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

Peck-Hoon Ong; Bee-Choo Tai; Wai-Pong Wong; Liang En Wee; Cynthia Chen; Angela Cheong; Ngan Phoon Fong; Kin Ming Chan; Boon Yeow Tan; Edward Menon; Kok Keng Lee; Chye Hua Ee; Robert Petrella; Amardeep Thind; Gerald Choon-Huat Koh

doi:10.1016/j.apmr.2017.02.021

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

Arch Phys Med Rehabil. 2017 Oct;98(10):2009-2020. doi: 10.1016/j.apmr.2017.02.021. Epub 2017 Mar 28.

Authors

Affiliations

¹ Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
² Singapore Institute of Technology, Singapore.
³ Singhealth Internal Medicine Residency, Singapore.
⁴ Ang Mo Kio Thye Hua Kwan Hospital, Singapore.
⁵ St Luke's Hospital, Singapore.
⁶ St Andrew's Community Hospital, Singapore.
⁷ Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore.
⁸ Elder Care & Health Consultancy, Singapore.
⁹ Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada.
¹⁰ Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
¹¹ Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore. Electronic address: Gerald_Koh@nuhs.edu.sg.

PMID: 28363700
DOI: 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: Caregivers; Rehabilitation; Stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Caregivers*
Cohort Studies
Family
Female
Humans
Male
Retrospective Studies
Sex Factors
Singapore
Spouses
Stroke Rehabilitation*
Treatment Outcome