Dyadic approach to supervised community rehabilitation participation in an Asian setting post-stroke: exploring the role of caregiver and patient characteristics in a prospective cohort study.
Date
2020-04-23
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Abstract
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To study the association of caregiver factors and stroke survivor factors with supervised community rehabilitation (SCR) participation over the first 3 months and subsequent 3 to 12 months post-stroke in an Asian setting.Design
Prospective cohort study.Setting
Community setting.Participants
We recruited stroke survivors and their caregivers into our yearlong cohort. Caregiver and stroke survivor variables were collected over 3-monthly intervals. We performed logistic regression with the outcome variable being SCR participation post-stroke.Outcome measures
SCR participation over the first 3 months and subsequent 3 to 12 months post-stroke RESULTS: 251 stroke survivor-caregiver dyads were available for the current analysis. The mean age of caregivers was 50.1 years, with the majority being female, married and co-residing with the stroke survivor. There were 61%, 28%, 4% and 7% of spousal, adult-child, sibling and other caregivers. The odds of SCR participation decreased by about 15% for every unit increase in caregiver-reported stroke survivor's disruptive behaviour score (OR: 0.845; 95% CI: 0.769 to 0.929). For every 1-unit increase in the caregiver's positive management strategy score, the odds of using SCR service increased by about 4% (OR: 1.039; 95% CI: 1.011 to 1.068).Conclusion
We established that SCR participation is jointly determined by both caregiver and stroke survivor factors, with factors varying over the early and late post-stroke period. Our results support the adoption of a dyadic or more inclusive approach for studying the utilisation of community rehabilitation services, giving due consideration to both the stroke survivors and their caregivers. Adopting a stroke survivor-caregiver dyadic approach in practice settings should include promotion of positive care management strategies, comprehensive caregiving training including both physical and behavioural dimensions, active engagement of caregivers in rehabilitation journey and conducting regular caregiver needs assessments in the community.Type
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Tyagi, Shilpa, Gerald Choon-Huat Koh, Nan Luo, Kelvin Bryan Tan, Helen Hoenig, David Bruce Matchar, Joanne Yoong, Angelique Chan, et al. (2020). Dyadic approach to supervised community rehabilitation participation in an Asian setting post-stroke: exploring the role of caregiver and patient characteristics in a prospective cohort study. BMJ open, 10(4). p. e036631. 10.1136/bmjopen-2019-036631 Retrieved from https://hdl.handle.net/10161/22769.
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Helen Marie Hoenig
- General Focus and Goals of Research: Dr. Hoenig's research career centered on geriatric rehabilitation, and included use of technology to ameliorate disability, improving access to care via telerehabilitation, and developing key conceptual models to guide rehabilitation practices. She led work diverse novel approaches to care across the Veterans Health System, including the development and implementation of the VA Spinal Cord Injury & Disorders Registry and the Asynchronous Telehealth My VA Images mobile app. Dr. Hoenig has been involved in global health research on telerehabilitation, community mobility and global rehabilitation needs. Currently, Dr. Hoenig is enrolled in the Hybrid mDiv Program at Duke Divinity School to explore the interface of science, art and theology.
- Specific Approaches or Techniques: Randomized controlled trials, large database analyses and survey research. Her clinical research included studies on rehabilitation intervention studies (e.g., provision of mobility aids) and novel ways to improve access to rehabilitation (e.g., group physical therapy, telerehabilitation). Epidemiological studies and survey research have examined factors exacerbating or ameliorating disability, including medical complications such as fractures, environmental factors, use of assistive technology, and daily activity participation. Her research has ranged from single and multisite studies, to nationwide epidemiological studies, and global health research.
- Special areas of expertise/national recognition: Rehabilitation health services research, geriatric rehabilitation, assistive technology outcomes, telerehabilitation.
KEY WORDS/PHRASES: Rehabilitation, Telehealth, Geriatrics, Disability. Art, Theology
David Bruce Matchar
My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention.
Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analysis and cost-effectiveness analysis; (2) a balancing of methodological rigor the needs of medical professionals; and (3) dependence on interdisciplinary groups of experts.
This approach is best illustrated by the Stroke Prevention Patient Outcome Research Team (PORT), for which I served as principal investigator. Funded by the AHCPR, the PORT involved 35 investigators at 13 institutions. The Stroke PORT has been highly productive and has led to a stroke prevention project funded as a public/private partnership by the AHCPR and DuPont Pharma, the Managing Anticoagulation Services Trial (MAST). MAST is a practice improvement trial in 6 managed care organizations, focussing on optimizing anticoagulation for individuals with atrial fibrillation.
I serve as consultant in the general area of analytic strategies for clinical policy development, as well as for specific projects related to stroke (e.g., acute stroke treatment, management of atrial fibrillation, and use of carotid endarterectomy.) I have worked with AHCPR (now AHRQ), ACP, AHA, AAN, Robert Wood Johnson Foundation, NSA, WHO, and several pharmaceutical companies.
Key Words: clinical policy, disease management, stroke, decision analysis, clinical guidelines
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