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

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.

journal_name

Arch Phys Med Rehabil

journal_title

Archives of physical medicine and rehabilitation

authors

Ong PH,Tai BC,Wong WP,Wee LE,Chen C,Cheong A,Fong NP,Chan KM,Tan BY,Menon E,Lee KK,Ee CH,Petrella R,Thind A,Koh GC

doi

10.1016/j.apmr.2017.02.021

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

2009-2020

issue

eissn

0003-9993

issn

1532-821X

pii

S0003-9993(17)30179-X

journal_volume

pub_type

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