Home-based Psychoeducational Program for Spousal Caregivers of Stroke Patients


PRINCIPAL INVESTIGATOR:

Sharon Ostwald, PhD
E-mail: sharon.k.ostwald@uth.tmc.edu

OVERALL SNAPSHOT OF CAREGIVER INTERVENTION/PROGRAM:


The focus of this intervention was on the caregiver- stroke survivor dyad, and provided education, counseling, skill training and community referrals in joint sessions at home and/or mailed to the couple. The intervention lasted for the first year after discharge from rehabilitation. The intensive home-based intervention lasted for 6 months after discharge, hoping to take advantage of neuroplasticity and thus speed recovery.

BACKGROUND RELATED TO THE DEVELOPMENT OF THE INTERVENTION/PROGRAM:

Content in the intervention protocols were based on a review of the literature, clinical experience, pilot work and the Agency for Health Research & Quality clinical guideline on post-stroke rehabilitation.

A rehabilitation team that met on a weekly basis developed, tested and delivered the multicomponent and flexible intervention. Computer software was used to track the number of contacts, the length of each contact, as well as the specific content delivered on each visit.

TARGETED CAREGIVER POPULATION (AGE, ETHNICITY, CONDITION/DISEASE):

Spousal caregivers of survivors of stroke post-discharge from rehabilitation hospital

MANUAL OF PROCEDURES:


A detailed account of how the intervention is reported in Ostwald, S.K., Davis, S., Hersch, G., Kelley, C., Godwin, K. (2008). Evidence-Based Educational Guidelines for Stroke Survivors Following Discharge Home. Journal of Neuroscience Nursing, 40 (3), 173-179,191.

INTERVENTION/PROGRAM SPECIFIC OUTCOME MEASURES:

Health status, depression, stress, burden, coping, support, mutuality and function were obtained on all dyads.

WORKBOOK/WORKSHEETS & OTHER INTERVENTION RESOURCES:


In addition to the home-based intervention, all dyads received mailed monthly personalized letters with information on signs and symptoms of stroke, stroke prevention, stress reduction strategies, diet and exercise guidelines, links to support groups and advocacy organizations, and tips for leisure activity adaptations. Dyads also received monthly copies of Stroke Smart, a magazine published by the National Stroke Association, and birthday and anniversary cards.

LENGTH OF INTERVENTION/PROGRAM:

1 year, though intensive home-based intervention lasted for 6 months after discharge

NUMBER OF SESSIONS & LENGTH OF EACH SESSION:


On average dyads participated in 16 visits of 70 minutes each with a mean total of 36.7 hours of education per dyad.

DESCRIPTION OF SESSION CONTENT:


Dyads in the home-based intervention received home visits for first 6 months post-discharge by advance practice nurses, occupational and physical therapists, who provided information following 39 pre-determined protocols, developed to provide education, support, skill training, counseling and linkages to social and community resources.

Protocols were divided into seven categories: stroke recovery, stress of stroke, promotion of a healthy lifestyle, special problems, therapeutic skill training, coping strategies and community networks.Within each of these categories, the nurses and therapists provided specific protocols based on the needs of the dyads.

METHOD OF ADMINISTRATION/DELIVERY:

Home-based nurse visits and printed materials

TRAINING:


Intervention delivered by advance practice nurses, occupational and physical therapists. The nurses and therapists all had MS or PhD in their specialty with years of experience caring for older frail adults with disabilities and their caregivers. They also used consultants in speech therapy and physical medicine.

COST AND TIME CONSIDERATIONS:

A secondary data analysis of the costs associated with the intensive home-based intervention demonstrated that an average of two home visits a month during the initial 6 months at home post-discharge from inpatient rehabilitation could be delivered at a mean cost of $2500 per dyad.

VIDEO CLIP OF INTERVENTION/PROGRAM:


The research team produced a DVD, entitled Stroke: Conversations and Explanations. The DVD is available from Terra Nova Films, www.terranova.org

This 2 video DVD (with Educational Booklet) shows the emotional impact of stroke on the lives and relationships of 6 diverse couples, and provides useful information on the warning signs of a stroke, preventive measures, and recent developments in treatment and rehabilitative therapy.

Living After Stroke: Conversations With Couples
Six couples share their experiences on how stroke has affected their lives and their spousal relationships. These stroke survivors and spouse caregivers, in their early 40's to late 70's, candidly touch on the very real issues of intimacy, finances, fear of dependence, frustration, and the rigors of day-to-day care.

Stroke: Early Recognition and Treatment
Providing an in-depth exploration of stroke, this video identifies what a stroke is, how it affects the brain and body, and what to do in case of a stroke. Through interviews with 3 neurologists and comments from stroke survivors describing the onset of their strokes, the video gives further information on how to recognize the symptoms, and take proactive measures to reduce the likelihood of a stroke.

BRIEF DESCRIPTION OF EVIDENCE:

Survivors of stroke in the home-based group demonstrated significantly improved self-reported health and cognitive function; caregivers demonstrated significantly improved self-reported health and coping strategies.

