, Wilmington, NC, USA
| | - Scott R. Beach
- University Center for Social and Urban Research, University of Pittsburgh, PA, USA
| | - Janet K. Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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Ponzini GT, Kirk B, Segear SE, Claydon EA, Engler-Chiurazzi EB, Steinman SA. Addressing Uncertainty in Informal Familial Caregivers of Stroke Survivors: A Systematic Meta-Ethnography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11116. [PMID: 36078846 PMCID: PMC9518135 DOI: 10.3390/ijerph191711116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
Background: Informal familial caregivers of stroke survivors experience uncertainty that begins at the time of the stroke event and continues into home-based care. The uncertainty faced by caregivers contributes to poor mental and physical health outcomes. Objective: This review details the factors associated with, impacts of, and coping skills used to manage uncertainty across the caregiving trajectory. By defining uncertainty reduction and tolerance recommendations, this review also builds upon the Stroke Caregiver Readiness Model to improve preparedness following the stroke event. Methods: A meta-ethnographic review was systematically conducted on thirteen qualitative studies with 218 participants from four countries. The Critical Appraisal Skills Programme (CASP) was used to assess study quality. Results: Following the stroke event, caregivers reported a lack of knowing (e.g., about the cause of the stroke event and survivor prognoses) as contributing to post-stroke uncertainty. As a result of this uncertainty, caregivers expressed concerns about their abilities to navigate caregiving responsibilities and how to plan for the future. Longer-term concerns (e.g., managing finances) and feelings of hopelessness occurred after discharge. Still, caregivers identified strategies to manage uncertainty. Caregiver coping skills included present-focused thinking, gratitude, faith, humor, and social support. Conclusions: The uncertainty faced by informal familial caregivers of stroke survivors is pervasive and changes across time. Uncertainty reduction and tolerance interventions can be used to build upon caregiver strengths and promote preparedness across the caregiving trajectory.
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Affiliation(s)
| | - Brenna Kirk
- School of Public Health, West Virginia University, Morgantown, WV 26506, USA
| | - Sarah E. Segear
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
| | | | | | - Shari A. Steinman
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
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