Family-Centered Care During Constraint-Induced Therapy After Chronic Stroke: A Feasibility Study

Abstract

Purpose This feasibility study evaluated a theory-based intervention (CARE-CITE) designed to engage carepartners (CPs) in supporting stroke survivor upper extremity rehabilitation. Design The study was a one-group design with pre- and posttest and 1 month follow-up (N = 7 dyads). Methods Feasibility was determined by participant retention, CP and stroke survivor intervention adherence, and CP acceptability of the intervention (exit interview). Measures of CP depressive symptoms, fatigue, and family conflict around stroke recovery and stroke survivor upper extremity function are reported. Data were analyzed using descriptive statistics. Findings All participants completed the study and adhered to the intervention, and CPs found CARE-CITE helpful. Descriptively, better scores were observed for CP's mental health, family conflict, stroke survivor confidence, and upper extremity tasks performed. Conclusion These results provide initial evidence that CARE-CITE is feasible after chronic stroke and that CPs and stroke survivors may benefit from family-centered care. Clinical Relevance Improving CP skills in supporting rehabilitation activities may improve stroke survivor upper extremity function.

Systematic Review of the Evidence for Stroke Family Caregiver and Dyad Interventions

“…Caregiver anxiety and depression were measured in 5 studies using the Hospital Anxiety and Depression Scale. 24–26,28,29 Other anxiety and depression measures included the Center for Epidemiological Studies Depression Scale, 19,21,30 Patient-Reported Outcomes Measurement Information System-Depression Short Form 8b, 35 Patient Health Questionnaire-9, 31 Beck Depression Scale, 27 Zung Self-rating Anxiety Scale, 28 and the Zung Self-Rating Depression Scale. 28…”

“…25,32 Upper arm function was measured in 1 study by the Wolf Motor Function Test, Upper Extremity Fugl-Meyer Test, Motor Activity Log, and the Confidence in Arm and Hand Movement Scale. 30…”

“…24 Caregiver anxiety and depression were measured in 5 studies using the Hospital Anxiety and Depression Scale. [24][25][26]28,29 Other anxiety and depression measures included the Center for Epidemiological Studies Depression Scale, 19,21,30 Patient-Reported Outcomes Measurement Information System-Depression Short Form 8b, 35 Patient Health Questionnaire-9, 31 Beck Depression Scale, 27 Zung Self-rating Anxiety Scale, 28 and the Zung Self-Rating Depression Scale. 28 Several studies measured caregiver health-related quality of life using the same measures that were used for stroke survivors (ie, Older People's Quality of Life Questionnaire, 35 the Satisfaction with Life Scale, 32 and the EuroQol European Quality of Life EuroQol 24,25 ).…”

“…22,30,35 Several articles (n=5) were small feasibility studies that reported data trends, rather than testing for significance in outcomes. 25,[29][30][31]35 Samples Among the 18 studies, sample sizes ranged from a total of 7 to 349 caregivers or dyads. The study with the largest sample (N=349) involved randomizing 36 clusters to a caregiver intervention (n=175; 18 clusters) or to usual care (n=174; 18 clusters).…”

Content validity and satisfaction with a caregiver-integrated web-based rehabilitation intervention for persons with stroke

“…Preliminary work 25 from a clinic based CARE-CITE intervention in the format of a printed workbook showed improvements in stroke survivors’ task performance in addition to reductions in depressive symptoms and family conflict for caregivers. However, exit interview results indicated caregivers struggled to meet the time and travel demands of attending the sessions.…”