The combined impact of dependency on caregivers, disability, and coping strategy on quality of life after ischemic stroke

Dewilde, Sarah; Annemans, Lieven; Lloyd, Andrew; Peeters, André; Hemelsoet, Dimitri; Vandermeeren, Yves; Desfontaines, Philippe; Brouns, Raf; Vanhooren, Geert; Cras, Patrick; Michielsens, B.; Redondo, Patrícia; Thijs, Vincent

doi:10.1186/s12955-018-1069-6

Cited by 29 publications

(22 citation statements)

References 48 publications

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“…Only studies that reported the sample size in addition to the mean and SD or SE of the mean for each mRS score and utility weights at each mRS score were included in the meta-analysis. Nine studies 13,16,25,36,37,[43][44][45]47 using the EQ-5D (n = 9607), 5 studies 31,[38][39][40]48 using the SIS (n = 777), and 1 study each using the SF-36-PF (n = 278), 27 SF-36-SF (n = 278), 27 World Health Organization Global Burden of Disease Project (n = 54), 28 Statistically significant differences were observed between the mean utility weights by mRS score for all health utility scales evaluated (Figure 2). For studies using an EQ-5D-weighted mRS score, between-study variance was higher for worse (mRS 2-5) compared with better (mRS 0-1)…”

Section: Resultsmentioning

confidence: 99%

Health Utility Weighting of the Modified Rankin Scale

Rebchuk

O’Neill

Szefer³

et al. 2020

JAMA Netw Open

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IMPORTANCE The utility-weighted modified Rankin Scale (UW-mRS) has been proposed as a patient-centered alternative primary outcome for stroke clinical trials. However, to date, there is no clear consensus on an approach to weighting the mRS. OBJECTIVE To characterize the between-study variability in utility weighting of the mRS in a population of patients who experienced stroke and its implications when applied to the results of a clinical trial. DATA SOURCES In this systematic review and meta-analysis, MEDLINE, Embase, and PsycINFO were searched from January 1987 through May 2019 using major search terms for stroke, health utility, and mRS. STUDY SELECTION Original research articles published in English were reviewed. Included were studies with participants 18 years or older with ischemic or hemorrhagic stroke, transient ischemic attack, or subarachnoid hemorrhage, with mRS scores and utility weights evaluated concurrently. A total of 5725 unique articles were identified. Of these, 283 met criteria for full-text review, and 24 were included in the meta-analysis. DATA EXTRACTION AND SYNTHESIS PRISMA guidelines for systematic review were followed. Data extraction was performed independently by multiple researchers. Data were pooled using mixed models. MAIN OUTCOMES AND MEASURES The mean utility weights and 95% CIs were calculated for each mRS score and health utility scale. Geographic differences in weighting for the EuroQoL 5-dimension (EQ-5D) and Stroke Impact Scale-based UW-mRS were explored using inverse variance-weighted linear models. The results of 18 major acute stroke trials cited in current guidelines were then reanalyzed using the UW-mRS weighting scales identified in the systematic review. RESULTS The meta-analysis included 22 389 individuals; the mean (SD) age of participants was 65.9 (4.0) years, and the mean (SD) proportion of male participants was 58.2% (7.5%). For all health utility scales evaluated, statistically significant differences were observed between the mean utility weights by mRS score. For studies using an EQ-5D-weighted mRS, between-study variance was higher for worse (mRS 2-5) compared with better (mRS 0-1) scores. Of the 18 major acute stroke trials with reanalyzed results, 3 had an unstable outcome when using different UW-mRSs. CONCLUSIONS AND RELEVANCE Multiple factors, including cohort-specific characteristics and health utility scale selection, can influence mRS utility weighting. If the UW-mRS is selected as a primary outcome, the approach to weighting may alter the results of a clinical trial. Researchers using (continued) Key Points Question Is a preexisting health utilityweighted outcome scale suitable for use in a clinical trial, or is a study-specific approach more appropriate? Findings Among 24 studies including 22 389 individuals, this systematic review and meta-analysis found statistically significant between-study differences for studies reporting utility weighting of the modified Rankin Scale. When applied to the results of major acute stroke trials, different studysp...

