Feasibility of the Hand in Hand Relationship Intervention for Stroke Survivor–Caregiver Dyads: A Randomized Trial

Abstract

Purpose: A strong interpersonal relationship after stroke is important for the prevention of depression in survivors and family caregivers. This study aimed to test the feasibility of quality of relationship intervention for stroke dyads called Hand in Hand (HiH). Methods: Sixteen dyads were randomized into either the HiH group ( n = 8) or information, support, and referral (ISR) control group ( n = 8). HiH dyads received up to eight sessions, with topics prioritized according to a 17-item screening tool. ISR dyads received up to eight sessions that included information, active listening, and referrals. Feasibility, acceptability, and outcomes data were collected for both groups. Results: The HiH and ISR groups were feasible and acceptable. Caregivers in both groups, as well as survivors in the ISR group, experienced improvements in depressive symptoms and other select outcomes. Conclusions: Findings suggest that HiH is feasible to implement with stroke dyads and that it merits further refinement and testing.

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 Survivor depression and anxiety were measured using a variety of measures including the Hospital Anxiety and Depression Scale, 25,28,29 Patient-Reported Outcomes Measurement Information System Depression Short Form 8b, 35 Patient Health Questionnaire, 31 Zung Self-rating Anxiety Scale, 28 and Zung Self-Rating Depression Scale. 28 Several studies used the Connor Davidson Resilience Scale, 35 General Self-Efficacy Scale, 29 Cognitive and Affective Mindfulness Scale-Revised, 29 Post Traumatic Stress Disorder Checklist Civilian Version for stress symptom severity, 29 and Measure of Current Status Part A.…”

“…32 Several studies addressed the stroke survivor's social functioning, dyadic interactions, and the quality of relationship with the caregiver and used the Social Relationships Index, 35 Active Engagement Communication Scale, 31 Protective Buffering Communication Scale, 31 McMaster Family Assessment Device General Functioning Subscale, 31 Patient Expectations Scale, 31 Perceived Criticism Scale, 31 Communication in Marriage Questionnaire, 33 Intimate Bond Measure, 29 Dyadic Adjustment Scale, 34 Mutuality Scale, 31 and the Relationship Assessment Scale. 31 Several studies measured survivor satisfaction with the Client Satisfaction Questionnaire 29 or investigator designed or adapted acceptability measures. 31,35 Most studies provided detailed descriptions of psychometric properties of instruments chosen to measure survivor outcomes, but only a few reported internal consistency or other psychometric data using their current sample.…”

“…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 ).…”

“…28 Several studies used the Connor Davidson Resilience Scale, 35 General Self-Efficacy Scale, 29 Cognitive and Affective Mindfulness Scale-Revised, 29 Post Traumatic Stress Disorder Checklist Civilian Version for stress symptom severity, 29 and Measure of Current Status Part A. 29 Two studies used the Stroke Impact Scale, 31,35 and 1 used the Stroke Specific Quality of Life Scale. 20 Other studies measured survivor quality of life using the European Quality of Life EuroQol, 25 Older People's Quality of Life Questionnaire, 35 and the Satisfaction with Life Scale.…”