Randomized controlled trial of a comprehensive stroke education program for patients and caregivers. Motivational Interviewing Early After Acute Stroke: A Randomized, Controlled Trial Telephone Group Intervention for Older Stroke Caregivers A randomized controlled trial of an education and counselling intervention for families after stroke The effect of the support program on the resilience of female family caregivers of stroke patients: Randomized controlled trial. Telephone Intervention With Family Caregivers of Stroke Survivors After Rehabilitation Frailty modifies effectiveness of psychosocial intervention in recovery from stroke Stroke Transition after Inpatient Rehabilitation. Brief Psychosocial–Behavioral Intervention With Antidepressant Reduces Poststroke Depression Significantly More Than Usual Care With Antidepressant: Living Well With Stroke: Randomized, Controlled Trial Recovery following stroke: the role of self-management education. Stress in caregivers of aphasic stroke patients: a randomized controlled trial Effects of a 4-week transitional care programme for discharged stroke survivors in Hong Kong: a randomised controlled trial. Interprofessional stroke rehabilitation for stroke survivors using home care. Reducing depression in stroke survivors and their informal caregivers: a randomized clinical trial of a Web-based intervention. Home-based psychoeducational and mailed information programs for stroke-caregiving dyads post-discharge: a randomized trial Long-term effects of a group support program and an individual support program for informal caregivers of stroke patients: which caregivers benefit the most? Recovery from disability after stroke as a target for a behavioural intervention: Results of a randomized controlled trial A clinical trial of an individualised intervention programme for family caregivers of older stroke victims in Taiwan. Telephone Assessment and Skill-Building Kit for Stroke Caregivers: A Randomized Controlled Clinical Trial Reducing depressive or anxiety symptoms in post-stroke patients: Pilot trial of a constructive integrative psychosocial intervention The impact of a nurse-led support and education programme for spouses of stroke patients: a randomized controlled trial. Stroke Caregiver Outcomes from the Telephone Assessment and Skill-Building Kit (TASK) Family Intervention: Telephone Tracking (FITT): A Pilot Stroke Outcome Study Effectiveness of a strength-oriented psychoeducation on caregiving competence, problem-solving abilities, psychosocial outcomes and physical health among family caregiver of stroke survivors: A randomised controlled trial. An exploratory study of anxiety in carers of stroke survivors. Evaluation of brief interventions for managing depression and anxiety symptoms during early discharge period after stroke: a pilot randomized controlled trial
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 Background and Purpose — The purpose of this study was to determine whether motivational interviewing , a patient-centered counseling technique , can benefit patients ' mood 3 months after stroke . Methods — A single-center , open , r and omized , controlled trial was conducted at a single hospital with a stroke unit . Subjects consisted of 411 consecutive patients on the stroke register who were over 18 years of age and who did not have severe cognitive and communication problems that would prevent them from taking part in an interview ; were not known to be moving out of the area after discharge ; and were not already receiving psychiatric or clinical psychology intervention . All patients received usual stroke care . Patients in the intervention group received 4 individual , weekly sessions of motivational interviewing with a trained therapist in addition to usual stroke care . The primary outcome was the proportion of patients with normal mood at 3 months poststroke measured by the 28-item General Health Question naire ( normal , < 5 ; low ≥5 ) using a mailed question naire . Results — Eighty-one of 207 ( 39.1 % ) patients in the control group and 100 of 204 ( 49.0 % ) patients in the intervention group had normal mood at follow up . A significant benefit of motivational interviewing over usual stroke care ( OR : 1.60 , 95 % CI : 1.04 to 2.46 , P=0.03 ) was found . Conclusion — Our results suggest motivational interviewing leads to an improvement in  patients ' mood 3 months after stroke 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 AIM The purpose of the study was to determine the effect of a support program on the resilience of female family caregivers of stroke patients . METHODS This is a r and omized controlled trial . The sample consisted 70 female family caregivers ( 34 experimental , 36 control group ) . Data were collected three times ( pretest-posttest , follow-up test ) . Data were collected using the demographical data form , the Family Index of Regenerativity and Adaptation-General . RESULTS A significant difference was determined between the experimental and control group 's follow-up test scores for relative and friend support , social support and family-coping coherence . A significant difference was determined between the experimental group 's mean pretest , posttest and follow-up test scores in terms of family strain , relative and friend support , social support , family coping-coherence , family hardiness and family distress . CONCLUSIONS These results suggest that the Support Program contributes to the improvement of the components of resilience of family caregivers of stroke patients 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 Objective : To evaluate the impact of a psychosocial intervention on instrumental activities of daily living , physical performance , cognition and mortality after stroke . Design : A r and omized clinical trial . Setting : Patients were recruited from hospitals and rehabilitation centres ; the intervention took place in subjects ' homes . Subjects : Two-hundred and ninety-one stroke survivors over age 45 . One-hundred and forty-six subjects were assigned to the intervention and 145 subjects were assigned to usual care .  