Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis.
BACKGROUND
Many patients experience depression, social isolation and anxiety post stroke. These are associated with a poorer outcome. Ameliorating these problems may improve patient wellbeing.


OBJECTIVE
To evaluate the impact of a healthcare worker or volunteer whose multi-dimensional roles have been grouped under the title 'stroke liaison worker'.


METHODS
We searched the Cochrane Stroke Group Trials Register (searched February 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to 2009), EMBASE (1980 to 2009) and four other databases. We performed a cited reference search, searched conference proceedings and trials registers, checked reference lists and contacted authors and trial investigators.


METHODS
Randomised controlled trials investigating the impact of a stroke liaison worker versus usual care.


METHODS
We invited trialists to participate in a review of individual patient data. Primary outcomes for patients were subjective health status and extended activities of daily living. Primary outcomes for carers were subjective health status including measures of carer strain.


RESULTS
We included 16 trials involving 4759 participants. Analysis did not show a significant overall difference for subjective health status (standardised mean difference (SMD) -0.03, 95% confidence interval (CI) -0.11 to 0.04, P = 0.34) or extended activities of daily living (SMD 0.04, 95% CI -0.03 to 0.11, P = 0.22). There was no overall significant effect for the outcome of carer subjective health status (SMD 0.04, 95% CI -0.05 to 0.14, P = 0.37). Patients with mild to moderate disability (Barthel 15 to 19) had a significant reduction in dependence (odds ratio (OR) 0.62, 95% CI 0.44 to 0.87, P = 0.006). This would equate to 10 fewer dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker. Similar results were seen for the outcome of death or dependence for the subgroup with Barthel 15 to 19 (OR 0.55, 95% CI 0.38 to 0.81, P = 0.002). This risk difference equates to 11 fewer dead or dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker.


CONCLUSIONS
There is no evidence for the effectiveness of this multifaceted intervention in improving outcomes for all groups of patients or carers. Patients with mild to moderate disability benefit from a reduction in death and disability. Patients and carers do report improved satisfaction with some aspects of service provision.
Ellis
Graham
G
Medicine for the Elderly, Monklands Hospital, Monkscourt Avenue, Airdrie, Scotland, UK, ML6 0JS.
Mant
Jonathan
J
Langhorne
Peter
P
Dennis
Martin
M
Winner
Simon
S
D000203:Activities of Daily Living; D000328:Adult; D001007:Anxiety / Q000517:prevention & control; D017028:Caregivers / Q000523:psychology*; D003376:Counseling; D003863:Depression / Q000517:prevention & control; D006304:Health Status; D006801:Humans; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic; D012934:Social Isolation / Q000523:psychology; D012944:Social Support; D012947:Social Work; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation; D014838:Volunteers
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