A comprehensive assessment of family caregivers of stroke survivors during inpatient rehabilitation

Young, Mary Ellen; Lutz, Barbara; Creasy, Kerry Rae; Cox, Kim J.; Martz, Crystal

doi:10.3109/09638288.2014.881565

Cited by 61 publications

(66 citation statements)

References 47 publications

(61 reference statements)

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“…To help therapists unfamiliar with PACT assist partners in their decisions as to whether to engage in training, the current study developed an interview format which will provide the partners with clearer information about the interactive nature of conversations and the support available in the future. This additional initiative was in line with the ideas of Young et al [50], who have argued for a comprehensive assessment of partners and/or family caregivers in order to better prepare them for their task ahead.…”

mentioning

confidence: 54%

ImPACT: a multifaceted implementation for conversation partner training in aphasia in Dutch rehabilitation settings

Wielaert

Sandt-Koenderman

Dammers

et al. 2016

Disability and Rehabilitation

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ImPACT: a multifaceted implementation for conversation partner training in aphasia inDutch rehabilitation settings. AbstractPurpose: Exploration of the clinical uptake of a novel conversation partner training (CPT) programme in aphasia in ten Dutch rehabilitation facilities and identification of its perceived facilitators and barriers in service providers, and the evaluation of the implementation methods used. Method:Ten rehabilitation centres took part in a multifaceted implementation of conversation partner training over thirteen months. Each centre selected two speech and language therapists to act as knowledge brokers whose role it was to raise awareness of CPT in the team and to facilitate getting partners of people with aphasia into the programme. The implementation was evaluated using analysis of recruitment data and questionnaires, supplemented by consensus data and scrutiny of implementation plans.Results: Successful implementation was described as 1) four dyads included during the intervention period, 2) two more dyads included after the intervention period, before the end of the study and 3) inclusion of Partners of Aphasic Clients Conversation Training (PACT) in a description of the logistics of local stroke care (stroke care pathway). Seven centres were successful in reaching the target inclusion of 6 dyads in total. Only one centre had care pathways in place. From a recruitment pool of 504 dyads, 41 dyads were recruited and 34 partners completed the implementation of PACT study (ImPACT). Observed facilitators included the motivation to engage partners in the rehabilitation process and the perceived added value of PACT. The perceived barriers focused on time limitations within current systems to discuss the consequences of PACT with relevant professionals and to establish allocated time for PACT within existing care routines. Conclusions:The motivation of professionals to involve partners in the rehabilitation process assisted with the introduction of PACT in practice. The main barrier was time, linked to the requirement to think through integration of this innovation within existing care. Longer term evaluation would ascertain how centres sustain uptake without support.

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mentioning

confidence: 54%

ImPACT: a multifaceted implementation for conversation partner training in aphasia in Dutch rehabilitation settings

Wielaert

Sandt-Koenderman

Dammers

et al. 2016

Disability and Rehabilitation

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“…King & Semik [8] found that the most difficult times for most caregivers were during hospitalization and the first few months post-discharge. This finding underscores the need for early caregiver assessment followed by individualized caregiver interventions during these critical time periods following stroke [19, 27, 28]. Results in Creasy et al’s [16] study showed it was important to caregivers that information about stroke was presented in a timely fashion and was applicable to the person with stroke, and also that health care providers emphasized the importance of this information to the caregivers.…”

Section: Discussionmentioning

confidence: 89%

“…The checklist assesses needs in five main categories: 1) information about stroke; 2) managing survivor’s emotions and behaviors; 3) providing physical care; 4) providing instrumental care; and 5) addressing personal responses to caregiving. Other studies in this context [15, 19, 23–26] have identified similar unmet caregiver needs regarding stroke education and knowledge, managing survivor emotions and behaviors, providing physical care, and dealing with the impact of caregiving on their own lives.…”

mentioning

confidence: 86%

“…Because the caregiver is primarily perceived as a resource for and providing assistance to the person with stroke, rather than someone who also needs support, caregiver needs are often overlooked [19]. Not only do caregivers experience unmet needs regarding the care of the person with stroke, but they also experience personal problems as they adapt to the many changes in their lives as a result of providing care [3, 10, 20, 21].…”

mentioning

confidence: 99%

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Tracking patterns of needs during a telephone follow-up programme for family caregivers of persons with stroke

