Randomized controlled trial of a comprehensive stroke education program for patients and caregivers. Beyond stroke: description and evaluation of an effective intervention to support family caregivers of stroke patients. The effect of a Web-based stroke intervention on carers' well-being and survivors' use of healthcare services Problems and Benefits Reported by Stroke Family Caregivers: Results From a Prospective Epidemiological Study Management patterns and costs of acute ischemic stroke : an international study. For the Stroke Economic Analysis Group. Telephone Group Intervention for Older Stroke Caregivers A randomized controlled trial of an education and counselling intervention for families after stroke Telephone Intervention With Family Caregivers of Stroke Survivors After Rehabilitation A culturally sensitive Transition Assistance Program for stroke caregivers: examining caregiver mental health and stroke rehabilitation. Emotional Support, Physical Help, and Health of Caregivers of Stroke Survivors Content validity and satisfaction with a stroke caregiver intervention program. Long-term effects of the intensification of the transition between inpatient neurological rehabilitation and home care of stroke patients Can rehabilitation in the home setting reduce the burden of care for the next-of-kin of stroke victims? Hypnosis Reduces Preoperative Anxiety in Adult Patients Stress in caregivers of aphasic stroke patients: a randomized controlled trial Caregiver burden and health-related quality of life among Japanese stroke caregivers. Community-based "powerful tools" intervention enhances health of caregivers. A multidisciplinary group programme in rural settings for community-dwelling chronic stroke survivors and their carers: a pilot randomized controlled trial Problem‐Solving Early Intervention: A Pilot Study of Stroke Caregivers Long-term effects of a group support program and an individual support program for informal caregivers of stroke patients: which caregivers benefit the most? A family caregiver-oriented discharge planning program for older stroke patients and their family caregivers. Recovery from disability after stroke as a target for a behavioural intervention: Results of a randomized controlled trial Distance education and caregiver support groups: comparison of traditional and telephone groups. A clinical trial of an individualised intervention programme for family caregivers of older stroke victims in Taiwan. Intensification of the transition between inpatient neurological rehabilitation and home care of stroke patients. Controlled clinical trial with follow-up assessment six months after discharge Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. Specialist nurse support for patients with stroke in the community: a randomised controlled trial Stroke Caregiver Outcomes from the Telephone Assessment and Skill-Building Kit (TASK) CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials
BACKGROUND AND PURPOSE We report the findings of a r and omized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program ( SEP ) for patients and their informal carers . METHODS Two hundred four patients admitted with acute stroke and their 176 informal carers were r and omized to receive an invitation to the SEP or to receive conventional stroke unit care . The SEP consisted of one 1-hour small group educational session for in patients followed by six 1-hour sessions after discharge . The primary outcome measure was patient- and carer-perceived health status ( SF-36 ) at 6 months after stroke . Knowledge of stroke , satisfaction with services , emotional outcome , disability , and h and icap and were secondary outcome measures . RESULTS Only 51 of 108 ( 47 % ) surviving patients r and omized to the SEP completed the program , as did 20 of 93 ( 22 % ) informal carers of surviving patients .  Perceived health status ( Short Form 36 [ SF-36 ] health survey ) scores were similar for SEP patients and controls . Informal carers in the control group scored better on the social functioning component of the SF-36 than the SEP group ( P=0.04 ) . Patients and informal carers in the SEP group scored higher on the stroke knowledge scale than controls ( patients , P=0.02 ; carers , P=0 . 01 ) . Patients in the SEP group were more satisfied with the information that they had received about stroke ( P=0.004 ) . There were no differences in emotional or functional outcomes between groups . CONCLUSIONS Although the SEP improved patient and informal carer knowledge about stroke and patient satisfaction with some components of stroke services , this was not associated with an improvement in their perceived health status . Indeed , the social functioning of informal carers r and omized to the SEP was less than in the control group OBJECTIVE The objective of this study was to evaluate the strengths and weaknesses of a group support program and a home visiting program for family caregivers of stroke patients . It also examined the best fit between intervention variant and family caregiver and patient characteristics . van den Heuvel 's previous effect study showed positive effects of the same intervention program , but unlike our present study differences between the two support variants could not be measured . METHODS Of 257 family caregivers who were included and r and omly assigned to an intervention variant or a control group , 127 family caregivers completed the intervention in either the group program or the home visiting program . RESULTS Evaluation data showed that both intervention variants had been helpful and feasible , but home visit participants missed peer contact and follow-up contacts were missed in both intervention programs . In comparison to the home visiting program , the group program participants showed more benefit especially with respect to informational and emotional components . Caregivers ' preference for type of intervention revealed that both types of intervention had its supporters . Those that preferred the group program could be clearly characterised : they were burdened , lived with a more psychologically h and icapped relative , were using active coping strategies more frequently or lived in a region which is considered to be more sociable . CONCLUSION The present study adds extensively to van den Heuvel 's effect study with respect to discriminative aspects of group and home intervention programs and their respective benefits for specific family caregiver groups . PRACTICE IMPLICATION