Educating Caregivers to Reduce Complications and Improve Outcomes of Stroke Patients (ECCOS) – A Cluster-Randomized Trial

Radhakrishna, Patta; Bhatia, Rohit; Shakywar, Maneesh; Gupta, Akash; Sreenivas, Vishnubhatla; Srivastava, M. V. Padma; Tripathi, Manjari; Singh, Mamta Bhushan; Singh, Rajesh; Y, Vishnu V.; Rajan, Roopa; Gupta, Anu; Aggarwal, Rajeev; Prasad, Kameshwar

doi:10.1016/j.jstrokecerebrovasdis.2021.105966

Cited by 2 publications

(2 citation statements)

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“…Strengthening caregiver knowledge and empowering them to assist during inpatient care is extremely relevant to LMICs due to shortage of nursing manpower. 36 This is an untapped strategy that leads to poor knowledge transfer that may affect patient outcomes, especially once discharged to home. 34,35 One of the important components of the IMPETUS project is to enhance caregiver knowledge using training strategies for patient care.…”

Section: Discussionmentioning

confidence: 99%

IMPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India

Salunkhe

Haldar

Bhatia

et al. 2023

International Journal of Stroke

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Background: India accounts for 13.3% of global disability-adjusted life years (DALYs) lost due to stroke with a relatively younger age of onset compared to the Western population. In India’s public healthcare system, many stroke patients seek care at tertiary-level government-funded medical colleges where an optimal level of stroke care is expected. However, there are no studies from India that have assessed the quality of stroke care, including infrastructure, imaging facilities, or the availability of stroke care units in medical colleges. Aim: This study aimed to understand the existing protocols and management of acute stroke care across 22 medical colleges in India, as part of the baseline assessment of the ongoing IMPETUS stroke study. Methods: A semi-structured quantitative pre-tested questionnaire, developed based on review of literature and expert discussion, was mailed to 22 participating sites of the IMPETUS stroke study. The questionnaire assessed comprehensively all components of stroke care, including human resources, emergency system, in-hospital care, and secondary prevention. A descriptive analysis of their status was undertaken. Results: In the emergency services, limited stroke helpline numbers, 3/22 (14%); prenotification system, 5/22 (23%); and stroke-trained physicians were available, 6/22 (27%). One-third of hospitals did not have on-call neurologists. Although non-contrast computed tomography (NCCT) was always available, 39% of hospitals were not doing computed tomography (CT) angiography and 13/22 (59%) were not doing magnetic resonance imaging (MRI) after routine working hours. Intravenous thrombolysis was being done in 20/22 (91%) hospitals, but 36% of hospitals did not provide it free of cost. Endovascular therapy was available only in 6/22 (27%) hospitals. The study highlighted the scarcity of multidisciplinary stroke teams, 8/22 (36%), and stroke units, 7/22 (32%). Lifesaving surgeries like hematoma evacuation, 11/22 (50%), and decompressive craniectomy, 9/22 (41%), were performed in limited numbers. The availability of occupational therapists, speech therapists, and cognitive rehabilitation was minimal. Conclusion: This study highlighted the current status of acute stroke management in publicly funded tertiary care hospitals. Lack of prenotification, limited number of stroke-trained physicians and neurosurgeons, relatively lesser provision of free thrombolytic agents, limited stroke units, and lack of rehabilitation services are areas needing urgent attention by policymakers and creation of sustainable education models for uniform stroke care by medical professionals across the country.

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Section: Discussionmentioning

confidence: 99%

IMPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India

Salunkhe

Haldar

Bhatia

et al. 2023

International Journal of Stroke

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“…39 A nurse-led education session for caregivers of people who had recently had a stroke was associated with reduced caregiver strain at time of discharge; 40 however, another study of in-hospital education for stroke caregivers found no significant difference in patient outcomes. 41 A hospital-based stroke education program that incorporated an in-home follow-up session resulted in improved caregiver and patient QoL and mood at 3 and 12 months as well as reduced health care costs. 42 In PD, a 9-week outpatient educational program for caregivers which incorporated psychoeducational sessions, when compared to an educational program without these sessions, showed improvements for both patients and caregivers in psychosocial adjustment and for caregivers in coping skills.…”

Section: Discussionmentioning

confidence: 99%

Multiple System Atrophy Caregivers’ Experience: A Mixed Methods Study

Langford

Zhou

2021

Can. J. Neurol. Sci.

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Background: Multiple system atrophy (MSA) is a rare Parkinson-plus syndrome with rapid progression and a high symptom burden. The experience of caregivers of people with MSA has not been closely examined. We therefore sought to document the impact of MSA on caregivers using a mixed methods approach. Methods: Patients and caregivers were recruited from a movement disorders program in Edmonton, Canada. Participants completed the following survey instruments based on their own or their loved one’s symptoms: 36-Item Short-Form Health Survey (SF-36), Multiple System Atrophy health-related Quality of Life scale (MSA-QoL), and Hospital Anxiety and Depression Scale (HADS). Caregivers also completed the Zarit Burden Interview and HADS based on their own experience. Qualitative data were obtained through semi-structured interviews. Results: Nine people with MSA (PwMSA) (age range: 48–78 years) and 11 caregivers (49–76 years) participated. All completed surveys; 7 PwMSA and 10 caregivers were interviewed. Eight PwMSA had the parkinsonian type of MSA (MSA-P) and one a mixed type. Caregivers had on average mild-moderate caregiver burden and mild anxiety. Caregiver burden and anxiety were correlated. Qualitative subthemes under the caregiving theme included keeping the patient safe, caregivers’ own health, and communication symptoms cause frustration. The rapid progression of illness was bewildering to caregivers and increased their workload. Public home care services were invaluable to caregivers’ maintaining their loved ones at home. Caregivers were inventive in finding sources of hope and quality of life for their loved ones. Conclusion: Publicly funded home care was essential for caregivers of PwMSA in this study. Caregiver support is needed to provide this unrecognized workforce with information and resources to face this challenging condition.

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Educating Caregivers to Reduce Complications and Improve Outcomes of Stroke Patients (ECCOS) – A Cluster-Randomized Trial

Cited by 2 publications

References 21 publications

IMPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India

IMPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India

Multiple System Atrophy Caregivers’ Experience: A Mixed Methods Study

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