Caregiver-mediated intervention can improve physical functional recovery of patients with chronic stroke: a randomized controlled trial.
Background and Purpose. Patients with chronic stroke may benefit from continuing rehabilitation training after hospital discharge. This study examined whether caregiver-mediated, home-based intervention (CHI) could improve physical functioning and social participation in these patients. Methods. A single-blind, randomized, controlled 12-week trial conducted with 51 patients from 3 hospitals in Taiwan who had chronic stroke (>6 months; Brunnstrom recovery stages III-V). Patients and their caregivers in the intervention arm (n = 25) were given weekly personalized CHI trainings designed by a physical therapist. Patients in the control arm (n = 26) received visits from the therapist without intervention. All were evaluated for physical recovery through the Stroke Impact Scale, Berg Balance Scale, 10-Meter Walk Test, 6-Minute Walk Test, and Barthel Index at baseline and endpoint. Caregivers were evaluated with the Caregiver Burden Scale. Results were analyzed through Mann-Whitney U test. Results. CHI significantly improved scores of the Stroke Impact Scale: strength (control vs intervention, respectively: 1.4 vs 15.5; P = .002), mobility (-0.5 vs 13.7; P < .001), composite physical (-0.7 vs 11.2; P < .001), and general recovery domain (0.2 vs 17.4; P < .001). CHI also significantly improved free-walking velocity (-1.4 vs 7.5 cm/s; P = .006), 6-minute walk distance (-10.5 vs 15.8 m; P = .003), Berg Balance Scale score (-0.8 vs 4.5; P = .006), and Barthel Index score (0.6 vs 7.2; P = .008). CHI did not significantly increase caregiver burden at endpoint. Conclusion. CHI can improve physical functional recovery and, possibly, social participation in patients with chronic stroke.
Department of Healthcare Administration, Asia University, Taichung, Taiwan Department of Physical Therapy, Tzu Hui Institute of Technology, Pingtung, Taiwan.
Tzu-Chi
TC
Wang
Department of Healthcare Administration, Asia University, Taichung, Taiwan Department of Health Services Management, School of Public Health, China Medical University, Taichung, Taiwan atsai@umich.edu.
Alan C
AC
Tsai
Department of Healthcare Administration, Asia University, Taichung, Taiwan.
Jiun-Yi
JY
Wang
Section of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Yu-Te
YT
Lin
Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Ko-Long
KL
Lin
Department of Rehabilitation, Kaohsiung Municipal Min-sheng Hospital, Kaohsiung, Taiwan.
Jiun Jiang
JJ
Chen
Department of Rehabilitation, Yuan's General Hospital, Kaohsiung, Taiwan.
Bei Yi
BY
Lin
Department of Rehabilitation, St Joseph Hospital, Kaohsiung, Taiwan.
Tai Ching
TC
Lin
D000203:Activities of Daily Living; D000368:Aged; D017028:Caregivers; D002908:Chronic Disease; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D020127:Recovery of Function / Q000502:physiology*; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D020521:Stroke / Q000451:nursing* / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013624:Taiwan; D016138:Walking / Q000502:physiology
caregiver; chronic stroke; functional recovery; home-based rehabilitation; rehabilitation; stroke