Advertisement

Effects of Home-Based Supportive Care on Improvements in Physical Function and Depressive Symptoms in Patients With Stroke: A Meta-Analysis

Published:April 18, 2017DOI:https://doi.org/10.1016/j.apmr.2017.03.014

      Abstract

      Objective

      To examine the effects of home-based supportive care on improvements in physical function and depressive symptoms in home-dwelling patients after stroke.

      Data Sources

      Seven electronic databases (eg, MEDLINE, PubMed, CINAL, EMBASE, the Cochrane Central Register of Controlled Trials, ProQuest, and Google Scholar) and 4 Chinese databases (eg, WANFANG MED ONLINE, Chinese Electronic Periodical Services, China Academic Journals Full-text Database, and National Central Library) were fully searched for all relevant articles up to June 25, 2016.

      Study Selection

      Randomized controlled trials examining the effects of home-based supportive care on physical function and depressive symptoms in home-dwelling patients after stroke were included. Finally, 16 articles in Chinese (n=4) and English (n=12) met the inclusion criteria.

      Data Extraction

      Data on patient characteristics, study characteristics, intervention details, and outcome were extracted. Two reviewers independently extracted data and assessed methodological quality using the Cochrane risk of bias tool.

      Data Synthesis

      Home-based supportive care had a small size effect on physical function (Hedges' g=.17; 95% confidence interval, .09–.26) and a moderate size effect on depressive symptoms (Hedges' g=−.44; 95% confidence interval, −.83 to −.05) in home-dwelling patients after stroke. The moderator analysis revealed that some components of study participants and intervention programs improved the effects on physical function and depressive symptoms; however, no significant moderators were further identified to have superiorly improved physical function and depressive symptoms.

      Conclusions

      Regular performance of home-based supportive interventions should be considered for inclusion as routine care for managing and improving physical function and depressive symptoms in home-dwelling patients after stroke. The present findings provide further evidence with which to design appropriate supportive interventions for home-dwelling stroke survivors.

      Keywords

      List of abbreviations:

      CI (confidence interval), DL (DerSimonian-Laird), RCT (randomized controlled trial)
      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

      1. World Heart Federation. The burden of stroke. 2016. Available at: http://www.world-heart-federation.org/cardiovascular-health/stroke/. Accessed May 29, 2017.

        • Ostwald S.K.
        • Davis S.
        • Hersch G.
        • Kelley C.
        • Godwin K.M.
        Evidence-based educational guidelines for stroke survivors after discharge home.
        J Neurosci Nurs. 2008; 40 (191): 173-179
        • Coombs U.E.
        Spousal caregiving for stroke survivors.
        J Neurosci Nurs. 2007; 39: 112-119
        • O'Connell B.
        • Hanna B.
        • Penney W.
        • Pearce J.
        • Owen M.
        • Warelow P.
        Recovery after stroke: a qualitative perspective.
        J Qual Clin Pract. 2001; 21: 120-125
        • Carod-Artal F.J.
        Determining quality of life in stroke survivors.
        Expert Rev Pharmacoecon Outcomes Res. 2012; 12: 199-211
        • Jullamate P.
        • de Azeredo Z.
        • Paul C.
        • Subgranon R.
        Thai stroke patient caregivers: who they are and what they need.
        Cerebrovasc Dis. 2006; 21: 128-133
        • Shi Y.Z.
        • Xiang Y.T.
        • Yang Y.
        • et al.
        Depression after minor stroke: the association with disability and quality of life—a 1-year follow-up study.
        Int J Geriatr Psychiatry. 2016; 31: 421-427
      2. Salinas J, Beiser A, Himali JJ, Rosand J, Seshadri S, Dunn EC. Factors associated with new-onset depression after stroke. J Neuropsychiatry Clin Neurosci. 2016 Apr 8. [Epub ahead of print].

