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
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Article info
Publication history
Published online: March 28, 2017
Footnotes
Supported by a National University of Singapore (NUS) Start-Up Grant, NUS Provost Matching Grant (R-186-000-076-133), and NUS Academic Research Fund (R-186-000-085-112).
Funding sources had no role and involvement in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
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- Commentary on “Rehabilitation Outcomes Associated With Foreign Domestic Workers as Caregivers”Archives of Physical Medicine and RehabilitationVol. 98Issue 9
- PreviewThe 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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