Intervention : Up to 16 meetings conducted over six months in the patient 's home ( approximately weekly for 12 weeks , followed by tri-weekly sessions for another 12 weeks ) . Sessions lasted approximately 1 hour and included , when possible , the entire support system ( stroke survivor , primary caregiver , additional family and friends , and professional caregivers ) . Main outcome measures : Instrumental activities of daily living , physical performance , and cognition were assessed six months post stroke ; mortality was assessed at an average of 47 months post stroke . Results : No significant differences in outcomes were observed between the intervention and usual care groups when analysing the total study population . Among non-frail participants ( n = 156 ) , subjects r and omized to treatment had better scores on instrumental activities of daily living ( mean score among treated = 12.4 ( st and ard deviation ( SD ) = 2.1 ) , mean score among usual care subjects = 11.3 ( SD = 2.9 ) , P-value for difference in means = 0.01 ) and reduced risk of mortality ( P = 0.03 ) than subjects r and omized to usual care . Conclusion : While there is evidence that the treatment benefited healthier subgroups , results also show evidence that the treatment was not effective , and possibly harmful , in frail subgroups This article describes a 3-year study testing the efficacy of a system of home-based , case-managed care for stroke survivors returning to the community following inpatient poststroke rehabilitation . The Stroke Transition after Inpatient Rehabilitation ( STAIR ) study was a r and omized , controlled trial of a postdischarge management strategy carried out in a group of 55 stroke patients , aged 65 or older , who did not have serious residual cognitive or language impairments and returned to the community following inpatient rehabilitation with the assistance of a primary caregiver . The program was shown to facilitate improvement in the general social activity level of the patients in the experimental group at 6 months compared to the control , and there was a trend for this effect to persist at 1 year . Strong relationships were identified between residual disability , social activity level , patients ' perceptions of efficacy , and caregiver stress Background and Purpose — Depression after stroke is prevalent , diminishing recovery and quality of life . Brief behavioral intervention , adjunctive to antidepressant therapy , has not been well evaluated for long-term efficacy in those with poststroke depression . Methods — One hundred one clinical ly depressed patients with ischemic stroke within 4 months of index stroke were r and omly assigned to an 8-week brief psychosocial – behavioral intervention plus antidepressant or usual care , including antidepressant . The primary end point was reduction in depressive symptom severity at 12 months after entry . Results — Hamilton Rating Scale for Depression raw score in the intervention group was significantly lower immediately posttreatment ( P<0.001 ) and at 12 months ( P=0.05 ) compared with control subjects . Remission ( Hamilton Rating Scale for Depression < 10 ) was significantly greater immediately posttreatment and at 12 months in the intervention group compared with the usual care control . The mean percent decrease ( 47%±26 % intervention versus 32%±36 % control , P=0.02 ) and the mean absolute decrease ( −9.2±5.7 intervention versus −6.2±6.4 control , P=0.023 ) in Hamilton Rating Scale for Depression at 12 months were clinical ly important and statistically significant in the intervention group compared with control . Conclusion — A brief psychosocial – behavioral intervention is highly effective in reducing depression in both the short and long term Current stroke rehabilitation tends to focus on the bio-medical course of disability , often responding to psychological and social issues only when they have been implicated in crises . Although this situation is costly , little evidence exists in relation to how psychological and social outcomes can be facilitated or how psychosocial decline can be prevented . In the area of adjustment following traumatic injury , there has been some suggestion that rehabilitation should focus on the expansion of re sources , skills and self-efficacy as this will enable individuals to cope more effectively with their medical condition and circumstances . The current study was a longitudinal r and omised controlled trial involving 100 people with stroke , 58 of whom were r and omly allocated to an intervention based on the notion of psychosocial skill expansion . All were patients of a major hospital in Queensl and , Australia . An existing self-management intervention ( The Chronic Disease Self-Management Course , Lorig et al. , 2001 ) was used to operationalise the concept of