Objective: To assess the effect of cognitive assessment on the functional outcome of stroke patients and quality of life for both patients and their carers.
Design: A multicentre, single-blind, randomized controlled trial.
Setting and participants: Two hundred and twenty-eight stroke patients were recruited from hospital wards in three UK centres.
Interventions: Patients were screened for cognitive impairment and randomly allocated to either routine care (116 patients) or routine care plus a detailed cognitive assessment (112 patients).
Main outcome measures: Outcome was assessed three and six months after recruitment by an independent assessor blind to the intervention on Extended ADL, Cognitive Failures Questionnaire, General Health Questionnaire-28 for patients and carers and Carer Strain Index.
Results: There was no signi”cant difference between the two groups in patients’ functional outcome, perceived cognitive ability, level of psychological distress or satisfaction with care. There was a trend for the assessment group to have lower levels of carer strain (p = 0.06).
Conclusions: The provision of information about cognitive assessment in stroke rehabilitation may decrease carer strain.
Get full access to this article
View all access options for this article.
References
1.
Martin J, Meltzer H, Elliot D. The prevalence of disability among adults. London: HMSO1988.
2.
Shimoda K, Robinson, RG. The relationship between social impairment and recovery from stroke. Psychiatry1998; 61: 101–111.
3.
Kausar R. Subjective burden on carers of patients with neurological problems as a consequence of precise objective symptoms (objective burden). Clin Rehabil1996; 10: 159–165.
4.
Anderson CS, Linto J, Stewart-Wynne EG. A population-based assessment of the impact and burden of caregiving for long-term stroke survivors. Stroke1995; 26: 843–849.
5.
Skilbeck C. Psychological aspects of stroke. In: Wood RT ed. Handbook of the clinical psychology of ageing. Chichester: Wiley, 1996.
6.
Tatemichi TK, Desmond DW, Stern Y, Paik M, Sano M, Bagiella E. Cognitive impairment after stroke: frequency, patterns and relationship to functional abilities. J Neurol Neurosurg Psychiatry1994; 57: 202–207.
7.
Folstein MF, Folstein SE, McHugh P. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatry Res1975; 12: 189–198.
8.
Skilbeck C. Neuropsychological assessment of stroke. In: Crawford R, Parker M, McKinlay W. A handbook of neuropsychological assessment. Hove: Lawrence Erlbaum, 1992.
9.
Riddoch J, Humphreys GW, Bateman A. Cognitive de” cits following stroke. Physiotherapy1995; 8: 465–473.
10.
Ebrahim S, Redfern J. Stroke care - a matter of chance. A national survey of stroke services. London: The Stroke Association, 1999.
11.
Wade DT. N ational guidelines for strok e. London: The Royal College of Physicians Clinical Effectiveness and Evaluation Unit, 1999.
12.
Ottenbacher KJ, Jannell S. The results of clinical trials in stroke rehabilitation research. A rch N eurol1993; 50: 37–44.
13.
Riddoch MJ, Humphreys GW (eds). Cognitive neuropsycho logy and cognitive rehabilitation. Hove: Lawrence Erlbaum, 1994.
14.
Dowswell G, Lawler J, Young J, Forster A, Hearn J. A qualitative study of specialist nurse support for stroke patients and caregivers at home. Clin Rehabil1997; 11: 293–301.
15.
Forster A, Young J. Specialist nurse support for patients with stroke in the community: a randomised controlled trial. BMJ1992; 7: 135–139.
16.
Dennis M, O'Rourke S, Slattery J, Staniforth T, Warlow C. Evaluation of a stroke family care worker: results of a randomised controlled trial. BMJ1997; 314: 1071–1077.
17.
Evans RL, Northwood LK. Social support needs in adjustment to stroke. Arch Phys Med Rehabil1983; 64: 61–64.
18.
Mant J, Carter J, Wade DT, Winner S. Family support for stroke: a randomised controlled trial. Lancet2000; 356: 808–813.
19.
WHO (World Health Organization). Cerebrovascular disease: a clinical and research classi” cation. WHO Offset Series No. 43. Geneva: WHO, 1978.
20.
Raven JC. Guide to using the Coloured Progressive Matrices. London: HK Lewis, 1965.
21.
Syder D, Body R, Parker M, Boddy M. Shef” eld Screening Test for Acquired Language Disorders. Windsor: NFER-Nelson, 1993.
22.
Wade DT, Collin C. The Barthel ADL Index: a standard measure of physical disability?Int Disabil Stud1988; 10: 64–67.
23.
Beardsall L, Brayne C. Estimation of verbal intelligence in an elderly community: a prediction analysis using a shortened NART. Br J Clin Psychol1990; 29: 83–90.
24.
Lezak MD. Neuropsychological assessment, second edition. New York: OUP, 1983.
25.
Wilson B, Cockburn J, Halligan PW. Behavioural Inattention Test. Titch” eld: Thames Valley Test Company, 1987.
26.
Burgess IS, Dean M, Lincoln NB, Pearce MJ. Salford Objective Recognition Test. Nottingham: Nottingham Rehab, 1996.
27.
Coughlan AK, Hollows SE. The Adult Memory and Information Processing Battery. Leeds: St James University Hospital, 1985.
28.
Kertesz A, Ferro JM. Lesion size and location in ideomotor apraxia. Brain1984; 107: 921–933.
29.
Snaith RP, Ahmed SN, Mehta S, Hamilton M. Assessment of the severity of primary depressive illness: the Wake” eld Depression Inventory. Psychol Med1971; 1: 143–149.
30.
Benton AL, Hamsher K. Multilingual Aphasia Examination. Iowa City: AJA Associates, 1989.
31.
Shallice T, Evans ME. The involvement of the frontal lobes in cognitive estimation. Cortex1978; 14: 294–303.
32.
Weschler D. Weschler Memory Scale - Revised. San Antonio: Psychological Corporation, 1987.
33.
Kay J, Lesser R, Coltheart M. Psycholinguistic assessment of language processing ability. Hove: Psychology Press, 1992.
Nouri FM, Lincoln NB. An extended activities of daily living scale for stroke patients. Clin Rehabil1987; 1: 301–305.
36.
Harwood RH, Rogers A. Dickinson E, Ebrahim S. Measuring handicap: the London Handicap Scale, a new outcome measure for chronic disease. Qual Health Care1994; 3: 11–16.
37.
Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med1979; 9: 139–145.
38.
Broadbent DE, Cooper PF, Fitzgerald P, Parkes KR. The Cognitive Failures Questionnaire (CFQ) and its correlates. Br J Clin Psychol1982; 21: 1–16.
39.
Robinson BC. Validation of a Caregiver Strain Index. J Gerontol1983; 38: 344–348.
40.
Matthews JNS, Altman D G, Campbell MJ, Royston P. Analysis of serial measurements in medial research. BMJ1990; 300: 230–235.
41.
Proulx Guy-B. Family education and family partnership in cognitive rehabilitation. In: Stuss DT, Winocur G, Robertson IA eds. Cognitive neurorehabilitation. Cambridge: Cambridge University Press, 1999: 252–259.
42.
Mant J, Carter J, Wade DT, Winner S. The impact of an information pack on patients with stroke and their carers: a randomised controlled trial. Clin Rehabil1998; 12: 465–476.
43.
Pain HSB, McLellan DL. The use of individualised booklets after a stroke. Clin Rehabil1990; 4: 265–272.