S In order to suitably match an intervention type with specific caregiver characteristics the intervention provider should utilize caregiver self- selection or undertake professional screening of caregiver burden . Telephone contacts should be offered in addition to the interventions Purpose . We hypothesised that carers of stroke survivors who participate in the Web-based intervention , Caring∼Web © , would have higher well-being than non-Web users . We also postulated that those survivors whose carers participated in Caring∼Web would use fewer healthcare services . Method . A r and omised , two-group , repeated measures design was used . Subjects were recruited from four rehabilitation centres from which first-time stroke survivors were discharged to home in two Midwestern states . Of 144 carers screened , 103 carers of these survivors who were novice Internet users were assigned to a Web or non-Web user group . Seventy-three subjects completed the study . Intervention . Caring∼Web was a Web-based intervention of education and support provided to the Web user group for 1 year . A bi-monthly telephone survey collected data on all carers well-being ( perceived depression , life satisfaction ) and survivors healthcare service use ( self-reported provider and emergency department visits , hospital re-admissions , nursing home placement ) . Results . No statistical differences were found between the groups in carers well-being or in the number of provider visits for survivors . There were significant differences in emergency department visits ( p = 0.001 ) and hospital re-admissions ( p = 0.0005 ) related to the health of survivors . Conclusions . This Web-based intervention helped new carers make informed decisions about healthcare needs of stroke survivors , thus reducing service use Background and Purpose — Stroke symptoms can be very stressful for family caregivers , but most knowledge about the prevalence and stressfulness of stroke-related patient problems is derived from convenience sample s. In addition , little is known about perceived benefits of the stroke caregiving experience . The purpose of this study was to determine the prevalence and stressfulness of stroke-related problems , and perceived benefits of caregiving , as reported by an epidemiologically derived sample of caregivers of stroke survivors . Methods — Stroke survivors ( N=75 ) from a prospect i ve epidemiological study of stroke , the REasons for Geographic and Racial Differences in Stroke ( REGARDS ) study , and their family caregivers were followed . Caregivers were given a comprehensive telephone interview 8 to 12 months after the stroke , using measures of stroke patient problems , caregiver appraisal s of the stressfulness of these problems , and perceived benefits of caregiving .  Results — Caregivers rated patient problems with mood ( depression , loneliness and anxiety ) , memory , and physical care ( bowel control ) , as the most stressful , but reported prevalence of these problems was lower than those reported previously in studies using clinical sample s. Caregivers also reported many benefits from caregiving , with over 90 % reporting that caregiving enabled them to appreciate life more . Conclusions — Epidemiologically based studies of stroke caregiving provide a unique picture of caregiver strains and benefits compared with clinical studies , which tend to over-represent more impaired patients . Support for caregivers should include interventions to aid their coping with highly stressful mood , physical care , and cognitive problems of stroke patients , but should also attend to perceived benefits of caregiving BACKGROUND AND PURPOSE [ corrected ] With the ever-increasing pressure on healthcare budgets , we witness a growing dem and for evidence of the economic implication s of care across many therapeutic areas . Stroke is no exception . METHODS Detailed information on healthcare use was collected in conjunction with two 12-week international trials design ed primarily to assess the safety and efficacy of a new potential neuroprotective agent . The information was gathered prospect ively by means of a customized re source use instrument that included both acute and long-term inpatient management as well as community care . In this report , the results pertaining to the 1341 acute ischemic stroke patients are described . RESULTS More than 70 % of the mean cost ( $ 13 668 ) was explained by the initial hospitalization , which averaged 24 days . The total cost and its components varied according to patient age , the presence of comorbidities , and several indicators of disease severity . Pronounced country differences could be observed in the management of this fairly homogeneous patient group . CONCLUSIONS This study provides a comprehensive picture of the healthcare services used for the treatment and rehabilitation of stroke victims , presented with respect to various patient and disease characteristics . It is expected that research ers evaluating the cost-efficiency of specific stroke treatments will benefit from the detailed information presented in this report Abstract Purpose : This study evaluated the effectiveness of telephone groups for older , spousal caregivers of stroke survivors . Method : The 88 caregivers were mostly white females who were 70 years old on average and who had been providing care for an average of 3 years . Participants were r and omized to treatment or control conditions , followed for 6 months , and assessed for depression , burden , loneliness , stress , and competence . Treatment participants engaged in an eight-session psychoeducational telephone group . Results : Treatment participants showed decreased stress over time but were not significantly different from control participants in the amount of change in stress . Control participants showed a significant increase in burden during the study ; treatment participants showed a significant increase in competence Objectives : To determine whether education and counselling after stroke leads to improved family functioning and psychosocial outcomes for stroke patients and their spouses , and better functional and social outcomes for patients . Design : Two-group r and omized controlled trial . Data were collected on admission to and discharge from rehabilitation , and again six months later . Setting : Rehabilitation units at Repatriation General Hospital and Griffith Hospital , in Adelaide , South Australia . Participants : Sixty-two