psychosocial skill expansion . The control group reported declines in functioning during the first year following stroke in the areas of family roles , activities of daily living , self-care and work productivity , that were not reported by the intervention group . Although the groups had reached similar levels by one year post-stroke , this intervention may have a protective function , presumably by improving capacity to manage the functional requirements of daily life . However , the intervention did not appear to have its impact through self-efficacy , as was expected , and failed to influence outcomes such as mood or social participation . Nevertheless , the intervention warrants further investigation , given that it appears to improve rehabilitation outcomes , at least in the short-term 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 Stroke rehabilitation involves care issues concerning the physical , psychosocial and spiritual aspects . Hospital-based rehabilitation has its limitations because many of the care issues only emerge when patients return home . Transitional care models supporting patients after discharge from the hospital have proved to be effective among chronically ill patients , but limited studies were conducted among stroke survivors . This study was a r and omised controlled trial conducted to test the effectiveness of a transitional care programme ( TCP ) which was a nurse-led 4-week programme design ed based on the assessment -intervention-evaluation Omaha System framework . Between August 2010 and October 2011 , 108 stroke patients who were discharged home , able to communicate , and had slight to moderate neurological deficits and disability were r and omised into control ( n = 54 ) and intervention groups ( n = 54 ) . Data on the patient-related and clinical outcomes were collected at baseline , 4 weeks when the TCP was completed and 8 weeks after discharge from hospital . Repeated measures analysis of variance with intention-to-treat strategy was used to examine the outcomes . There were significant between-group differences in quality of life , the primary outcome measure of this study , in both physical ( F(1 , 104 ) = 10.15 , P = 0.002 ) and mental ( F(1 , 104 ) = 8.41 , P = 0.005 ) domains , but only the physical domain achieved a significant time × intervention interaction effect ( F(1 , 103 ) = 7.73 , P = 0.006 ) . The intervention group had better spiritual-religion-personal measures , higher satisfaction , higher Modified Barthel Index scores and lower depression scores when compared with the control group . They also had lower hospital readmission and use of emergency room rates , but only the use of emergency room had significant difference when compared to control . This study is original in testing a transitional model among stroke patients discharged from hospital . The TCP shares common features that have been proved to be effective when applied to chronically ill patients , and the duration of 4 weeks seems to be adequate to bring about immediate effects OBJECTIVE To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services . METHODS R and omized controlled trial of 101 community-living stroke survivors ( < 18 months post-stroke ) using home care services . Subjects were r and omized to intervention ( n=52 ) or control ( n=49 ) groups . The intervention was a 12-month specialized , evidence -based rehabilitation strategy involving an interprofessional team . The primary outcome was change in health-related quality of life and functioning ( SF-36 ) from baseline to 12 months . Secondary outcomes were number of strokes during the 12-month follow-up , and changes in community reintegration ( RNLI ) , perceived social support ( PRQ85-Part 2 ) , anxiety and depressive symptoms ( Kessler-10 ) , cognitive function ( SPMSQ ) , and costs of use of health services from baseline to 12 months . RESULTS A total of 82 subjects completed the 12-month follow-up . Compared with the usual care group , stroke survivors in the intervention group showed clinical ly important ( although not statistically significant ) greater improvements from baseline in mean SF-36 physical functioning score ( 5.87 , 95 % CI -3.98 to 15.7 ; p=0.24 ) and social functioning score ( 9.03 , CI-7.50 to 25.6 ; p=0.28 ) . The groups did not differ for any of the secondary effectiveness outcomes . There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant ( p=0.76 ) . CONCLUSIONS A 12-month specialized , interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care . Clinical trials.gov identifier : NCT00463229 PURPOSE / OBJECTIVES To develop and test the efficacy of a Web-based intervention for alleviating depression in male stroke survivors ( SSs ) and their spousal caregivers ( CGs ) that blends both peer and professional support . DESIGN AND METHODS The research consisted of an intervention protocol evaluated by a focus group of rehabilitation professionals , a " think aloud " session conducted with female stroke CGs , and a usability test of the intervention 's online features with 7 female stroke CGs . Efficacy of the final protocol was tested in a 2-group r and omized clinical trial with a sample of 32 CG-SS dyads . The CGs in the intervention condition received an online group intervention . Intervention components were based on the Stress Process Model . Those CGs in a control condition received minimal support with individualized access to relevant online information . Measures of