Advertisement

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

Published:March 28, 2017DOI:https://doi.org/10.1016/j.apmr.2017.02.021

      Abstract

      Objective

      To evaluate the relationship between caregiver nature and availability, and rehabilitation outcomes in subacute stroke.

      Design

      Retrospective cohort study.

      Setting

      Four community rehabilitation hospitals.

      Participants

      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).

      Interventions

      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.

      Results

      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).

      Conclusions

      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.

      Keywords

      List of abbreviations:

      ADL (activities of daily living), CI (confidence interval), FDW (foreign domestic worker), mBI (modified Barthel Index)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Murray C.J.
        • Vos T.
        • Lozano R.
        • et al.
        Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.
        Lancet. 2013; 380: 2197-2223
        • Glass T.A.
        • Matchar D.B.
        • Belyea M.
        • Feussner J.R.
        Impact of social support on outcome in first stroke.
        Stroke. 1993; 24: 64-70
        • Tsouna-Hadjis E.
        • Vemmos K.N.
        • Zakopoulos N.
        • Stamatelopoulos S.
        First-stroke recovery process: the role of family social support.
        Arch Phys Med Rehabil. 2000; 81: 881-887
        • Lynch E.B.
        • Butt Z.
        • Heinemann A.
        • et al.
        A qualitative study of quality of life after stroke: the importance of social relationships.
        J Rehabil Med. 2008; 40: 518-523
        • Glass T.A.
        • Maddox G.L.
        The quality and quantity of social support: stroke recovery as psycho-social transition.
        Soc Sci Med. 1992; 34: 1249-1261
        • Ong P.H.
        • Koh G.C.
        Caregiver factors in stroke: are they the missing piece of the puzzle?.
        Arch Phys Med Rehabil. 2016; 97: 1223-1225
        • Harris J.E.
        • Eng J.J.
        • Miller W.C.
        • Dawson A.S.
        The role of caregiver involvement in upper-limb treatment in individuals with subacute stroke.
        Phys Ther. 2010; 90: 1302-1310
        • Koh G.C.
        • Chen C.
        • Cheong A.
        • et al.
        Trade-offs between effectiveness and efficiency in stroke rehabilitation.
        Int J Stroke. 2012; 7: 606-614
        • Koh G.C.
        • Lim D.Y.
        • Zhang S.L.
        • et al.
        Predictors of participation in supervised therapy by post-stroke patients in the Singapore community: a one-year cohort study.
        Singapore Family Physician. 2015; 41: 63-74
        • Ahn D.H.
        • Lee Y.J.
        • Jeong J.H.
        • Kim Y.R.
        • Park J.B.
        The effect of post-stroke depression on rehabilitation outcome and the impact of caregiver type as a factor of post-stroke depression.
        Ann Rehabil Med. 2015; 39: 74-80
        • Hinojosa M.S.
        • Rittman M.
        • Hinojosa R.
        • Rodriguez W.
        Racial/ethnic variation in recovery of motor function in stroke survivors: role of informal caregivers.
        J Rehabil Res Dev. 2009; 46: 223-232
        • Fong N.
        • Wong P.
        • Lau-Ting C.
        • Devathasan G.
        • Chong P.
        Disability, rehabilitation and after-care of stroke patients after discharge from hospital, Singapore 1983-84.
        Ann Acad Med Singapore. 1987; 16: 122-127
        • Ireland P.R.
        Female migrant domestic workers in Southern Europe and the levant: towards an expanded Mediterranean model?.
        Mediterr Polit. 2011; 16: 343-363
        • Kvist E.
        Changing social organizations of care: a comparison of European policy reforms encouraging paid domestic work.
        Eur J Ageing. 2012; 9: 111-117
        • Koh G.
        • Wee L.
        • Rizvi N.
        • et al.