stroke patients and their spouses , 32 in the intervention group and 30 in the control group . Intervention : Stroke information package and three visits from a social worker trained in family counselling . Outcome measures : Family functioning : McMaster Family Assessment Device ( FAD ) ; functional status : Barthel Index ( BI ) ; social recovery : Adelaide Activities Profile ( AAP ) ; depression : Geriatric Depression Scale ( GDS ) ; anxiety : Hospital Anxiety and Depression Scale ( HADS ) ; mastery : Mastery Scale ( MS ) ; health status : SF-36 . Results : At six months the intervention group had better family functioning for both patients ( mean FAD difference 0.19 ) and spouses ( mean difference 0.09 ) . A modest benefit in functional status for intervention patients ( mean BI difference 1.3 ) was related to improved family functioning . Intervention patients reported better social recovery ( mean AAP differences : domestic chores 5.7 , household maintenance 4.6 , social activities 11.5 ) , but there were no significant effects on depression , anxiety , mastery or health status . Conclusions : An education and counselling intervention maintained family functioning , and in turn led to improved functional and social patient outcomes . This approach helps patients and their spouses to make the optimal adjustment to living with stroke Background and Purpose — Social problem-solving therapy shows promise as an intervention to improve the well-being of  family caregivers .  There is some evidence that training in problem solving may be effectively delivered by telephone . The purpose of this study was to quantify the impact of social problem-solving telephone partnerships on primary family caregiver outcomes after stroke survivors are discharged home from a rehabilitation facility . Methods — Using a r and omized 3-group repeated- measures experimental design , 74 stroke survivors with an admitting diagnosis of ischemic stroke and their primary family caregivers were entered into the study . The intervention consisted of an initial 3-hour home visit between a trained nurse and the family caregiver within 1 week after discharge to begin problem-solving skill training . This initial session was followed by weekly ( the first month ) and biweekly ( the second and third month ) telephone contacts . Results — Compared with the sham intervention and control groups , family caregivers who participated in the social problem-solving telephone partnership intervention group had better problem-solving skills ; greater caregiver preparedness ; less depression ; and significant improvement in measures of vitality , social functioning , mental health , and role limitations related to emotional problems . There were no significant differences among the groups in caregiver burden . Satisfaction with healthcare services decreased over time in the control group while remaining comparable in the intervention and sham intervention groups . Conclusion — These results indicate that problem-solving training may be useful for family caregivers of stroke survivors after discharge from rehabilitative facilities This study developed and implemented the Transition Assistance Program ( TAP ) for stroke caregivers . The program is composed of ( 1 ) skill development , ( 2 ) education , and ( 3 ) supportive problem solving .  Sixty-one dyads ( n = 122 ) participated : thirty-nine from Puerto Rico and twenty-two from Texas . Participants were r and omly assigned to the TAP treatment or a control group . As caregiver satisfaction with the TAP increased , strain and depression decreased , and caregivers reported a very high rate of program satisfaction ( 9.5 out of 10 ) . The TAP effectively reduced caregiver strain at the 3-month follow-up . When controlling for baseline differences , we found that the treatment group had lower depression ( p = 0.07 ) than the control group at follow-up and that the TAP may have had a preventative effect on depression for caregivers who had not been depressed at discharge , although this visual trend did not reach statistical significance . Among veterans with low functioning at baseline , veterans whose caregivers had received the TAP improved in functioning more than did veterans whose caregivers had been in the control group , although this visual trend was not significant . Functioning in veterans with stroke was also significantly linked to caregiver satisfaction with the TAP . The findings from the current study warrant further evaluation of the TAP intervention & NA ; Guided by Orem 's self‐care deficit nursing theory , the purpose of this descriptive comparative study was to examine the emotional support , physical help , and health of caregivers of stroke survivors . Seventy‐three caregivers from the Midwest participated in a parent study that examined their experience of caring during the first 12 months after stroke . Caregivers were r and omized to an online intervention of support and education ( n = 36 Web users ) or a control group ( n = 37 non‐Web users ) . A secondary analysis of data collected during telephone interviews at baseline , 3 , 6 , and 12 months after stroke was performed . No significant mean differences were found between Web and non‐Web users in the above variables at these points in time . Consequently , the caregivers were merged into one group , and the relationships among the variables at the different points in time were analyzed . Significant , moderately positive relationships were found between emotional support and physical help at baseline , 3 , and 12 months . There were also significant , moderately positive relationships between emotional support and caregiver health at 6 and 12 months . Results highlight the importance of caregivers ( dependent care agents in Orem 's terms ) establishing an adequate self‐care system that provides emotional support and physical help . Findings also denote the need for nurses ( as caring agents ) to assess caregiver health later in the caring process and be aware of its relationship to emotional support BACKGROUND AND PURPOSE Establishing evidence of content validity and satisfaction is an integral part of intervention research . The purpose of this article is to describe content validity and satisfaction relative to the Telephone Assessment and Skill-Building Kit ( TASK ) , an 8-week follow-up program based on individualized assessment of stroke caregiver needs . DESIGN AND METHODS The TASK intervention enables caregivers to