Familial caregiving following stroke: findings from the comprehensive post-acute stroke services (COMPASS) pragmatic cluster-randomized transitional care study

Stroke patients discharged home often require prolonged assistance from caregivers. Little is known about the real-world effectiveness of a comprehensive stroke transitional care intervention on relieving caregiver strain. To describe the effect of the COMPASS transitional care (COMPASS-TC) interven...

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Bibliographic Details
Published in:Topics in stroke rehabilitation 2023-07, Vol.30 (5), p.436-447
Main Authors: Lutz, Barbara J., Kucharska-Newton, Anna M., Jones, Sara B., Psioda, Matthew A., Gesell, Sabina B., Coleman, Sylvia W., Johnson, Anna M., Radman, Meghan D, Levy, Samantha, Bettger, Janet Prvu, Freburger, Janet K, Chou, Aileen, Celestino, Joan, Rosamond, Wayne D., Bushnell, Cheryl D., Duncan, Pamela W.
Format: Article
Language:English
Subjects:
Aftercare
caregiver burden
comparative effectiveness research
Female
Humans
Ischemic Attack, Transient - therapy
Male
Patient Discharge
patient engagement
pragmatic clinical trial
Stroke
Stroke - therapy
Transitional Care
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Summary:Stroke patients discharged home often require prolonged assistance from caregivers. Little is known about the real-world effectiveness of a comprehensive stroke transitional care intervention on relieving caregiver strain. To describe the effect of the COMPASS transitional care (COMPASS-TC) intervention on caregiver strain and characterize the types, duration, and intensity of caregiving. The cluster-randomized COMPASS pragmatic trial evaluated the effectiveness of COMPASS-TC versus usual care with patients with mild stroke and TIA at 40 hospitals in North Carolina, USA. Of 5882 patients enrolled, 4208 (71%) identified a familial caregiver. A follow-up Caregiver Questionnaire, including the Modified Caregiver Strain Index, was administered at approximately three months post-discharge. Demographics and frequency, duration, and intensity of caregiving were compared between groups. 1228 caregivers (29%) completed the questionnaire. Completion was positively associated with older patient age, white race, and spousal relationship. One-third of the caregivers provided ≥30 hours of care per week and 889 (79%) provided care ≥9 weeks. Average standardized caregiver strain was 21.9 (0-100), increasing with stroke severity and comorbidity burden. Women caregivers reported higher strain than men. Treatment allocation was not associated with caregiver strain. This sample of mild stroke and TIA survivors received significant assistance from familial caregivers. However, caregiver strain was relatively low. Findings support the importance of familial caregiving in stroke, the continued disproportionate burden on women within the family, and the need for future research on caregiver support.
ISSN:1074-9357
1945-5119
DOI:10.1080/10749357.2022.2077520