title: Caregivers: Do They Make a Difference to Patient Recovery in Subacute Stroke?
abstract: To evaluate the relationship between caregiver nature and availability, and rehabilitation outcomes in subacute stroke.
  
  
  
  Retrospective cohort study.
  
  
  
  Four community rehabilitation hospitals.
  
  
  
  Patients with subacute, first-time stroke (N=4042; 48.5% men; mean age ± SD, 70.12±10.4y; 51.5% women; mean age ± SD, 72.54 ±10.0y).
  
  
  
  Not applicable.
  
  
  
  Rehabilitation effectiveness, defined as the percentage of potential improvement eventually achieved with rehabilitation; and rehabilitation efficiency, defined as the rate of functional improvement during rehabilitation.
  
  
  
  In our cohort, 96.7% had available caregiver(s), of which 42.0% were primarily supported by foreign domestic workers (FDWs), 25.9% by spouses, 19.3% by first-degree relatives, 7.8% by other relatives, and 5.1% by other caregivers. Using quantile regression, we found that having a caregiver was independently associated with rehabilitation efficiency (β=-3.83; 95% confidence interval [CI], -6.99 to -0.66; P=.018). The relationship between caregiver availability and rehabilitation effectiveness was modified by patient sex in that the negative association was significantly greater in men (β=-22.81; 95% CI, -32.70 to -12.94; P<.001) than women (β=-5.64; 95% CI, -14.72 to 3.44; P=.223). Having a FDW as a caregiver compared with a spousal caregiver was negatively associated with rehabilitation effectiveness (β=-3.95; 95% CI, -6.94 to -0.95; P=.01) and rehabilitation efficiency (β=-1.83; 95% CI, -3.14 to -0.53; P=.006). The number of potential caregivers was only significantly associated with rehabilitation effectiveness at the bivariate level (P=.006).
  
  
  
  Caregiver identity, and possibly availability, appears to negatively affect rehabilitation outcomes in subacute stroke. A better understanding of these relationships has potential implications on clinical practice and policy directions.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
authors.forename: Peck-Hoon
authors.initials: PH
authors.lastname: Ong
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
authors.forename: Bee-Choo
authors.initials: BC
authors.lastname: Tai
authors.affiliation: Singapore Institute of Technology, Singapore.
authors.forename: Wai-Pong
authors.initials: WP
authors.lastname: Wong
authors.affiliation: Singhealth Internal Medicine Residency, Singapore.
authors.forename: Liang En
authors.initials: LE
authors.lastname: Wee
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chen
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
authors.forename: Angela
authors.initials: A
authors.lastname: Cheong
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
authors.forename: Ngan Phoon
authors.initials: NP
authors.lastname: Fong
authors.affiliation: Ang Mo Kio Thye Hua Kwan Hospital, Singapore.
authors.forename: Kin Ming
authors.initials: KM
authors.lastname: Chan
authors.affiliation: St Luke's Hospital, Singapore.
authors.forename: Boon Yeow
authors.initials: BY
authors.lastname: Tan
authors.affiliation: St Andrew's Community Hospital, Singapore.
authors.forename: Edward
authors.initials: E
authors.lastname: Menon
authors.affiliation: Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore.
authors.forename: Kok Keng
authors.initials: KK
authors.lastname: Lee
authors.affiliation: Elder Care & Health Consultancy, Singapore.
authors.forename: Chye Hua
authors.initials: CH
authors.lastname: Ee
authors.affiliation: Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Petrella
authors.affiliation: Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
authors.forename: Amardeep
authors.initials: A
authors.lastname: Thind
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore. Electronic address: Gerald_Koh@nuhs.edu.sg.
authors.forename: Gerald Choon-Huat
authors.initials: GC
authors.lastname: Koh
mesh_terms: D000368:Aged; D017028:Caregivers; D015331:Cohort Studies; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012737:Sex Factors; D012846:Singapore; D018454:Spouses; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
keywords: Caregivers; Rehabilitation; Stroke