depression , as well as the secondary outcomes of mastery , self-esteem , and social support , were obtained from SSs and CGs at pretest , posttest , and 1-month later . RESULTS At posttest and 1 month later , CGs in the intervention condition reported significantly lower depression than CGs in the control condition with baseline depression controlled . There was no significant effect on depression among SSs . Although no significant treatment effects for either SSs or CGs were found on the secondary outcomes , posttreatment changes on some constructs were significantly correlated with change in depression . CONCLUSIONS / IMPLICATION S CGs benefit from Web-based programs that help them better underst and both their emotional needs and those of the SS Abstract Purpose : This r and omized trial compared 6- and 12-month outcomes of a home-based psychoeducational program to mailed information provided to 159 survivors of stroke ( SS ) and their spousal caregivers ( CG ) . Methods : SS ( age 50 + ) and CG were recruited as dyads post-discharge from inpatient rehabilitation . All dyads received mailed information for 12 months . Dyads r and omized to the home-based group received an average of 36.7 h of psychoeducation over 6 months . Health status , depression , stress , burden , coping , support , mutuality and function were obtained on all dyads . Repeated measures analysis with linear mixed models was used to compare the groups for change over time in the outcome variables . Results : Both groups demonstrated less depression and stress over time . Compared to the mailed information group , SS in the home-based group demonstrated significantly improved self-reported health and cognitive function ; CG demonstrated significantly improved self-reported health and coping strategies . Mutuality and social support decreased in both groups . Conclusions : The home-based intervention was effective in improving self-reported health , coping skills in CG and cognitive functioning in SS . However , the finding that dyads in both groups demonstrated decreased depression and stress suggests that providing repeated doses of relevant , personalized information by mail may result in positive changes . Implication s for Rehabilitation A stroke affects both the stroke survivor and the spousal caregiver , so nurses and therapists should use multicomponent strategies to provide education , support , counseling and linkages to community re sources to ease the transition from hospital to home . Stroke may have a negative impact on the dyad ’s relationship with each other and also on the availability of support people in their lives during the 12 months after hospital discharge . Comprehensive stroke programs should encourage dyads to attend support groups and to seek individual and group counseling , as needed . Establishing an ongoing relationship with stroke survivors and their spouses and providing relevant and engaging information by mail can reduce stress and depression over 12 months post-discharge at a minimal cost . Nurses and therapists should consider home visits post-discharge to reinforce education and skills taught in the hospital , increase self-reported health in stroke survivors and spousal CG , increase coping skills and to link the couple to community re sources 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 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 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 Background and Purpose — There are few evidence -based programs for stroke family caregivers postdischarge . The purpose of this study was to evaluate efficacy of the Telephone Assessment and Skill-Building Kit ( TASK II ) , a nurse-led intervention enabling caregivers to build skills based on assessment of their own needs . Methods — A total of 254 stroke caregivers ( primarily female TASK II/information , support , and referral 78.0%/78.6 % ; white 70.7%/72.1 % ; about half spouses 48.4%/46.6 % ) were r and omized to the TASK II intervention ( n=123 ) or to an information , support , and referral group ( n=131 ) . Both groups received 8 weekly telephone sessions , with a booster at 12 weeks . General linear models with repeated measures tested efficacy , controlling for patient hospital days and call minutes . Prespecified 8-week primary outcomes were depressive symptoms ( with Patient Health Question naire Depressive Symptom Scale PHQ-9 ≥5 ) , life changes , and unhealthy days . Results — Among caregivers with baseline PHQ-9 ≥5 , those r and omized to the TASK II intervention had a greater reduction in depressive symptoms from baseline to 8 , 24 , and 52 weeks and greater improvement in life changes from baseline to 12 weeks compared with the information , support , and referral group ( P<0.05 ) ; but not found for the total sample . Although not sustained at 12 , 24 , or 52 weeks , caregivers r and omized to the TASK II intervention had a relatively greater reduction in unhealthy days from baseline to 8 weeks ( P<0.05 ) . Conclusions — The TASK II intervention reduced depressive symptoms and improved life changes for caregivers with mild to severe depressive symptoms . The TASK II intervention reduced unhealthy days for the total sample , although not sustained over the long term . Clinical Trial Registration — URL : https://www . clinical trials.gov . Unique identifier : NCT01275495 Background : About 30 % of stroke survivors clinical ly have depressive symptoms at some point following stroke and