        • Martinsen R.
        • Kirkevold M.
        • Sveen U.
        Young and midlife stroke survivors' experiences with the health services and long-term follow-up needs.
        J Neurosci Nurs. 2015; 47: 27-35
        • MacIsaac L.
        • Harrison M.B.
        • Godfrey C.
        Supportive care needs of caregivers of individuals following stroke: a synopsis of research.
        Can J Neurosci Nurs. 2010; 32: 39-46
        • Friedland J.F.
        • McColl M.
        Social support intervention after stroke: results of a randomized trial.
        Arch Phys Med Rehabil. 1992; 73: 573-581
        • Langford C.P.
        • Bowsher J.
        • Maloney J.P.
        • Lillis P.P.
        Social support: a conceptual analysis.
        J Adv Nurs. 1997; 25: 95-100
        • Clarke P.
        • Marshall V.
        • Black S.E.
        • Colantonio A.
        Well-being after stroke in Canadian seniors: findings from the Canadian Study of Health and Aging.
        Stroke. 2002; 33: 1016-1021
        • Sit J.W.
        • Wong T.K.
        • Clinton M.
        • Li L.S.
        • Fong Y.M.
        Stroke care in the home: the impact of social support on the general health of family caregivers.
        J Clin Nurs. 2004; 13: 816-824
        • 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
        • Torp C.R.
        • Vinkler S.
        • Pedersen K.D.
        • et al.
        Model of hospital-supported discharge after stroke.
        Stroke. 2006; 37: 1514-1520
        • Mayo N.E.
        • Wood-Dauphinee S.
        • Cote R.
        • et al.
        There's no place like home: an evaluation of early supported discharge for stroke.
        Stroke. 2000; 31: 1016-1023
        • Aslund C.
        • Larm P.
        • Starrin B.
        • Nilsson K.W.
        The buffering effect of tangible social support on financial stress: influence on psychological well-being and psychosomatic symptoms in a large sample of the adult general population.
        Int J Equity Health. 2014; 13: 85
        • Arnberg F.K.
        • Hultman C.M.
        • Michel P.O.
        • Lundin T.
        Social support moderates posttraumatic stress and general distress after disaster.
        J Trauma Stress. 2012; 25: 721-727
        • Lipman A.
        • Longino J.C.F.
        Formal and informal support: a conceptual clarification.
        J Appl Gerontol. 1982; 1: 141-146
        • Lord J.
        • Hutchison P.
        The process of empowerment: implications for theory and practice.
        Can J Commun Ment Health. 1993; 12: 5-22
        • Smith J.
        • Forster A.
        • Young J.
        A randomized trial to evaluate an education programme for patients and carers after stroke.
        Clin Rehabil. 2004; 18: 726-736
        • Folden S.L.
        Effect of a supportive-educative nursing intervention on older adults' perceptions of self-care after a stroke.
        Rehabil Nurs. 1993; 18: 162-167
        • Clark M.S.
        • Rubenach S.
        • Winsor A.
        A randomized controlled trial of an education and counselling intervention for families after stroke.
        Clin Rehabil. 2003; 17: 703-712
        • Mant J.
        • Carter J.
        • Wade D.T.
        • Winner S.
        Family support for stroke: a randomised controlled trial.
        Lancet. 2000; 356: 808-813
        • Zhang Q.
        • Li J.N.
        • Luo S.B.
        The effect evaluation of the family rehabilitation nursing intervention on the patients with stroke.
        Int J Nurs. 2012; 31: 56-57
        • Boter H.
        Multicenter randomized controlled trial of an outreach nursing support program for recently discharged stroke patients.
        Stroke. 2004; 35: 2867-2872
        • Tilling K.
        • Coshall C.
        • McKevitt C.
        • Daneski K.
        • Wolfe C.
        A family support organiser for stroke patients and their carers: a randomised controlled trial.
        Cerebrovasc Dis. 2005; 20: 85-91
        • Dennis M.
        • O'Rourke S.
        • Slattery J.
        • Staniforth T.
        • Warlow C.
        Evaluation of a stroke family care worker: results of a randomised controlled trial.
        BMJ. 1997; 314 (discussion 6-7): 1071-1076
        • Chang T.H.
        • Li I.C.
        The effect of social support intervention on home-bound stroke patients' physical and mental health in the Ilan area.
        J Nurs Res. 2000; 8: 423-434
        • Shamseer L.
        • Moher D.
        • Clarke M.
        • et al.
        Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015: elaboration and explanation.
        BMJ. 2015; 349: g7647
        • Wan X.
        • Wang W.
        • Liu J.
        • Tong T.
        Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range.
        BMC Med Res Methodol. 2014; 14: 135
        • Bagos P.G.
        Meta-analysis in Stata using gllamm.
        Res Synth Methods. 2015; 6: 310-332
        • Kontopantelis E.
        • Reeves D.
        Performance of statistical methods for meta-analysis when true study effects are non-normally distributed: a simulation study.
        StatMethods Med Res. 2012; 21: 409-426
        • Cohen J.
        A power primer.
        Psychol Bull. 1992; 112: 155-159