develop skills based on assessment of their own needs . During the development of the TASK program , 10 experts rated the validity of the TASK intervention components for accuracy , feasibility , acceptability , and problem relevance . After incorporating feedback from the experts , a r and omized controlled clinical trial was instituted using a convenience sample of 40 stroke caregivers to determine satisfaction ( usefulness , ease of use , and acceptability ) with the TASK intervention ( n=21 ) compared with an attention control group ( n=19 ) . Data collection occurred between March 2005 and June 2006 . Data were analyzed using descriptive statistics , independent sample t tests , and content analysis . FINDINGS Expert ratings on a 1 to 5 scale , with 5 being strongly agree , provided evidence of content validity ( accuracy 4.71 , feasibility 4.46 , acceptability 4.40 , problem relevance 4.67 ) . Caregivers in the TASK group scored significantly higher than the attention control group on all satisfaction measures ( usefulness p=.02 ; ease of use p=.02 ; acceptability p=.05 ) . Qualitative comments from caregivers provided further evidence of satisfaction . CONCLUSIONS Evidence of content validity and user satisfaction for the TASK intervention relative to an attention control group was found . CLINICAL RELEVANCE The TASK program may be a viable telephone-based program that can be implemented by nurses to support family caregivers during the first few months after stroke survivors are discharged home Objective : To investigate an intensified transition concept between neurological inpatient rehabilitation and home care for long-term effects on the care situation two and a half years after stroke patients ' discharge . Design : Controlled clinical trial allocating patients to intervention group ( intensified transition on ward II ) or control group  ( st and ard transition on ward I ) ;  patients were allocated to whichever ward had a vacancy . The last follow-up assessment was carried out on average 31 months after discharge . Intervention : The intensified transition concept consisted of therapeutic weekend care , bedside teaching and structured information for relatives during the second phase of the rehabilitation . Subjects : Seventy-one patients and their family carers were included , of which one case dropped out . Therefore 70 family carers - 35 individuals in each group - were available for assessment at long-term follow-up . Data collection : Family carers were asked via telephone whether the patient was still alive and if so , where he or she is living - at home or in a nursing home . Statistical methods : Binary logistic regression analysis with the care situation ( home care versus institutionalized care or deceased ) as dependent variable . Results : Two and a half years after discharge ( T3 ) in the intervention group significantly fewer patients were institutionalized ( 2 versus 5 ) or deceased ( 4 versus 11 ) ( P = 0.010 ) . Multivariate analysis showed that besides a higher functional life quality at discharge and lower patient 's age , the participation in the intensified transition programme is the third significant predictor for home care at T3 . Conclusion : Effects of an intensified transition programme can persist over a long-term period . They can sustain home care by reducing institutionalization and mortality BACKGROUND More evidence of the efficacy of caregiver interventions is needed . The aim of this study was to evaluate whether counselling in the home setting reduces the caregiver burden . METHODS Thirty-six patients after stroke , median age 53 years , with a close family member , were selected for an evaluation of the burden of care and 35 participated . They were part of a r and omized controlled trial , comparing rehabilitation in the home setting with outpatient rehabilitation . In the home setting , counselling about the stroke and its consequences was included . Assessment s with the Caregiver Burden scale were made at 3 weeks , 3 months and one year after discharge . RESULTS The burden of the 2 groups did not differ . After the intervention , there was a tendency to a lower burden for the home setting . The burden for the home setting was then unchanged from 3 weeks to 1 year , while outpatient rehabilitation showed a reduced burden over time . For the home setting , significant correlations to activity level were seen after the intervention . CONCLUSION A positive effect of counselling was seen , as the home setting burden tends to be lower after the intervention , while outpatient rehabilitation seems to adjust with time . The results suggest that counselling reduces burden and the remaining burden is associated with the patient 's ability In this study we examined the effect of hypnosis on  preoperative anxiety . Subjects were r and omized into 3 groups , a  hypnosis group ( n = 26 ) who received suggestions of well-being ; an attention-control group ( n = 26 )  who received attentive listening and support without any specific hypnotic suggestions and a “ st and ard of care ” control group ( n = 24 ) . Anxiety was measured pre- and postintervention as well as on entrance to the operating rooms . We found that patients in the hypnosis group were significantly less anxious postintervention as compared with patients in the attention-control group and the control group ( 31 ± 8 versus 37 ± 9 versus 41 ± 11 , analysis of variance , P = 0.008 ) . Moreover , on entrance to the operating rooms , the hypnosis group reported a significant decrease of 56 % in their anxiety level whereas the attention-control group reported an increase of 10 % in anxiety and the control group reported an increase of 47 % in their anxiety ( P = 0.001 ) . In conclusion , we found that hypnosis significantly alleviates preoperative anxiety . Future studies are indicated to examine the effects of preoperative hypnosis on postoperative outcomes Background : Communication difficulties due to aphasia following stroke are particularly stressful to caregivers . Objective : To examine the impact of a psychoeducation programme on  caregivers ’ burden and stress and communication between the caregiver and aphasic stroke patient . Design : R and omized wait-list controlled trial with immediate or three-month delayed treatment . Setting : Three public hospital rehabilitation services in Sydney , Australia . Subjects : Thirty-nine caregivers of aphasic stroke patients , up to 12 months post stroke : 19 