Effect of a telephone and web-based problem-solving intervention for stroke caregivers on stroke patient activities of daily living: A randomized controlled trial

Abstract

Objective To test for effects of a problem-solving intervention for stroke caregivers on stroke survivor activities of daily living. Design Two-arm parallel randomized clinical trial with repeated measures at 11 weeks and 19 weeks. Setting Medical centers for US military Veterans. Subjects Caregivers of stroke survivors. Intervention A registered nurse guided caregivers in using problem-solving strategies emphasizing creative thinking, optimism, planning, and expert information to address challenges associated with caregiving. Caregivers in the intervention completed one telephone orientation session followed by eight online, asynchronous messaging center sessions. The messaging center sessions involved (a) education on the Resources and Education for Stroke Caregivers’ Understanding and Empowerment website ( https://www.stroke.cindrr.research.va.gov/en/ ), (b) supportive communication between the nurse and caregiver, (c) nurse and caregiver interactions to improve problem-solving, and (d) maintain adherence to discharge planning instructions. Main Outcome The Barthel Index was used to measure activities of daily living. Results 174 participants (standard care n = 88, intervention n = 86) were enrolled at baseline. There were no significant differences between groups at baseline. Change scores in activities of daily living between baseline and 11 weeks were significantly higher in the intervention group than the standard care group (group difference = 6.43, 95% confidence interval: 1.28, 11.58). Group differences in change scores between baseline and 19 weeks were not statistically significant (group difference = 3.89, 95% confidence interval: −3.58, 11.36). Conclusions This web-based caregiver intervention improved stroke survivor activities of daily living by 11 weeks, but intervention effects were undetectable after 19 weeks.

Home-based educational interventions for family caregivers of older adults after stroke: a scoping review

“…When analyzing the information of the articles, in relation to the year of publication, it was identified that it covered between 2006 and 2020. Moreover, four studies were carried out in the United States (44%) (26)(27)(28)(29) two in Brazil (22%) (30,31) and one in China, the United Kingdom and Egypt (11%) (17,32,33) , respectively. Likewise, 88.8% of studies were articles (17,(26)(27)(28)(29)(31)(32)(33) and 11.1% were a thesis (30) .…”

“…Moreover, four studies were carried out in the United States (44%) (26)(27)(28)(29) two in Brazil (22%) (30,31) and one in China, the United Kingdom and Egypt (11%) (17,32,33) , respectively. Likewise, 88.8% of studies were articles (17,(26)(27)(28)(29)(31)(32)(33) and 11.1% were a thesis (30) .…”

“…Of the nine studies analyzed, 44.4% had as their main objective to carry out theoretical/practical educational interventions (26,(30)(31)(32) ; 33.6% were interventions with a theoretical approach (17,28,29) ; and 22.4% were educational interventions for guidance and support (27,33) .…”

“…In terms of methodological design, seven (77.7%) were Randomized Clinical Trials (RCT) (17,27,(29)(30)(31)(32)(33) and in two (22.3%) the methodological design was not identified. However, the type of intervention performed was described, and the results are presented (26,28) .…”

“…Of the previous interventions, only the studies (17,31) reported significant changes in the psychological-social domains and social relationships and autonomy, respectively, which attribute the changes to the intervention carried out. It should be noted that the problem-solving study ( 29 ) , published in 2023, only found a significant change in activities of daily living of survivors after 11 weeks of application of the intervention. An important finding is that participants report that it is necessary to reinforce the information in follow-up sessions to strengthen and/or improve practical care skills (27,29) .…”