Caregivers: Do They Make a Difference to Patient Recovery in Subacute Stroke?

Published:March 28, 2017DOI:



      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.

      Main Outcome Measures

      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.


      List of abbreviations:

      ADL (activities of daily living), CI (confidence interval), FDW (foreign domestic worker), mBI (modified Barthel Index)
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      Linked Article

      • Commentary on “Rehabilitation Outcomes Associated With Foreign Domestic Workers as Caregivers”
        Archives of Physical Medicine and RehabilitationVol. 98Issue 9
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          The purpose of this commentary is to illuminate the role of foreign domestic workers (FDW) as caregivers for patients undergoing rehabilitation in Asia. The authors of a published study in this issue of the Archives of Physical Medicine and Rehabilitation investigate the association between the characteristics of caregivers for patients recovering from sub-acute stroke and the rehabilitation outcomes of those patients in Singapore. The investigators examined over 4,000 caregivers and one of the findings showed that after controlling for characteristics of both caregivers and patients, there was a significant and negative association between having an FDW as a caregiver, compared to a spouse, and patient rehabilitation effectiveness.
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