given immediate treatment and 20 in a delayed treatment control group . Interventions : Four-session weekly caregiver programme that included elements of education , support and communication skills conducted by a speech pathologist , social worker and clinical psychologist . Main measures : The General Health Question naire ( GHQ ) was used to measure caregiver stress , the Relatives ’ Stress Scale was used to measure caregiver burden and a communication question naire was design ed specifically for this project . Results : Thirty-one caregivers completed the study . Caregivers in the immediate treatment group had significant reductions in GHQ measured stress ( GHQ mean ( SD ) at baseline= 6.26 ( 5.67 ) , GHQ post treatment 3.21 ( SD 4.20 ) , P = 0.006 ) . There was no improvement in wait-listed caregivers . Improvement was not maintained at three-month follow-up . There were no significant effects of the programme on communication skills or on caregiver burden . Conclusions : Stroke caregiver support , education and training programmes have short-term effects on caregiver stress levels but are likely to require ongoing involvement to maintain their effect OBJECTIVE the present study had two main purpose s : 1 . To examine the relationship between  caregiver burden  and health-related quality of life in family caregivers of older stroke patients in Japan ; and 2 . To examine which characteristics of the caregiving situation significantly relate to increased burden . METHODS subjects ( n=100 ) were recruited from seven r and omly selected neurological hospitals with out-patient rehabilitation clinics in western Japan and interviewed using the  Zarit Burden Interview , the Modified Barthel Index , the Geriatric Depression Scale and the SF-12 Health Survey for health-related quality of life .  RESULTS increased caregiver burden was significantly related to worsening health-related quality of life , particularly worsening mental health ( Geriatric Depression Scale and SF-12 items ) , even after controlling for caregiver age , sex , chronic illness , average caregiving hours/day , and functional dependence of the care-recipient . DISCUSSION findings indicate that increased burden significantly relates to decreased health-related quality of life among stroke caregivers . In addition , the prevalence of depressive symptoms among caregivers was twice that of community dwelling older people . Roughly 52 % of caregivers had Geriatric Depression Scale scores that warranted further evaluation . Despite the prevalence of depressive symptoms only one caregiver had received any psychiatric care during their caregiving tenure Family caregiving is prevalent and may have adverse impacts on health , particularly for elder caregivers who tend to have chronic health conditions which need ongoing self-management . Interventions that empower family caregivers to take care of themselves are needed . This study examined the impact on caregivers of participation in a self-care skill-building , self-efficacy enhancing , community-based program called powerful tools for caregiving ( PTC ) . We assessed health-risk behaviors , self-care , and psychological well-being among 118 adult caregivers who participated in PTC in western Washington state between July 2001 and June 2004 , about half of whom were aged 65 or older .  Health-risk behaviors were reduced and self-care and psychological well-being improved significantly , overall and for each stratum of age ( > or = 65 years of age versus < 65 ) Objectives : To explore whether a group programme for community-dwelling chronic stroke survivors and their carers is feasible in rural setting s ; to measure the impact of the programme on health-related quality of life and functional performance ; and to determine if any benefits gained are maintained . Design : R and omized , assessor blind , cross-over , controlled trial . Setting : Rural outpatient . Subjects : Twenty-five community-dwelling , chronic stroke survivors and 17 carers of participant stroke survivors . Intervention : The intervention group undertook a once-a-week , seven-week group programme combining physical activity , education , self-management principles and a ‘ healthy options ’ morning tea . At completion , the control group crossed over to receive the intervention . Main measures : Stroke Impact Scale ( stroke survivors ) , Health Impact Scale ( carers ) , Six Minute Walk Test , Timed Up and Go , Caregiver Strain Index . Results : There were insufficient participants for results to reach statistical significance . However between-group trends favoured the intervention group in the majority of outcome measures for stroke survivors and carers . The majority of measures remained above baseline at 12 weeks post programme for stroke survivor participants . The programme was well attended . Of the seven sessions all participants attended four or more and 88 % attended six or seven sessions . Conclusions : This novel programme incorporating physical activity , education and social interaction proved feasible to undertake by a stroke-specific multidisciplinary team in three rural Australian setting s. This programme may improve and maintain health-related quality of life and physical functioning for chronic stroke survivors and their carers and warrants further investigation & NA ; Caregivers ( CGs ) of stroke survivors assume their role suddenly and with little preparation . Negative emotions are common , persist over time , and are related to other negative outcomes . This pilot study , guided by a coping model , examined the efficacy and durability of a  caregiver problem‐solving intervention ( CPSI ) on CG and stroke survivor outcomes . Additional aims included assessment of feasibility issues and reliability and sensitivity of the study measures . The nonr and om sample of 15 stroke CGs was matched on depression and demographics with a comparison group . The CPSI started during acute rehabilitation and continued through 2 months after discharge . Parametric and nonparametric tests were used to assess achievement of the aims . CG depression , anxiety , preparedness , and survivor motor function improved significantly in the intervention group over time . Burden , life changes , and taking care of CG 's own needs did not change significantly . CPSI group CG depression significantly improved compared with the matched group . The improvement in outcomes for the CPSI group supports further testing of the intervention with a large sample In this article , we report the long-term outcomes of an intervention for informal caregivers who are the main provider of stroke survivors ' emotional and physical support . Based on the stress-coping theory of Lazarus and Folkman two intervention design s were developed : a group support program and individual home visits . Both design s aim ed at an increase in caregivers ' active coping and knowledge , reducing caregivers ' strain and improving well-being and social support .  