Stroke Caregiver Outcomes from the Telephone Assessment and Skill-Building Kit (TASK)

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 randomized 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.

Evidence for Stroke Family Caregiver and Dyad Interventions

“…30 Fifteen of the studies involved a dyad intervention in which survivors were enrolled. Nine of the studies had samples sizes <50 caregivers, 27,35,42,44,50,52,55,58,60,62 although much can be learned from these small studies. Some reported effect sizes for a larger trial, 50,60 and others reported positive caregiver outcomes such as reduced depressive symptoms, 44,55 improved problem solving and preparedness, 44 and improved knowledge and satisfaction.…”

“…Future studies should be responsive and tailored to both the needs of the care of the survivor and the unique needs of the family caregiver. 25,27,38,40,41,[44][45][46][47][48][49][50][51][52][53][54][55][56][58][59][60][61] 17 (53.1) 4 (23.5) 16 (94) Stroke survivor-caregiver dyad 26,[28][29][30][31][32][33][35][36][37]39,42,43,57,62,63 15 ( Psycho-educational 26,29,33,37,39,42,58 7 (21.9) 6 (85.7) 6 (85.7)Skill building and psycho-educational 25,27,28...…”

“…Telephone delivery certainly has advantages in terms of cost and convenience to caregivers, and 2 studies using interventions delivered completely by telephone resulted in significant improvements in caregiver burden and competence, 49 as well as caregiver optimism, perceived task difficulty, threat, and satisfaction. 50,60 Only 2 studies tested Web-based interventions.38,55 Although the "Caring~Web" intervention of Pierce and colleagues 38 did not result in any significant caregiver improvements, benefits were found for stroke survivors, with fewer caregiver-reported emergency room visits and hospital readmissions for the survivor at 1 year. Smith and colleagues 55 tested a similar Webbased intervention that included online education and support but also included skill building (stress management, pleasant activities) that resulted in significant improvements in caregiver depression persisting up to 1 year.…”

Response Rates in a Nursing Intervention Longitudinal Study on Vulnerable Elderly Patients

“…Experimental studies examining the effects of educational interventions on quality of life or functional status in elderly people show response rates of 30.9% [5], 59.6% [6], 62.6% [7], 77.1% [8], or 99.6% [9]. However in some studies it is not comprehensible why the authors differentiate between eligible patients and patients fulfilling inclusion criteria.…”

“…Thus the sample sizes are not clear. If the authors reported reasons for nonparticipation these were refusal or decline to participate [5,6,7] or lack of consent [8].…”