How is carer strain related to the recovery of stroke survivors with right hemisphere dysfunction? Implications for practice

Journal article


Stein, M. and Reynolds, F. 2020. How is carer strain related to the recovery of stroke survivors with right hemisphere dysfunction? Implications for practice. Disability and Rehabilitation. 44 (5), pp. 693-701. https://doi.org/10.1080/09638288.2020.1775311
AuthorsStein, M. and Reynolds, F.
Abstract

Aim: Right hemisphere strokes are associated with neuro-behavioural impairments including hemi-inattention, impulsiveness and anosognosia, which can impede stroke recovery and adversely affect carer health. This study explored the impact of associated impairments on carer strain and depression through a mixed methods approach.
Method: Fifty-one carer-survivor dyads were recruited from inpatient rehabilitation units and followed-up for six months. Validated measures assessed survivors’ physical and cognitive function and carers’ strain and depression levels. Survey methods captured qualitative experiences of the caring role. Data collection occurred at baseline, discharge, six weeks post-discharge and six months. Multilevel-modelling and thematic data analysis, were employed.

Results: Carer strain median scores were within normal ranges of the Caregiver Strain Index scale. Carer strain was positively linked to carer depression, number of carers’ concerns reported and survivors’ anosognosia levels. Carer strain was negatively linked to the survivors’ functional and cognitive abilities. Carers’ experiences differed qualitatively with caring concerns increasing over time.

Conclusion: Carer strain worsens with increases in significant concerns about the rehabilitation process and poor survivor functioning skills, which potentially increase risk of depression in carers. Consequently, improving right-hemisphere stroke survivors’ recovery and nurturing the carer-survivor relationship are likely to enhance overall outcomes and caring experiences.

KeywordsRehabilitation
Year2020
JournalDisability and Rehabilitation
Journal citation44 (5), pp. 693-701
PublisherTaylor & Francis
ISSN0963-8288
1464-5165
Digital Object Identifier (DOI)https://doi.org/10.1080/09638288.2020.1775311
Official URLhttps://doi.org/10.1080/09638288.2020.1775311
Publication dates
Online16 Jun 2020
Print27 Feb 2022
Publication process dates
Accepted25 May 2020
Deposited28 May 2020
Accepted author manuscript
License
Output statusPublished
References

