Sage Journals: Discover world-class research

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.

Keywords

Stroke caregiver caregiver intervention rehabilitation activities of daily living

Get full access to this article

View all access options for this article.

References

GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18: 439–458.

Oliva-Moreno

Peña-Longobardo

Mar

, et al. Determinants of informal care, burden, and risk of burnout in caregivers of stroke survivors: the CONOCES study. Stroke 2018; 49: 140–146.

Dewey

Thrift

Mihalopoulos

, et al. Informal care for stroke survivors: results from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2002; 33: 1028–1033.

Skolarus

Freedman

Feng

, et al. Care received by elderly US stroke survivors may be underestimated. Stroke 2016; 47: 2090–2095.

Skolarus

Burke

Brown

, et al. Understanding stroke survivorship: expanding the concept of poststroke disability. Stroke 2014; 45: 224–230.

Joo

Dunet

Fang

, et al. Cost of informal caregiving associated with stroke among the elderly in the United States. Neurology 2014; 83: 1831–1837.

Lambert

Bowe

Livingston

, et al. Impact of informal caregiving on older adults’ physical and mental health in low-income and middle-income countries: a cross-sectional, secondary analysis based on the WHO’s study on global AGEing and adult health (SAGE). BMJ Open 2017; 7: e017236.

Kokorelias

FKT

Santos

, et al. “Caregiving is a full-time job” impacting stroke caregivers’ health and well-being: a qualitative meta-synthesis. Health Soc Care Community 2020; 28: 325–340.

Grant

Hunt

Steadman

Common caregiver issues and nursing interventions after a stroke. Stroke 2014; 45: e151–e153.

10.

Quinn

Murray

Malone

Spousal experiences of coping with and adapting to caregiving for a partner who has a stroke: a meta-synthesis of qualitative research. Disabil Rehabil 2014; 36: 185–198.

11.

Greenwood

Mackenzie

Cloud

, et al. Informal primary carers of stroke survivors living at home-challenges, satisfactions and coping: a systematic review of qualitative studies. Disabil Rehabil 2009; 31: 337–351.

12.

Haley

Roth

Hovater

, et al. Long-term impact of stroke on family caregiver well-being: a population-based case-control study. Neurology 2015; 84: 1323–1329.

13.

Pucciarelli

Vellone

Savini

, et al. Roles of changing physical function and caregiver burden on quality of life in stroke: a longitudinal dyadic analysis. Stroke 2017; 48: 733–739.

14.

Mei

Lin

, et al. Effects of A benefit-finding intervention in stroke caregivers in communities. Clin Gerontol 2022; 45: 1317–1329.

15.

Zhang

Sun

. A newly designed intensive caregiver education program reduces cognitive impairment, anxiety, and depression in patients with acute ischemic stroke. Braz J Med Biol Res 2019; 52: e8533.

16.

Kalra

Evans

Perez

, et al. Training carers of stroke patients: randomised controlled trial. Br Med J 2004; 328: 1099.

17.

Deyhoul

Vasli

Rohani

, et al. The effect of family-centered empowerment program on the family caregiver burden and the activities of daily living of Iranian patients with stroke: a randomized controlled trial study. Aging Clin Exp Res 2020; 32: 1343–1352.

18.

Pitthayapong

Thiangtam

Powwattana

, et al. A community based program for family caregivers for post stroke survivors in Thailand. Asian Nurs Res (Korean Soc Nurs Sci) 2017; 11: 150–157.

19.

Forster

Dickerson

Young

, et al. A structured training programme for caregivers of inpatients after stroke (TRACS): a cluster randomised controlled trial and cost-effectiveness analysis. Lancet 2013; 382: 2069–2076.

20.

Bakas

McCarthy

Miller

. Update on the state of the evidence for stroke family caregiver and dyad interventions. Stroke 2017; 48: e122–e125.

21.

Bakas

Clark

Kelly-Hayes

, et al. Evidence for stroke family caregiver and dyad interventions: a statement for healthcare professionals from the American Heart Association and American Stroke Association. Stroke 2014; 45: 2836–2852.

22.

Bakas

McCarthy

Israel

, et al. Adapting the telephone assessment and skill-building kit to the telehealth technology preferences of stroke family caregivers. Res Nurs Health 2021; 44: 81–91.

23.

Lorca-Cabrera

Grau

Martí-Arques

, et al. Effectiveness of health web-based and mobile app-based interventions designed to improve informal caregiver’s well-being and quality of life: a systematic review. Int J Med Inform 2020; 134: 104003.

24.

Ploeg

Ali

Markle-Reid

, et al. Caregiver-focused, web-based interventions: systematic review and meta-analysis (part 2). J Med Internet Res 2018; 20: e11247.