REPRESENTATIVE PUBLICATIONS/REFERENCES:


Schulz, C. H., Wasserman, J., & Ostwald, S.K. (2006). Recruitment and retention of stroke survivors: The CAReS experience. Physical & Occupational Therapy in Geriatrics, 25(2), 17-29.

Ostwald, S.K., Wasserman, J., Davis, S. (2006). Medications, Co-morbidities & Medical Complications in Stroke Survivors: The CAReS Study. Rehabilitation Nursing, 31 (1), 14-18.

Tariah, H., Hersch, G., Ostwald, S.K. (2006). Factors Associated with Quality of Life: Perspectives of Stroke Survivors. Physical & Occupational Therapy in Geriatrics, 25 (2), 33-50. (PhD Dissertation)

Ostwald, S.K., Davis, S., Hersch, G., Kelley, C., Godwin, K. (2008). Evidence-Based Educational Guidelines for Stroke Survivors Following Discharge Home. Journal of Neuroscience Nursing, 40 (3), 173-179,191.

Ostwald, S.K., Swank, P.R., Khan, M.M. (2008) Predictors of Functional Independence and Stress Level of Stroke Survivors at Discharge from Inpatient Rehabilitation. Journal of Cardiovascular Nursing, 23(4), 371-377. (Won Manuscript of the Year Award, CVN Council, American Heart Association)

Ostwald, S.K., Godwin, K.M., Cheong, H., Cron, S. (2009). Predictors of resuming therapy within four weeks after discharge from inpatient rehabilitation. Topics in Stroke Rehabilitation,16(1), 80-91.

Ostwald, S.K., Bernal, M.P., Cron, S., Godwin, K.M. (2009). Stress Experienced by Stroke Survivors and Spousal Caregivers During the First Year After Discharge from Inpatient Rehabilitation. Topics in Stroke Rehabilitation, 16(2), 93–104. (Invited)

Ostwald, S.K., Godwin, K.M., Cron, S. (2009.) Predictors of Life Satisfaction in Stroke Survivors and Spousal Caregivers Twelve to Twenty-Four Months Post Discharge From Inpatient Rehabilitation. Rehabilitation Nursing, 34(4), 160-167,174.

Chalermwannopong, S., Panuthai, S., Srisuphan, W., Panya, P., Ostwald, S.K. (2010). Effects of the transitional care program on functional ability and quality of life of stroke survivors, CMU Journal of Natural Science, 9(1), 49-66. (PhD Dissertation)

Kelley, C., Graham, C., Christy, J.B., Hersch, G., Shaw, S., Ostwald, S.K. (2010). Falling and Mobility Experiences of Stroke Survivors and Spousal Caregivers, Physical and Occupational Therapy in Geriatrics, 28(3), 235-248. (PHD Dissertation)

Godwin, K.M., Wasserman, J., Ostwald, S.K. (2011) Cost Associated with Stroke the First Year Post Discharge: Rehabilitative Services and Medication. Topics in Stroke Rehabilitation. 18(6), 676-684.

Parker, E.K., Swint, J.M., Godwin, K,, Ostwald, S.K. (2012) Examining the Cost per Caregiver of an Intervention Designed to Improve the Quality of Life of Spousal Caregivers of Stroke Survivors, Rehabilitation Nursing, 37(5), 244-51. (MS Thesis)

Schulz, C. H., Hersch, G. I., Foust J. L., Wyatt, A. L., Godwin, K. M., Virani, S., & Ostwald, S. K. (2012). Identifying Occupational Performance Barriers of Stroke Survivors: Utilization of a Home Assessment. Physical and Occupational Therapy in Geriatrics, 30(2),109-123

Godwin, K.M., Swank, P., Vaeth, P., Ostwald, S.K. (2013) The Longitudinal Effects of Dyadic Mutuality on Dyadic Stress for Stroke Survivor and their Spousal Caregivers. Aging and Mental Health. Aging & Mental Health, DOI:10.1080/13607863.2012.756457 (PhD Dissertation)

Godwin, K.M., Ostwald, S.K., Cron, S.G., Wasserman, J., (2013) Long-term Health Related Quality of life of Stroke Survivors and their Spousal Caregivers. Journal of Neuroscience Nursing (online pre-publication DOI: 10,1097/JNN.06013E31828A410b)

Ostwald, S.K., Godwin, K.M., Ye, F., Cron, S.G. (2013) Serious Adverse Events Experienced by Survivors of Stroke in the First Year Following Discharge From Inpatient Rehabilitation. Rehabilitation Nursing (online pre-publication. DOI::10,1002/mj.87)

* Ostwald, S.K., Godwin, K.M., Cron, S.G., Kelley, C.P., Hersch, G., Davis, S. (2013) Home-based Psychoeducational and Mailed Information Programs for Stroke-Caregiving Dyad Post Discharge: A Randomized Trial. Disability and Rehabilitation (online pre-publication DOI:10, 3109/09638288.2013.777806)

*intervention summary derived from this publication