title: Information provision for stroke patients and their caregivers.
abstract: BACKGROUND
  Research shows that stroke patients and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues.
  
  
  OBJECTIVE
  To assess the effectiveness of information provision strategies in improving the outcome for stroke patients or their identified caregivers, or both.
  
  
  METHODS
  For this update we searched the Cochrane Stroke Group Trials Register (June 2012), the Cochrane Central Register of Controlled trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the NHS Economic Evaluation Database (EED), and the Health Technology Assessment (HTA) Database (The Cochrane Library June, 2012), MEDLINE (1966 to June 2012), EMBASE (1980 to June 2012), CINAHL (1982 to June 2012) and PsycINFO (1974 to June 2012). We also searched ongoing trials registers, scanned bibliographies of relevant articles and books and contacted researchers.
  
  
  METHODS
  Randomised trials involving patients or carers of patients with a clinical diagnosis of stroke or transient ischaemic attack (TIA) where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone.
  
  
  METHODS
  Two review authors independently assessed trial eligibility and methodological quality and extracted data. Primary outcomes were knowledge about stroke and stroke services, and impact on mood.
  
  
  RESULTS
  We have added four new trials to this update. This review now includes 21 trials involving 2289 patient and 1290 carer participants. Nine trials evaluated a passive and 12 trials an active information intervention. Meta-analyses showed a significant effect in favour of the intervention on patient knowledge (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.12 to 0.46, P < 0.001), carer knowledge (SMD 0.74, 95% CI 0.06 to 1.43, P = 0.03), one aspect of patient satisfaction (odds ratio (OR) 2.07, 95% CI 1.33 to 3.23, P = 0.001), and patient depression scores (mean difference (MD) -0.52, 95% CI -0.93 to -0.10, P = 0.01). There was no significant effect (P > 0.05) on number of cases of anxiety or depression in patients, carer mood or satisfaction, or death. Qualitative analyses found no strong evidence of an effect on other outcomes. Post-hoc subgroup analyses showed that active information had a significantly greater effect than passive information on patient mood but not on other outcomes.
  
  
  CONCLUSIONS
  There is evidence that information improves patient and carer knowledge of stroke, aspects of patient satisfaction, and reduces patient depression scores. However, the reduction in depression scores was small and may not be clinically significant. Although the best way to provide information is still unclear there is some evidence that strategies that actively involve patients and carers and include planned follow-up for clarification and reinforcement have a greater effect on patient mood.
authors.affiliation: Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK. a.forster@leeds.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Forster
authors.forename: Lesley
authors.initials: L
authors.lastname: Brown
authors.forename: Jane
authors.initials: J
authors.lastname: Smith
authors.forename: Allan
authors.initials: A
authors.lastname: House
authors.forename: Peter
authors.initials: P
authors.lastname: Knapp
authors.forename: John J
authors.initials: JJ
authors.lastname: Wright
authors.forename: John
authors.initials: J
authors.lastname: Young
mesh_terms: D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000534:rehabilitation*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D002546:Ischemic Attack, Transient / Q000523:psychology*; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000523:psychology*