1. National Audit Office (2010) Department of Health: progress in improving stroke care. London: HMSO.
2. Bakas T, Kroenke K, Plue L, et al. Outcomes among family caregivers of aphasic versus non-aphasic stroke survivors. Rehabil Nurs. 2006;31(1):33-42.
3. Luker J, Murray C, Lynch E, et al. Carers' experiences, needs, and preferences during inpatient stroke rehabilitation: a systematic review of qualitative studies. Archives of physical medicine and rehabilitation. 2017;98(9), 1852-1862
4. Aziz, N, Pindus D, Mullis R et al. Understanding stroke survivors’ and informal carers’ experiences of and need for primary care and community health services—a systematic review of the qualitative literature: protocol. BMJ. 2016;6(1), e009244
5. Bulley C, Shiels J, Wilkie K, et al. Carer experiences of life after stroke–a qualitative analysis. Disabil Rehabil. 2010;32(17):1406-1413.
6. Byun E, Evans L. Concept analysis of burden in caregivers of stroke survivors during the early post stroke period. Clin Nurs Res. 2015;24(5):468-486.
7. Honea N, Colao D, Somers S. Putting Evidence Into Practice: nursing assessment and interventions to reduce family caregiver strain and burden. Clin J Oncol Nurs. 2008;12(3):507-516.
8. Ellis-Hill C, Robinson J, Wiles R, et al. Going home to get on with life: patients and carers experiences of being discharged from hospital following a stroke. Disabil Rehabil. 2009;31(2):61-72
9. Legg L, Drummond A, Leonardi-Bee J, et al. Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials. Br Med J. 2007;335(7626):922.
10. Intercollegiate Stroke Working Party. National clinical guideline for stroke. 5th edition. London: Royal College of Physicians Clinical Effectiveness and Evaluation Unit 2016.
11. Le Dorze G, Signori F. Needs, barriers and facilitators experienced by spouses of people with aphasia. Disabil Rehabil. 2010;32(13):1073-1087.
12. Howe, T, Davidson B, Worrall L, et al. ‘You needed to rehab… families as well’: family members’ own goals for aphasia rehabilitation. Int J Lang Commun Dis. 2012;47(5):511-521.
13. Grawburg M, Howe T, Worrall L, et al. A qualitative investigation into third-party functioning and third-party disability in aphasia: Positive and negative experiences of family members of people with aphasia. Aphasiology 2013;27(7):828-848.
14. Greenwood N, Mackenzie A, Cloud G, et al. Informal carers of stroke survivors–factors influencing carers: a systematic review of quantitative studies. Disabil Rehabil. 2008;30(18):1329-1349.
15. Hultman M, Everson-Rose S, Tracy M, et al. Associations between characteristics of stroke survivors and caregiver depressive symptoms: a critical review. Top Stroke Rehabil. 2019;1-10.
16. Minshall C, Pascoe M, Thompson D, et al. Psychosocial interventions for stroke survivors, carers and survivor-carer dyads: a systematic review and meta-analysis. Top Stroke Rehabil. 2019;1-11
17. Cherney L. Ethical issues involving the right hemisphere stroke patient: To treat or not to treat? Top Stroke Rehabil. 2006;13(4):47-53.
18. Kortte K, Hillis A. Recent advances in the understanding of neglect and anosognosia following right hemisphere stroke. Curr Neurol Neurosci Rep. 2009;9(6):459-465.
19. Kottorp A, Ekstam L, Petersson L. Differences in awareness between persons with left and right hemispheric stroke. Scand J Occup Ther. 2013;20(1):37-44.
20. Blonder L, Langer S, Pettigrew L, et al. The effects of stroke disability on spousal caregivers. Neuro Rehabil. 2007;22(2):85-92.
21. Williams S. The impact of aphasia on marital satisfaction. Arch Phys Med Rehabil. 1993;74(4):361-367.
22. Buxbaum LJ, Ferraro M, Veramonti T, et al. Hemispatial neglect subtypes, neuroanatomy, and disability. Neurology 2004;62(5):749-756.
23. Brott T, Adams H, Olinger C, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989;20(7):864-870.
24. Prosiegel M, Böttger S, Schenk T, et al. Der erweiterte Barthel-Index (EBI)–eine neue Skala zur Erfassung von Fähigkeitsstörungen bei neurologischen Patienten. Neurol Rehabil. 1996;1:7-13.
25. Benaim C, Pérennou D, Villy J, et al. Validation of a standardized assessment of postural control in stroke patients: the postural assessment scale for stroke patients (PASS). Stroke 1999;30(9):1862-1868.
26. Golding E. MEAMS: the Middlesex Elderly Assessment of Mental State. Titchfield (Hampshire): Thames Valley Test Company 1989.
27. Cutting J. Study of Anosognosia. J Neurol Neurosurg Psychiatry. 1978;41(6):548-555.
28. Jerusalem M, Schwarzer R. Self-efficacy as a resource factor in stress appraisal processes. Self-efficacy: Thought control of action. 1992;195213.
29. Wilson B, Cockburn J, Halligan P. Behavioural inattention test. London: Thames Valley Test Company 1987.
30. Yesavage J, Sheikh J. Geriatric Depression Scale (GDS) recent evidence and development of a shorter violence. Clin Gerontol.1986;5(1-2):165-173.
31. Robinson B. Validation of a Caregiver Strain Index. J Gerontol. 1983;38(3): 344-348.
32. IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.
33. Rasbash J, Charlton C, Jones K, & Pillinger, R. (2017) Manual supplement for MLwiN Version 3.01.
34. Snijders T, Bosker J. Multilevel Analysis: An Introduction to Basic and Advanced Multilevel Modeling, second edition. London (UK): Sage Publishers; 2012
35. Blake H, Lincoln N. Factors associated with strain in co-resident spouses of patients following stroke. Clin. Rehabil. 2000;14(3):307-314.
36. Cheng J, Edwards L, Maldonado‐Molina M, et al. Real longitudinal data analysis for real people: building a good enough mixed model. Stat Med. 2010;29(4):504-520.
37. Dong Y, Peng C. Principled missing data methods for researchers. Springer Plus 2013; (2(1):222.
38. Di Monaco M, Schintu S, Dotta M, et al. Severity of unilateral spatial neglect is an independent predictor of functional outcome after acute inpatient rehabilitation in individuals with right hemispheric stroke. Arch Phys Med Rehabil. 2011;92(8):1250-1256.
39. Nijboer T, Van de Port I, Schepers V, et al. Predicting functional outcome after stroke: the influence of neglect on basic activities in daily living. Front Hum Neurosci. 2013;7(182):9-14
40. Visser-Keizer A, Jong B, Deelman B, Berg I, et al. Subjective change in emotive, cognition and behaviour after stroke: factors affecting the perception of patients and partners. J Clin Exp Neuropsychol. 2002;24(8):032-1045.
41. Twisk JW. Applied multilevel analysis: a practical guide for medical researchers. Cambridge university press; 2006
42. Gale N, Heath G, Cameron E, et al. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13(1):117.
43. Greenwood N, Pelone F, Hassenkamp A. General practice based psychosocial interventions for supporting carers of people with dementia or stroke: a systematic review. BMC family practice, 2016;17(1), 3.
44. Ostwald S, Bernal M, Cron S, et al. Stress experienced by stroke survivors and spousal caregivers during the first year after discharge from inpatient rehabilitation. Top Stroke Rehabil. 2009;16(2):93-104.
45. Jenkinson P, Preston C, Ellis S. Unawareness after stroke: A review and practical guide to understanding, assessing, and managing anosognosia for hemiplegia. J Clin Exp Neuropsychol. 2011;33(10):1079-1093.
46. Mackenzie A, Greenwood N. Positive experiences of caregiving in stroke: a systematic review. Disabil Rehabil. 2012;34 (17):1413–22.
47. Klinedinst N, Gebhardt M, Aycock D,et al. Caregiver characteristics predict stroke survivor quality of life at 4 months and 1 year. Res Nurs Health 2009;32(6):592-605.

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