Randomized Controlled Trial of a Comprehensive Stroke Education Program for Patients and Caregivers

Abstract

Background and Purpose-We report the findings of a randomized 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 randomized 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 inpatients 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 handicap and were secondary outcome measures. T he need for better information, in addition to greater provision of support, has been voiced by stroke patients and their informal carers. 1 Over 10 years ago, a UK Consensus Statement on the treatment of stroke recommended that stroke patients and their informal carers were entitled to "a clear account of the nature and causes of their stroke. . . and [that] more information rather than less should be given." 2 However, evidence suggests that many patients and carers continue to express a lack of understanding about stroke and its causes, secondary preventative measures, and information about both statutory and informal support. [3][4][5] Information needs of patients and informal carers in hospital and after discharge are not being met, despite the efforts of health services and voluntary agencies. 3,4,6,7 It is not unusual for patients and carers to report that they have not received any information about their illness, despite having had discussions with health professionals and being given written information. Results-OnlyThis could occur for a number of reasons: the information was not retained due to the stress of the situation, was not clear, was too complicated, was too general, or did not address the patient or carer's own issues of concern.A study of stroke patients' and carers' satisfaction with care reported that although 89% were satisfied with their overall care, 49% were dissatisfied with the information they had received while in hospital. 8 These results were mirrored in an audit undertaken at North Tyneside General Hospital in 1996, which found that although only 15% of stroke patients and carers felt dissatisfied with their care in general, 40% of stroke patients and 45% of their informal carers were dissatisfied with the information received about stroke before discharge. In light of these findings, a multidisciplinary group consisting of stroke unit staff, community nurses, and representatives from the Stroke Association and the local voluntary sector developed a Stroke Education Program (SEP) that Received July 9, 1999; final revision received September 13, 1999; accepted September 13, 1999. The aim of the present study was to determine the effectiveness of the Stroke Education Program for improving patients' and carers' perceived health status...

Caregiver strain in spouses of stroke patients

“…Knowledge, satisfaction with services and emotional outcome were secondaty measures. Although patient and carer knowledge was greater in the SEP group, there were no significant differences in health status between groups and the carers in the control group had greater social functioning than the carers in the SEP group (Rodgers et al, 1999). The literature suggests that patient and carer knowledge of cognitive problems after stroke is poor and that there is an unmet need for more information (Wellwood et al, 1994;Hangar and Mulley, 1993), in particular, specific individualised information (Wiles et al, 1998) provided in more than one way (Hangar et al, 1998).…”

“…Indeed, research has shown that providing packages of support in various forms to patients and carers can increase knowledge and satisfaction (Mant et al, 1998;Rodgers et al, 1999) and reduce caregiver strain (WaUcer et al, 1999), anxiety (Dennis et al, 1997) and psychological distress (Mant et al, 1998). The present study lends support to these findings.…”

A qualitative study exploring patients’ and carers’ experiences of Early Supported Discharge services after stroke

“…Lack of knowledge in these areas has been identified as a source of anxiety and worry, and may contribute to patient's failure to achieve their maximal potential. 17 Participants' reports question the appropriateness and effectiveness of current methods of providing information to stroke patients and carers. We need to be clear about the specific information needs of patients and their carers, and further research is needed to evaluate the most timely, appropriate, and effective ways of providing such information.…”

Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient

“…One RCT was unable to demonstrate improvements in caregiver knowledge, satisfaction, or mood after an educational program initiated within a stroke unit. 548 Two other trials found that caregiver knowledge about stroke and satisfaction improved significantly after an inpatient caregiver educational program 515,585 ; however, there were no significant improvements in caregiver emotional state, burden, or perceived health. Another study found that transitional care initiated during inpatient rehabilitation that covered information about stroke for caregivers resulted in decreased patient institutionalization and mortality but did not significantly change caregiver physical or emotional health.…”