Bakas

Jessup

McLennon

et al. 2015

Disability and Rehabilitation

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Purpose Programs that address stroke family caregiver needs and skill-building are recommended based on the literature and patient care guidelines for stroke rehabilitation. The purpose of this study was to explore patterns of perceived needs and skill-building during a stroke caregiver intervention program. Method Descriptive statistics were used to analyze data from 123 stroke caregivers enrolled in the intervention group of a randomized controlled clinical trial. Caregivers received 8 weekly telephone sessions, with a booster session a month later. At each session, the Caregiver Needs and Concerns Checklist (CNCC) was used to identify and prioritize current needs that were then addressed through skill-building strategies. Results Perceived needs changed over time. Information about stroke was the highest priority need during Session 1. Managing survivor emotions and behaviors was the highest priority for Sessions 2 through 4. Caregivers generally waited until Sessions 5 through 9 to address their own emotional and physical health needs. Physical and instrumental care needs were relatively low but stable across all 9 sessions. Skill-building was consistently high, though it peaked during Sessions 2 and 3. Conclusions Tracking patterns of needs and skill-building suggest appropriate timing for targeting different types of family caregiver support during stroke rehabilitation.

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“…Others have shown that social support is strongly associated with discharge destination. 7,9,17 Young and colleagues 18 also recently concluded that caregiver commitment, capacity, and preparedness are key factors in ‘long-term’ outcomes for patients with stroke following discharge from inpatient rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Social Support and Actual Versus Expected Length of Stay in Inpatient Rehabilitation Facilities

Lewis

Hay

Graham

et al. 2016

Archives of Physical Medicine and Rehabilitation

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Objectives Describe impairment-specific patterns in shorter- and longer-than-expected lengths of stay in inpatient rehabilitation and examine the independent effects of social support on deviations from expected lengths of stay. Design Retrospective cohort study. Setting Inpatient rehabilitation facilities across the United States. Participants Medicare fee-for-service beneficiaries (N=119,437) who were discharged from inpatient rehabilitation facilities in 2012 following stroke, lower extremity fracture, or lower extremity joint replacement. Intervention Not applicable. Main Outcome Measure Relative length of stay (actual – expected). The Centers for Medicare and Medicaid Services posts annual expected lengths of stay based on patients’ clinical profiles at admission. We created a 3-category outcome variable: short, expected, long. Our primary independent variable (social support) also included 3 categories: family/friends, paid/other, none. Results Mean (SD) actual lengths of stay for joint replacement, fracture, and stroke were 9.8 (3.6), 13.8 (4.5), and 15.8 (7.3) days, respectively; relative lengths of stay were −1.2 (3.1), −1.6 (3.7), and −1.7 (5.2) days. Nearly half of patients (47–48%) were discharged more than 1 day earlier than expected in all 3 groups, whereas 14% of joint replacement, 15% of fracture, and 20% of stroke patients were discharged more than 1 day later than expected. In multinomial regression analysis, using family/friends as the reference group, paid/other support was associated (p<.05) with higher odds of long stays in joint replacement. No social support was associated with lower odds of short stays in all 3 impairment groups and higher odds of long stays in fracture and joint replacement. Conclusion Inpatient rehabilitation experiences and outcomes can be substantially impacted by a patient’s level of social support. More research is needed to better understand these relationships and possible unintended consequences in terms of patient access issues and provider-level quality measures.

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A comprehensive assessment of family caregivers of stroke survivors during inpatient rehabilitation

Cited by 61 publications

References 47 publications

ImPACT: a multifaceted implementation for conversation partner training in aphasia in Dutch rehabilitation settings

ImPACT: a multifaceted implementation for conversation partner training in aphasia in Dutch rehabilitation settings

Tracking patterns of needs during a telephone follow-up programme for family caregivers of persons with stroke

Social Support and Actual Versus Expected Length of Stay in Inpatient Rehabilitation Facilities

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