anxiety prevalence is around 20 - 25 % . Objective : The purpose of this brief report is to evaluate a pilot trial of a constructive integrative psychosocial intervention ( CIPI ) over st and ard care in post-stroke depression or anxiety . Methods : Patients were r and omly assigned to either CIPI ( n = 23 ) or st and ard care ( n = 19 ) . Patients were assessed using the Hospital Anxiety and Depression Scale at the 1st , 3rd , and 6th months to monitor changes of mood . Results : A Wilcoxon signed-rank test indicated that compared to admission baseline , patients with the intervention had significantly normal post-stroke depression symptom levels at the 1st , 3rd , and 6th months ( P < 0.005 ) . Conclusion : CIPI appears to be of incremental value in treating depression as well as anxiety in subacute care AIMS AND OBJECTIVES The aim of the present study was to determine the impact of a nurse-led support and education programme for improving the spouses ' perceived general quality of life , life situation , general well-being and health state . BACKGROUND Stroke is a disease with great consequences for the patients and their families . The spouses often feel obligated to care for the patient , providing psychological and physical support and having to cope with the patient 's physical and cognitive impairments . This might lead to increased problems , as family members struggle to adapt to their new roles and responsibilities . DESIGN AND METHODS Longitudinal , r and omized controlled trial . One hundred spouses were r and omly assigned to intervention or control groups , 50 in each group . The intervention group participated in a support and education programme , six times during six months , led by stroke specialist nurses . Both groups were followed for 12 months . RESULTS No significant differences were found , between intervention and control groups , over time . In the sub analyses , we found that the group attending 5 - 6 times had a significant decrease in negative well-being and increased quality of life over time , while the group attending fewer times had a significant decrease in positive well-being and health state , similar to the control group , which also had a significant decrease in negative and general well-being . CONCLUSIONS A support and education programme might have a positive effect on  spouses ' well-being , on condition that they attend at least five times . RELEVANCE TO CLINICAL PRACTICE To facilitate the spouses ' role as informal caregivers to the stroke patients , further development of the support and education programme used in the present study is needed , including empowerment approach and implementation of coping strategies 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 Abstract Objective : The goal of this study was to preliminarily test the efficacy of a telephone intervention , Family Intervention : Telephone Tracking , design ed to assist stroke survivors and their primary caregivers during the first 6 months after stroke . Method : Forty-nine stroke survivors and their caregivers were r and omly assigned to treatment as usual or treatment as usual plus the telephone intervention . Global outcomes are reported for health care utilization , family functioning , and general functioning . Results : Family and general functioning were positively and significantly changed at 3 and 6 months . Health care utilization was positively and significantly changed at 3 months . Conclusion : Findings suggest that the model has the potential to decrease health care utilization and improve quality of life for stroke survivors and their caregivers . Further study is warranted BACKGROUND Family caregivers provide the foundation for long-term home care of stroke survivors . The overwhelming stress associated with caregiving hinders the ability of family caregivers to utilise their internal and external re sources to cope with this situation , thereby placing their own health at risk . We conducted a r and omised controlled trial of a strength-oriented psychoeducational programme on conventional stroke rehabilitation for family caregivers . OBJECTIVES To evaluate the effectiveness of a strength-oriented psychoeducational programme on the caregiving competence , problem-solving coping abilities , caregiver 's depressive symptoms , caregiving burden and re sources ( family functioning , social support ) and physical health ( such as caregiving-related injury ) , as well as potential placement of stroke survivors . DESIGN A prospect i ve multi-centre and single-blinded r and omised controlled trial stratified by survivors ' history of stroke . SETTING AND PARTICIPANTS Adult stroke patients and their family caregivers were recruited from the medical wards of a regional acute and two rehabilitation hospitals in the Eastern New Territories of Hong Kong . METHODS The design of the trial was based on the relational/problem-solving model . Family caregivers of stroke survivors who had been admitted to the study hospitals completed a set of question naires before r and omisation , immediately , one- and three-months post-intervention . The control group received usual care , whereas the intervention group received an additional 26-week strength-oriented psychoeducational programme ( two structured individual face-to-face pre-discharge education sessions on stroke and its associated caregiving skills and six biweekly post-discharge telephone-based problem-solving coping skills training sessions ) . Data were analysed using the generalized estimating equation and multiple regression models and chi-square tests . RESULTS We recruited 128 caregiver-survivor dyads . The intervention group demonstrated significantly greater improvements throughout the study ( p < 0.01 ) in terms of caregiving competence , problem-solving coping abilities and social support satisfaction . This group also displayed significantly greater improvements in terms of family functioning ( p < 0.05 ) at one-month post-intervention , an increased number of social support ( p < 0.001 ) and a lower level of burden at three-month post-intervention . However , there was no significant effect on enabling stroke survivors to remain in their home . Post-hoc analysis showed a significant and indirect effect of problem-solving coping abilities , which suggested its mediating effect on caregiving competence of stroke caregivers . CONCLUSIONS Findings suggest that incorporating a strength-oriented psychoeducational programme into the existing stroke rehabilitation protocol can foster a healthy transition to caregiving among family members of stroke survivors AIMS AND OBJECTIVES To investigate anxiety in informal carers of stroke survivors in the first three months after discharge . BACKGROUND Informal carers , also called caregivers , play a vital role in supporting stroke survivors . However , caring for stroke survivors can have adverse consequences amongst carers such as burden , stress and reduced quality of life . Emotional distress is also commonly reported but anxiety has received less attention than depression . DESIGN Prospect i ve , longitudinal , descriptive study . METHOD Forty-five carers completed the  Hospital Anxiety and Depression Scale  on two occasions - within one month and at three months after discharge from stroke and rehabilitation units . RESULTS Carers were more likely to have scores indicating anxiety than depression . In the first month , half the carers ( 51·1 % ) scored in the cut-off for anxiety and a third were in the cut-off for depression ( 31·1 % ) . At three months , the picture was very similar with nearly identical proportions in the anxious and depressed categories ( 48·9 % and 28·9 % , respectively ) . Changes in numbers of cases of anxiety and depression and in mean anxiety scores were non-significant but there was a significant decrease in depression scores ( p=0·048 ) . Fourteen carers ( 31·1 % ) at one month and eleven ( 24·4 % ) at three months fell into both anxious and depressed categories . CONCLUSIONS Anxiety is a relatively neglected emotional outcome in stroke carers . Our study suggests anxiety is an important issue very early in caring whilst other research suggests it remains prevalent for many months . Given the significant role carers play in rehabilitation of stroke survivors , greater recognition of their emotional state is required . Further , longitudinal research with larger sample sizes from a range of geographical areas and improved underst and ing of factors associated with anxiety is needed . RELEVANCE TO CLINICAL PRACTICE Nurses working in the community are ideally placed to identify and support carers suffering from anxiety Abstract Background : Prevalence estimates for depression and anxiety in individuals post-stroke are approximately 33 and 29 % , yet there are few effective preventive interventions . Interventions which commence pre-discharge and continue during the early post-discharge period may support individuals during the critical transition to home adjustment period . This study aim ed to evaluate the efficacy of a self-management intervention and a coping skills intervention , compared to usual care , on anxiety and depression post-stroke . Methods : A pilot , three-arm r and omized trial involving 33 stroke patients ( coping skills : n = 11 , self-management : n = 12 , usual care : n = 10 ) recruited from an Australian stroke unit . Both interventions were eight 1-hour weekly sessions , with the first two pre-discharge and the remainder at home ; targeted both anxiety and depression ; and tailored content to individuals . Primary outcome was severity of depressive and anxiety symptoms ( measured using Montgomery and Åsberg Depression Rating Scale and Hospital Anxiety and Depression Scale ) . Secondary measures were : self-efficacy , stroke knowledge , basic and extended activities of daily living , and quality of life . Outcome measures were administered at baseline , one week post-intervention , and at a three month follow-up by a blinded assessor . Results : Thirty ( 91 % ) participants completed the trial . Immediately post-intervention there was a small improvement in stroke knowledge and a small increase in depression symptoms ( on one of the two measures of depression symptoms ) in the coping skills group compared to usual care . These differences did not remain significant at the 3-month follow-up , nor were there any other significant differences . Conclusion : Neither a coping skills nor self-management intervention reduced anxiety nor depression symptoms early post-stroke more than usual care . Lack of statistical power may have contributed to the non-significant findings in this pilot study
ABSTRACT Objective : To evaluate the effectiveness of psychosocial interventions on depressive symptoms , anxiety symptoms , quality of life , self-efficacy , coping , carer strain and carer satisfaction among stroke survivors , carers and survivor-carer dyads .