Caregivers were interviewed before entering the program , and 1 and 6 months after completion of the program . After 6 months , 100 participants remained in the group program , 49 in the home visit program , and 38 in the control group .  Multiple stepwise regression analysis was used to determine the effects of the interventions . In the long-term , the interventions ( group program and home visits together ) contributed to a small to medium increase in confidence in knowledge and the use of an active coping strategy . The amount of social support remained stable in the intervention groups , whereas it decreased in the control group . The same results were found when only the group program was compared with the control group . However , no significant differences between the home visit group and the participants in the group support program were found . Younger female caregivers benefit the most from the interventions . They show greater gains in confidence in knowledge about patient-care and the amount of social support received compared with other caregivers AIMS To test the effectiveness of a discharge planning program for dyads of older stroke survivors and their family caregivers in Taiwan . BACKGROUND Family caregivers of stroke survivors often feel inadequately prepared to deal with the physical , cognitive and emotional needs of the stroke survivors . However , little information could be found on discharge planning programs for caregivers of stroke survivors in Asian families . DESIGN A r and omised experimental design was used to explore the effects of a discharge planning program for 158 dyads of older stroke patients and their family caregivers . METHODS The control group ( n = 86 dyads ) received only routine hospital discharge planning services  and the experimental group ( n = 72 dyads ) received routine hospital discharge planning services plus the caregiver-oriented discharge planning program . Outcome variables were measured at baseline , before discharge and one month after hospital discharge . Variables were measured by the Nurse Evaluation of Caregiver Preparation Scale , Preparedness for Caregiving Scale , Caregiver Discharge Needs Satisfaction Scale and Perception of Balance between Competing Needs Scale . RESULTS Caregivers in the experimental group had significantly better nurse evaluation and self-evaluation of preparation after the program than before , and greater satisfaction of discharge needs one month after discharge than before discharge . Caregivers in the experimental group had significantly better nurse evaluations and self-evaluations of preparation and better satisfaction of discharge needs after the program compared with the control group . However , no significant difference was found between caregiver groups in perceived balance of competing needs . CONCLUSIONS This discharge planning program benefited family caregivers of older stroke patients during the transition from hospitalisation to one month after discharge . RELEVANCE TO CLINICAL PRACTICE This caregiver-oriented discharge planning program , with its emphasis on individualised health education and home visits following discharge may improve caregivers ' preparation and the satisfaction of their needs during the discharge transition Purpose . Disability following stroke is highly prevalent and is predicted by psychological variables such as control cognitions and emotions , in addition to clinical variables . This study evaluated the effectiveness of a workbook-based intervention , design ed to change cognitions about control , in improving outcomes for patients and their carers . Method . At discharge , stroke patients were r and omly allocated ( with their carers ) to a 5-week intervention ( n = 103 ) or control ( normal care : n = 100 ) . The main outcome ( at 6 months ) was recovery from disability using a performance measure , with distress and satisfaction as additional outcomes . Results . The intervention group showed significantly better disability recovery , allowing for initial levels of disability , than those in the control group , F(1,201 ) = 5.61 , p = 0.019 . Groups did not differ in distress or satisfaction with care for patients or carers . The only psychological process variable improved by the intervention was Confidence in Recovery but this did not mediate the effects on recovery . Conclusions . A large proportion of intervention participants did not complete the workbook tasks . This was perhaps associated with the fairly low level of personal contact with workbook providers . The modest success of this intervention suggests that it may be possible to develop effective behavioural interventions to enhance recovery from disability in stroke patients OBJECTIVE To implement and evaluate the impact of  telephone caregiver groups  , compared with traditional face-to-face , on-site caregiver groups . DESIGN Quasi-experimental design comparing the two group types across time . SETTING An urban tertiary rehabilitation hospital with a brain injury program servicing a vast geographical area . PARTICIPANTS Caregivers of an adult person with a brain injury participated in either one of the 10 telephone groups ( TGs ) ( N = 52 caregivers who completed a full set of research forms ) or one of the 10 on-site groups ( OGs ) ( N = 39 caregivers who completed a full set of research forms ) . The combined total from both groups was 91 . INTERVENTION Caregivers who lived within 40 km of the facility were placed in one of the OGs , and all others were placed in one of the TGs . Both types of groups met weekly for 9 to 10 weeks and were led by either social work or psychology professionals . The TGs met using teleconference technology . MAIN OUTCOME MEASURES Profile of Moods States ( POMS ) , Caregiver Burden Inventory ( CBI ) , and the McMaster Model Family Assessment Devise ( FAD ) , were administered 2 months before the first day of group , on the first day of group , on the last day of group , and 6 months after