        Socio-demographic and clinical profile of admissions to community hospitals in Singapore from 1996 to 2005: a descriptive study.
        Ann Acad Med Singapore. 2012; 41: 494-510
        • Yeoh B.S.
        • Huang S.
        Foreign domestic workers and home-based care for elders in Singapore.
        J Aging Soc Policy. 2010; 22: 69-88
        • Degiuli F.
        A job with no boundaries: home eldercare work in Italy.
        European Journal of Women's Studies. 2007; 14: 193-207
        • Cangiano A.
        • Shutes I.
        • Spencer S.
        • Leeson G.
        Migrant care workers in ageing societies: research findings in the United Kingdom.
        ESRC Centre on Migration, Policy and Society, Oxford2009
        • Iecovich E.
        What makes migrant live-in home care workers in elder care be satisfied with their job?.
        Gerontologist. 2011; 51: 617-629
        • Ostbye T.
        • Malhotra R.
        • Malhotra C.
        • Arambepola C.
        • Chan A.
        Does support from foreign domestic workers decrease the negative impact of informal caregiving? Results from Singapore survey on informal caregiving.
        J Gerontol B Psychol Sci Soc Sci. 2013; 68: 609-621
        • Chin C.W.
        • Phua K.H.
        Long-term care policy: Singapore's experience.
        J Aging Soc Policy. 2016; 28: 113-129
        • Thom T.J.
        Stroke mortality trends an international perspective.
        Ann Epidemiol. 1993; 3: 509-518
        • Zhang X.
        • Patel A.
        • Horibe H.
        • et al.
        Cholesterol, coronary heart disease, and stroke in the Asia Pacific region.
        Int J Epidemiol. 2003; 32: 563-572
        • Jørgensen H.
        • Nakayama H.
        • Raaschou H.
        • Vive-Larsen J.
        • Støier M.
        • Olsen T.
        Outcome and time course of recovery in stroke. Part II: Time course of recovery. The Copenhagen Stroke Study.
        Arch Phys Med Rehabil. 1995; 76: 406-412
        • Koh G.C.
        Functional recovery and caregiver support of stroke patients admitted for rehabilitation in Singapore community hospitals (1996 to 2005) [thesis].
        School of Graduate and Postdoctoral Studies, The University of Western Ontario London, London, Ontario2012
        • Sacco R.L.
        • Kasner S.E.
        • Broderick J.P.
        • et al.
        An updated definition of stroke for the 21st century a statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2013; 44: 2064-2089
        • Dewey H.
        • Thrift A.
        • Mihalopoulos C.
        • et al.
        Informal care for stroke survivors: results from the North East Melbourne Stroke Incidence Study (NEMESIS).
        Stroke. 2002; 33: 1028-1033
        • Koh G.C.
        • Chen C.H.
        • Petrella R.
        • Thind A.
        Rehabilitation impact indices and their independent predictors: a systematic review.
        BMJ Open. 2013; 3: e003483
        • Shah S.
        • Vanclay F.
        • Cooper B.
        Improving the sensitivity of the Barthel Index for stroke rehabilitation.
        J Clin Epidemiol. 1989; 42: 703-709
        • Ministry of Health
        Healthcare services for the Elderly. An information booklet for healthcare professionals.
        Ministry of Health, Singapore2004
        • Ministry of Health
        Hospitalisation and day surgery.
        (Available at:) (Accessed October 20, 2016)
        • Heinemann A.
        • Roth E.
        • Cichowski K.
        • Betts H.
        Multivariate analysis of improvement in outcome following stroke rehabilitation.
        Arch Neurol. 1987; 44: 1167-1172
        • Shah S.
        • Vanclay F.
        • Cooper B.
        Efficiency, effectiveness, and duration of stroke rehabilitation.
        Stroke. 1990; 21: 241-246
        • Gialanella B.
        • Monguzzi V.
        • Santoro R.
        • Rocchi S.
        Functional recovery after hemiplegia in patients with neglect: the rehabilitative role of anosognosia.
        Stroke. 2005; 36: 2687-2690
