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

Publication date: Available online 28 March 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): 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
ObjectiveTo evaluate the relationship between caregiver nature and availability, and rehabilitation outcomes in subacute stroke.DesignRetrospective cohort study.SettingFour community rehabilitation hospitals in Singapore.ParticipantsSubacute, first-time stroke patients (N=4,042; 48.5% men, mean age ±SD 70.12±10.4y; and 51.5% women, mean age ±SD 72.54 ±10.0y).InterventionNot applicableMain Outcome MeasuresRehabilitation effectiveness (R-effectiveness), defined as percentage of potential improvement eventually achieved with rehabilitation; and rehabilitation efficiency (R-efficiency), defined as rate of functional improvement during rehabilitation.ResultsIn 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 R-efficiency (ß -3.83, 95% confidence interval (CI) -6.99 to -0.66; P=0.018). The relationship between caregiver availability and R-effectiveness was modified by patient gender in that the negative association was significantly greater in males (ß -22.81, 95%CI -32.70 to -12.94; P<0.001) than females (ß -5.64, 95%CI -14.72 to 3.44; P=0.223). Having a FDW as a caregiver compared to spousal-caregiver was negatively associated with R-effectiveness (ß -3.95, 95%CI -6.94 to -0.95; P=0.01) and R-efficiency (ß -1.83, 95%CI -3.14 to -0.53; P=0.006). The number of potential caregivers was only significantly associated with R-effectiveness at bivariate level (P=0.006).ConclusionCaregiver 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.



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