group . On the last day of group , a participant satisfaction survey was administered . RESULTS There were similar amounts of improvements for the outcomes from OGs and TGs . Rural caregivers had fewer difficulties on all measures at all measurement intervals . In both types of group , participants showed a statistically significant improvement in POMS scores and a trend toward improvement in FAD and CBI results . Participants of both group types rated their experience highly , although rural caregivers were somewhat more satisfied . CONCLUSIONS Telephone groups offer a method of providing support and education to rural caregivers that is as effective as traditional in-person OGs AIM AND OBJECTIVE To explore the long-term effects of a discharge-preparation programme targeting Taiwanese family caregivers of older patients with stroke . BACKGROUND Little is known about the effects of interventions for caregivers of patients with stroke in Asian and Chinese families . DESIGN A r and omised experimental design was used . METHOD Participants included 158 older patients with stroke ( 72 in the experimental group and 86 in the control group ) and their family caregivers . A caregiver-oriented intervention programme was design ed to increase caregiver preparedness , to enhance caregiver perception of balance between competing needs and to satisfy specific needs during the transition between hospitalisation and discharge . Long-term outcomes were measured by caregiver 's health-related quality of life , quality of care , stroke patient 's self-care ability , patient 's health-related quality of life and service utilisation . Longitudinal data were analysed by the generalised estimating equation approach . RESULTS During the 12 months following discharge of older patients with stroke , caregivers in the experimental group provided significantly better quality of care ( beta = 0.45 ; p = 0.03 ) than the control group . Between the sixth-twelfth months following discharge , patients in the control group were more likely to be institutionalised than those in the experimental group ( chi(2 ) = 5.11 ; p = 0.03 ) . CONCLUSION Using a sample from Taiwan , this intervention programme succeeded in improving quality of care provided by family caregivers to older patients with stroke and in decreasing the likelihood of their institutionalisation . RELEVANCE TO CLINICAL PRACTICE Older Chinese patients with stroke and their family caregivers can benefit from an individualised programme that prepares caregivers for patient discharge . Similar programmes may be applicable to other countries with Chinese population Objective : An intensified transition concept between  neurological inpatient rehabilitation  and home care was investigated for effects on the functional status of stroke patients and the physical and emotional health of their carers . Design : Controlled clinical trial allocating patients to intervention group ( intensified transition on ward II ) or control group ( st and ard transition on ward I ) ;  patients were allocated to whichever ward had a vacancy . Follow-up assessment was carried out six months after discharge . Subjects : Seventy-one patients and their family carers were included , of which nine cases dropped out . Therefore 62 stroke patients with persisting disability and their family carers were available for assessment at follow-up - 33 patients in the intervention group , 29 patients in the control group . Intervention : The intensified transition concept consisted of therapeutic weekend care , bedside teaching and structured information for relatives during the second phase of the rehabilitation . Main measures : Patients were assessed with the Barthel Index , Functional Independence Measure , Ashworth Spastic Scale , Frenchay Arm Test , and Timed Up and Go Test . The carers completed SF-36 , and were assessed using the Giessen Symptom List , Depression Scale and Burden Scale for Family Caregivers . Results : The intensified transition did not lead to significant change in the functional status of the patients or in the physical and emotional health of the family carers . Within the first four weeks after discharge , the patients in the intervention group had fewer new illnesses . In the observation period the use of outpatient care services was more frequent in the intervention group than in the control group . Conclusion : Even though there are few differences of moderate intensity between the two groups the intensified transition programme does not affect either the functional status of the stroke patients  or the health of the carers CONTEXT There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity . Research ers have also suggested that the combination of loss , prolonged distress , the physical dem and s of caregiving , and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for physical health problems , leading to increased mortality . OBJECTIVE To examine the relationship between caregiving dem and s among older spousal caregivers and 4-year all-cause mortality , controlling for sociodemographic factors , prevalent clinical disease , and sub clinical disease at baseline . DESIGN Prospect i ve population -based cohort study , from 1993 through 1998 with an average of 4.5 years of follow-up . SETTING Four US communities . PARTICIPANTS A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years who were living with their spouses . MAIN OUTCOME MEASURE Four-year mortality , based on level of caregiving : ( 1 ) spouse not disabled ; ( 2 ) spouse disabled and not helping ; ( 3 ) spouse disabled and helping with no strain reported ; or(4 ) spouse disabled and helping with mental or emotional strain  reported . RESULTS After 4 years of follow-up , 103 participants ( 12.6 % ) died . After adjusting for sociodemographic factors , prevalent disease , and sub clinical cardiovascular disease , participants who were providing care and experiencing caregiver strain had mortality risks that were 63 % higher than noncaregiving controls ( relative risk [ RR ] , 1.63 ; 95 % confidence interval [ CI ] , 1.00 - 2.65 ) . Participants who were providing care but not experiencing strain ( RR , 1.08 ; 95 % CI , 0.61 - 1.90 ) and those with a disabled spouse who were not providing care ( RR , 1.37 ; 95 % CI , 0.73 - 2.58 ) did not have elevated adjusted mortality rates relative to the noncaregiving controls . CONCLUSIONS Our study suggests that being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality  among