25.

Pierce

Steiner

Khuder

, et al. The effect of a web-based stroke intervention on carers’ well-being and survivors’ use of healthcare services. Disabil Rehabil 2009; 31: 1676–1684.

26.

LeLaurin

Lamba

Eliazar-Macke

, et al. Postdischarge intervention for stroke caregivers: protocol for a randomized controlled trial. JMIR Res Protoc 2020; 9: e21799.

27.

Wade

Collin

. The Barthel ADL index: a standard measure of physical disability? Int Disabil Stud 1988; 10: 64–67.

28.

Haun

Noland-Dodd

Varnes

, et al. Testing the BRIEF health literacy screening tool. Fed Pract 2009; 26: 24–31.

29.

Cohen

Kamarck

Mermelstein

. A global measure of perceived stress. J Health Soc Behav 1983; 24: 385–396.

30.

Pocock

Simon

. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics 1975; 31: 103–115.

31.

Radloff

LS.

The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977; 1: 385–401.

32.

Aycock

Hayat

Helvig

, et al. Essential considerations in developing attention control groups in behavioral research. Res Nurs Health 2018; 41: 320–328.

33.

Freedland

KE.

Demanding attention. Psychosom Med 2013; 75: 100–102.

34.

Houts

Nezu

, et al. The prepared family caregiver: a problem-solving approach to family caregiver education. Patient Educ Couns 1996; 27: 63–73.

35.

Rivera

Elliott

Berry

, et al. Problem-solving training for family caregivers of persons with traumatic brain injuries: a randomized controlled trial. Arch Phys Med Rehabil 2008; 89: 931–941.

36.

McMillan

Small

Weitzner

, et al. Impact of coping skills intervention with family caregivers of hospice patients with cancer: a randomized clinical trial. Cancer 2006; 106: 214–222.

37.

Grant

Elliott

Weaver

, et al. Telephone intervention with family caregivers of stroke survivors after rehabilitation. Stroke 2002; 33: 2060–2065.

38.

RESCUE Home - Resources and Education for Stroke Caregivers’ Understanding and Empowerment, https://www.stroke.cindrr.research.va.gov/en/ (accessed July 16, 2021).

39.

LeLaurin

Sypniewski

Wing

, et al. Development, usability testing, and promotion of the English- and spanish-language RESCUE stroke caregiver websites. American Journal of Health Education 2022; 53: 174–185.

40.

Bendixen

Levy

Olive

, et al. Cost effectiveness of a telerehabilitation program to support chronically ill and disabled elders in their homes. Telemed J E Health 2009; 15: 31–38.

41.

Shinar

Gross

Bronstein

, et al. Reliability of the activities of daily living scale and its use in telephone interview. J Cardiopulm Rehabil 1988; 8: 157.

42.

Della Pietra

Savio

Oddone

, et al. Validity and reliability of the barthel index administered by telephone. Stroke 2011; 42: 2077–2079.

43.

Bell

Kenward

Fairclough

, et al. Differential dropout and bias in randomised controlled trials: when it matters and when it may not. Br Med J 2013; 346: e8668.

44.

van Buuren

Groothuis-Oudshoorn

. Mice : multivariate imputation by chained equations in R. J Stat Softw 2011; 45: 1–67.

45.

R Core Team. R: A language and environment for statistical computing. Computer Software, Vienna, Austria: R Foundation for Statistical Computing, 2021.

46.

Naqvi

Montiel

Bittar

, et al. Internet access and usage among stroke survivors and their informal caregivers: cross-sectional study. JMIR Formativ Res 2021; 5: e25123.

47.

Jakobsen

Gluud

Wetterslev

, et al. When and how should multiple imputation be used for handling missing data in randomised clinical trials – a practical guide with flowcharts. BMC Med Res Methodol 2017; 17: 162.

48.

AARP and National Alliance for Caregiving. Caregiving in the United States 2020. Washington, DC: AARP, https://doi.org/10.26419/ppi.00103.001 (May 2020, accessed November 11, 2022). 2020.

49.

Veterans Affairs. Community Care. https://www.va.gov/COMMUNITYCARE/programs/veterans/index.asp (accessed November 18, 2022).

50.

Bakas

McCarthy

Miller

EL.

Systematic review of the evidence for stroke family caregiver and dyad interventions. Stroke 2022; 53: 2093–2102.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.05 MB

0.08 MB

Effect of a telephone and web-based problem-solving intervention for stroke caregivers on stroke patient activities of daily living: A randomized controlled trial

Abstract

Objective

Design

Setting

Subjects

Intervention

Main Outcome

Results

Conclusions

Keywords

Get full access to this article

References

Supplementary Material