        • Platz T.
        • van-Kaick S.
        • Mehrholz J.
        • Leidner O.
        • Eickhof C.
        • Pohl M.
        Best conventional therapy versus modular impairment-oriented training for arm paresis after stroke: a single-blind, multicenter randomized controlled trial.
        Neurorehabil Neural Repair. 2009; 23: 706-716
        • Rothman K.J.
        Dealing with biases. Epidemiology: an introduction.
        2nd ed. Oxford University Press, New York2012: 124-147
        • Kwakkel G.
        • Wagenaar R.C.
        • Kollen B.J.
        • Lankhorst G.J.
        Predicting disability in stroke–a critical review of the literature.
        Age Ageing. 1996; 25: 479-489
        • Thompson S.
        • Galbraith M.
        • Thomas C.
        • Swan J.
        • Vrungos S.
        Caregivers of stroke patient family members: behavioral and attitudinal indicators of overprotective care.
        Psychol Health. 2002; 17: 297-312
        • Kaplan R.M.
        • Toshima M.T.
        The functional effects of social relationships on chronic illnesses and disability.
        in: Sarason B.R. Sarason I.G. Pierce G.R. Social support: an interactional view. John Wiley & Sons, Oxford1990: 427-453
        • Ng Y.
        • Jung H.
        • Tay S.
        • Bok C.
        • Chiong Y.
        • Lim P.
        Results from a prospective acute inpatient rehabilitation database: clinical characteristics and functional outcomes using the Functional Independence Measure.
        Ann Acad Med Singapore. 2007; 36: 3-10
        • Omu O.
        • Reynolds F.
        Health professionals' perceptions of cultural influences on stroke experiences and rehabilitation in Kuwait.
        Disabil Rehabil. 2012; 34: 119-127
        • Agency for Integrated Care
        Introduction to foreign domestic worker (FDW) grant.
        (Available at:) (Accessed April 14, 2017)
        • Agency for Integrated Care
        Introduction to foreign domestic worker (FDW) levy concession for persons with disabilities.
        (Available at:) (Accessed April 14, 2017)
        • Mak A.
        • Mackenzie A.
        • Lui M.
        Changing needs of Chinese family caregivers of stroke survivors.
        J Clin Nurs. 2007; 16: 971-979
        • Ku L.
        • Liu L.
        • Wen M.
        Trends and determinants of informal and formal caregiving in the community for disabled elderly people in Taiwan.
        Arch Gerontol Geriatr. 2013; 56: 370-376
        • Romero B.A.
        Towards a model of externalisation and denationalisation of care? The role of female migrant care workers for dependent older people in Spain.
        Eur J Soc Work. 2012; 15: 45-61
        • Hobson B.
        • Hellgren Z.
        • Bede L.
        How institutional contexts matter: migration and domestic care services and the capabilities of migrants in Spain and Sweden.
        (Available at:) (Accessed December 30, 2015)
        • Devasahayam T.W.
        Organisations that care: the necessity for an eldercare leave scheme for caregivers of the elderly in Singapore.
        (Available at:) (Accessed May 28, 2016)
        • Duff J.
        Financing to foster community health care: a comparative analysis of Singapore, Europe, North America and Australia.
        Curr Sociol. 2001; 49: 135-154
        • Colombo F.
        • Llena-Nozal A.
        • Mercier J.
        • Tjadens F.
        Policies to support family carers. In: Help wanted? Providing and paying for long-term care. OECD Publishing, Paris2011
        • Goy P.
        Working caregivers need more support from employers: NTUC U Family survey. Straits Times. October 5, 2013.
        (Available at:) (Accessed April 12, 2015)

      Linked Article

      • Commentary on “Rehabilitation Outcomes Associated With Foreign Domestic Workers as Caregivers”
        Archives of Physical Medicine and RehabilitationVol. 98Issue 9
        • Preview
          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.
        • Full-Text
        • PDF