Measuring the capacity of families to provide unpaid support for a disabled family member: using BIGSTEPS to identify primary and secondary dimensions.
The Principal Components subroutine of the BIGSTEPS computer program (Rasch analysis) was used to identify primary and secondary dimensions within an item set composed of variables pertaining to family capacity to provide assistance to a family member with disability. Data were obtained through interviews with family caregivers of patients in a major rehabilitation hospital, both during patients' inpatient rehabilitation stay and 3 and 6 months after inpatient discharge. Rasch analysis revealed the primary dimension within these data to be family capacity to provide unpaid instrumental help (18 items) and the strongest secondary dimension to be stressors on the caregivers as assessed during the inpatient stay (5-11 items). A scale consisting of the caregiver stressor items significantly predicted patients' functional gain at 3 months after discharge from inpatient rehabilitation (r = -.21) and at 6 months (r = -.20), and also the number of days that the patient had spent in a nursing facility as of 6 months after discharge (r = +.17). Caregiver stress, burnout, and quality of life at 3 months and 6 months were also significantly predicted. These findings strongly suggest the importance of more definitive research into family stressors that affect long-term patient outcomes.
Kessler Medical Rehabilitation Research and Education Corporation, West Orange, NJ, USA.
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Wood
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Johnston
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D017281:Cost of Illness; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005163:Factor Analysis, Statistical; D005190:Family / Q000523:psychology*; D005260:Female; D006701:Home Nursing / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D009716:Numerical Analysis, Computer-Assisted; D010351:Patient Discharge; D011237:Predictive Value of Tests; D012047:Rehabilitation Centers; D012944:Social Support; D012984:Software; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology; D011795:Surveys and Questionnaires; D016526:Workload