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Section: Resultsmentioning

confidence: 99%

Health Utility Weighting of the Modified Rankin Scale

Rebchuk

O’Neill

Szefer³

et al. 2020

JAMA Netw Open

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“…23 In another study by Dewilde et al, it was found that patients' QOL after a stroke is dictated by their disability, level of dependence on caregivers, and coping strategy. 24 The added obligation of taking care of a disabled stroke survivor along with adjusting their own lifestyle with financial apprehensions, worry about future, prolonged hours of care, and stress are major factors that increase the burden of the caregivers. Several other studies have published similar results.…”

Section: Discussionmentioning

confidence: 99%

“… 23 In another study by Dewilde et al, it was found that patients' QOL after a stroke is dictated by their disability, level of dependence on caregivers, and coping strategy. 24 …”

Section: Discussionmentioning

confidence: 99%

Impact of Stroke on Quality of Life of Stroke Survivors and Their Caregivers: A Qualitative Study from India

Tiwari¹,

Joshi

Rai

et al. 2021

JNRP

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Objectives Stroke is a significant global public health challenge attributable to an array of disabilities it causes alongside an impairment in cognition. The monetary impact of stroke care includes acute treatment expenses as well as outrageous expenses of postdischarge chronic hospital care and rehabilitation services. The current study aimed to study the perceptions along with experiences of stroke survivors and caregivers. Materials and Methods In-depth interviews (IDIs) of stroke survivors and their primary caregivers were conducted at their home 2 months after their discharge from the hospital in Bhopal, India. These IDIs were later analyzed. Results The following eight themes emerged: pervasive and irreversible, multifunction loss and dependency, holistic impact on the health of person and family, money and matter, nonaccommodative cost and baffled belief, professional paralysis, social crisis, and slow and obscured progress. The added obligation of taking care of a disabled stroke survivor along with adjusting their own lifestyle with financial apprehensions, worry about future, prolonged hours of care, and stress are major factors that increase the burden of the caregivers. Conclusion Caregivers should be sensitized with proper counseling and training through health care institutions to ensure appropriate care and management of stroke survivors at home, as it will also help in addressing their psychosocial needs, and minimizing the knowledge gap, doubts and uncertainties about the disease and its aftereffects.

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“…Ischemic stroke, accounting for approximately 80% of all strokes, is one of the major causes of disability [ 1 , 2 ]. Even when stroke symptoms are stabilized, stroke survivors’ daily lives are still seriously affected [ 3 ]. The goal of stroke rehabilitation is to help patients restore physical and mental functions, and relearn the necessary skills to live everyday life.…”

Section: Introductionmentioning

confidence: 99%

Effect of Buyang Huanwu decoction for the rehabilitation of ischemic stroke patients: a meta-analysis of randomized controlled trials

Gao

Xiao

Jia

et al. 2021

Health Qual Life Outcomes

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Purpose Buyang Huanwu decoction (BHD) is a widely used traditional Chinese medicine for the rehabilitation of ischemic stroke patients in China, but its clinical efficacy and safety have not been adequately assessed. In this paper, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of BHD. Methods We searched seven electronic databases from inception to 31 March 2019. The language was limited to Chinese and English. Randomized controlled trials evaluating the efficacy and safety of BHD for the rehabilitation of ischemic stroke patients were included in the meta-analysis. Reviewers independently performed the screening, data extraction, bias assessment, and data analysis. The treatment efficacy was pooled in a meta-analysis using RevMan 5.3 software with a random-effect model. Any disagreement was resolved by discussion among all reviewers. The PRISMA statement was used in the review process. Results A total of 11 studies with 1084 patients were included in the meta-analysis. The results suggested that BHD was superior to other treatments in terms of clinical efficacy in symptoms and daily activities (n = 684, RR = 1.12, 95% CI: 0.99 to 1.27), clinical efficacy in TCM symptoms (n = 280, RR = 1.45, 95% CI: 1.03 to 2.03), National Institute of Health stroke scale (n = 192, MD = 1.66, 95% CI: -1.08 to 4.40), and activities of daily living (n = 200, MD = 8.20, 95% CI: -3.95 to 20.35). Conclusions The results supported the clinical use of BHD for the rehabilitation of ischemic stroke patients. However, the methodological qualities of the included studies were relatively low, and there were limited reports on adverse events. The clinical efficacy and safety of BHD need to be further confirmed by more well-designed and high-quality randomized controlled trials to warrant the clinical recommendation of BHD for the rehabilitation of ischemic stroke patients.

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The combined impact of dependency on caregivers, disability, and coping strategy on quality of life after ischemic stroke

Cited by 29 publications

References 48 publications

Health Utility Weighting of the Modified Rankin Scale

Health Utility Weighting of the Modified Rankin Scale

Impact of Stroke on Quality of Life of Stroke Survivors and Their Caregivers: A Qualitative Study from India

Effect of Buyang Huanwu decoction for the rehabilitation of ischemic stroke patients: a meta-analysis of randomized controlled trials

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