        • Huedo-Medina T.B.
        • Sanchez-Meca J.
        • Marin-Martinez F.
        • Botella J.
        Assessing heterogeneity in meta-analysis: Q statistic or I2 index?.
        Psychol Methods. 2006; 11: 193-206
        • Song F.
        • Sheldon T.A.
        • Sutton A.J.
        • Abrams K.R.
        • Jones D.R.
        Methods for exploring heterogeneity in meta-analysis.
        Eval Health Prof. 2001; 24: 126-151
        • Orwin R.G.
        A fail-safe N for effect size in meta-analysis.
        J Educ Behav Stat. 1983; 8: 157-159
        • Duval S.
        • Tweedie R.
        Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.
        Biometrics. 2000; 56: 455-463
        • Andersen H.E.
        • Eriksen K.
        • Brown A.
        • Schultz-Larsen K.
        • Forchhammer B.H.
        Follow-up services for stroke survivors after hospital discharge–a randomized control study.
        Clin Rehabil. 2002; 16: 593-603
        • Forster A.
        • Young J.
        Specialist nurse support for patients with stroke in the community: a randomised controlled trial.
        BMJ. 1996; 312: 1642-1646
        • Glass T.A.
        • Berkman L.F.
        • Hiltunen E.F.
        • et al.
        The Families In Recovery From Stroke Trial (FIRST): primary study results.
        Psychosom Med. 2004; 66: 889-897
        • Jonsson A.C.
        • Hoglund P.
        • Brizzi M.
        • Pessah-Rasmussen H.
        Secondary prevention and health promotion after stroke: can it be enhanced?.
        J Stroke Cerebrovasc Dis. 2014; 23: 2287-2295
        • Lincoln N.B.
        • Francis V.M.
        • Lilley S.A.
        • Sharma J.C.
        • Summerfield M.
        Evaluation of a stroke family support organiser: a randomized controlled trial.
        Stroke. 2003; 34: 116-121
        • Markle-Reid M.
        • Orridge C.
        • Weir R.
        • et al.
        Interprofessional stroke rehabilitation for stroke survivors using home care. “The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques”.
        Can J Neurol Sci. 2011; 38: 317-334
        • Ostwald S.K.
        • Godwin K.M.
        • Cron S.G.
        • Kelley C.P.
        • Hersch G.
        • Davis S.
        Home-based psychoeducational and mailed information programs for stroke-caregiving dyads post-discharge: a randomized trial.
        Disabil Rehabil. 2014; 36: 55-62
        • Wang A.H.
        • Xu G.H.
        • Wu Q.D.
        • Liu Y.X.
        • Ge X.R.
        Influence of comprehensive nursing intervention on quality of life and activity of daily living in community patients with convalescent stroke.
        China Journal of Practice Nursing. 2010; 26: 11-14
        • Wong F.K.
        • Yeung S.M.
        Effects of a 4-week transitional care programme for discharged stroke survivors in Hong Kong: a randomised controlled trial.
        Health & social care in the community. 2015; 23: 619-631
        • Ontario H.
        In-home care for optimizing chronic disease management in the community: an evidence-based analysis.
        Ont Health Technol Assess Ser. 2013; 13: 1-65
        • Salter K.
        • Foley N.
        • Teasell R.
        Social support interventions and mood status post stroke: a review.
        Int J Nurs Stud. 2010; 47: 616-625
        • Karube N.
        • Sasaki A.
        • Hondoh F.
        • et al.
        Quality of life in physical and psychological health and social environment at posthospitalization period in patients with stroke.
        J Stroke Cerebrovasc Dis. 2016; 25: 2482-2487
        • Suresh K.
        An overview of randomization techniques: an unbiased assessment of outcome in clinical research.
        J Hum Reprod Sci. 2011; 4: 8-11
        • Bilge C.
        • Kocer E.
        • Kocer A.
        • Turk Boru U.
        Depression and functional outcome after stroke: the effect of antidepressant therapy on functional recovery.
        Eur J Phys Rehabil Med. 2008; 44: 13-18
        • Huang H.C.
        • Huang L.K.
        • Hu C.J.
        • et al.
        The mediating effect of psychological distress on functional dependence in stroke patients.
        J Clin Nurs. 2014; 23: 3533-3543
        • Ouimet M.A.
        • Primeau F.
        • Cole M.G.
        Psychosocial risk factors in poststroke depression: a systematic review.
        Can J Psychiatry. 2001; 46: 819-828
        • Mutai H.
        • Furukawa T.
        • Araki K.
        • Misawa K.
        • Hanihara T.
        Long-term outcome in stroke survivors after discharge from a convalescent rehabilitation ward.
        Psychiatry Clin Neurosci. 2013; 67: 434-440
        • Park J.H.
        • Ovbiagele B.
        Neurologic symptom severity after a recent noncardioembolic stroke and recurrent vascular risk.
        J Stroke Cerebrovasc Dis. 2015; 24: 1032-1037
        • Schulz K.F.
        • Chalmers I.
        • Hayes R.J.
        • Altman D.G.
        Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials.
        JAMA. 1995; 273: 408-412
        • Savovic J.
        • Jones H.E.
        • Altman D.G.
        • et al.
        Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials.
        Ann Intern Med. 2012; 157: 429-438