elderly spousal caregivers . Caregivers who report strain associated with caregiving are more likely to die than noncaregiving controls Abstract Objective : To evaluate whether specialist nurse visits enhance the social integration and perceived health of  patients with stroke or alleviate  stress  in carers in longer term stroke care . Design : Stratified r and omised controlled trial ; both groups assessed at time of recruitment and at 3 , 6 , and 12 months . Setting : Patients with disability related to new stroke who lived in their own homes in the Bradford Metropolitan District . Subjects : 240 patients aged 60 years or over , r and omly allocated to control group ( n = 120 ) or intervention group ( n = 120 ) . Intervention : Visits by specialist outreach nurses over 12 months to provide information , advice , and support ; minimum of six visits during the first six months . The control group received no visits . Main outcome measures : The Barthel index ( functional ability ) , the Frenchay activities index ( social activity ) , the Nottingham health profile ( perceived health status ) . Stress among carers was indicated by the general health question naire-28 ( 28 items ) . The nurses recorded their interventions in trial diaries . Results : There were no significant differences in perceived health , social activities , or stress among carers between the treatment and control groups at any of the assessment s points . A subgroup of mildly disabled patients with stroke ( Barthel index 15 - 19 ) had an improved social outcome at six months ( Frenchay activities index , median difference 3 ( 95 % confidence interval 0 to 6 ; P = 0.03 ) ) and for the full 12 months of follow up ( analysis of covariance P = 0.01 ) compared with the control group . Conclusions : The specialist nurse intervention result ed in a small improvement in social activities only for the mildly disabled patients . No proved strategy yet exists that can be recommended to address the psychosocial difficulties of patients with stroke and their families . Key messages This r and omised controlled trial using specialist nurses in an intervention strategy found that no significant differences were seen at one year follow up between the two groups of patients in wellbeing or social activities and no reduction in stress among carers A significant but small increase in social activities was reported by a subgroup of mildly disabled patients with stroke No proved strategy yet exists to address the psychosocial difficulties of patients with stroke and their Abstract Purpose : Stroke caregivers often express the need for information about stroke and assistance with stroke-related care in the early discharge period . The Telephone Assessment and Skill-Building Kit ( TASK ) is an 8-week program that addresses caregiver needs . This study explored the efficacy of the TASK program in improving stroke caregiver outcomes . Method : Guided by a conceptual model , 6 outcomes ( optimism , task difficulty , threat appraisal , depressive symptoms , life changes , general health perceptions ) were measured in 40 caregivers r and omized to the TASK ( n = 21 ) or an attention control group ( n = 19 ) . Data were analyzed using analysis of covariance ( ANCOVA ) , controlling for baseline scores and minutes spent with the nurse . Results : Significant increases in optimism at 4 weeks , 8 weeks , and 12 weeks were found , with medium effect sizes for the TASK group relative to the control group ( p < .05 ) . Significant improvements in task difficulty at 4 weeks , and threat appraisal at both 8 weeks and 12 weeks were also found ( p < .05 ) . Conclusion : Caregivers receiving the TASK intervention improved in optimism , task difficulty , and threat appraisal . Further testing of an enhanced version of the TASK program is warranted , with attention directed toward more distal stroke caregiver outcomes Overwhelming evidence shows the quality of reporting of r and omised controlled trials ( RCTs ) is not optimal . Without transparent reporting , readers can not judge the reliability and validity of trial findings nor extract information for systematic review s. Recent method ological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects . Such systematic error is seriously damaging to RCTs , which are considered the gold st and ard for evaluating interventions because of their ability to minimise or avoid bias . A group of scientists and editors developed the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to improve the quality of reporting of RCTs . It was first published in 1996 and up date d in 2001 . The statement consists of a checklist and flow diagram that authors can use for reporting an RCT . Many leading medical journals and major international editorial groups have endorsed the CONSORT statement . The statement facilitates critical appraisal and interpretation of RCTs . During the 2001 CONSORT revision , it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports . A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement . After an expert meeting in January 2007 , the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement . This up date improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition , such as selective outcome reporting bias . This explanatory and elaboration document-intended to enhance the use , underst and ing , and dissemination of the CONSORT statement-has also been extensively revised . It presents the meaning and rationale for each new and up date d checklist item providing examples of good reporting and , where possible , references to relevant empirical studies . Several examples of flow diagrams are included . The CONSORT 2010 Statement , this revised explanatory and elaboration document , and the associated website ( www.consort-statement.org ) should be helpful re sources to improve reporting of r and omised trials
BACKGROUND Family caregivers play a significant role in the rehabilitation of stroke survivors .
Various types of psychosocial interventions have been developed to improve the well-being of both stroke survivors and their caregivers .
However , studies showed the results to be mixed and provided insufficient evidence about the optimal dose , approach and format of interventions .
OBJECTIVES To identify the best available evidence related to the effectiveness of psychosocial interventions for family caregivers on the psychosocial and physical wellbeing of family caregivers and stroke survivors .