Because of improved management, man...

Because of improved management, many more survivors of acute reverse are discharged and sent fireside These patients may be extremely disabled and often are cared for through family members who are poorly prepared for or supported in their task. Training of caregivers in essential skills is believed to mould the burden of care and contribute to improved patient consequences but this belief has not been evaluated systematically. Kalra and colleagues studied the impact of caregiver training upon patient outcomes and economic aspects of reverse care in more than 250 English patients.

They recruited patients from a visitation rehabilitation unit. All patients had been independent in activities of daily living before the shock but were expected to require a caretaker's supervision or assistance in as it is activities when they returned place of abode Patients were neurologically and medically stable onward entry to the study. Baseline assessments included the Barthel index and other standardized instruments to assess function and quality of life. forward entry to the study, care-givers also were assessed for demographic details and health condition, as well as quality of life and functional status.

The patients were assigned randomly to receive conventional care or conventional care plus caregiver training. Conventional care included information upon stroke management and outcomes, involvement in setting rehabilitation goals, encouragement to attend nursing and therapy activities to learn basic skills, and advice about voluntary and community services.

In addition to these services, the caregivers in the intervention cluster received instructions on the management and prevention of often met with stroke-related problems, plus active training in lifting and handling techniques, transfers and mobility assistance, management of incontinence, assistance with activities of daily living, and communication skills. The training for each caregiver was individualized to the straits of the patient. The training was provided in up to five sessions, each lasting 30 to 45 minutes, plus a follow-up session at dwelling Patients and caregivers were assessed (independently, if possible) three and 12 month after the first brunt of stroke. The outcomes measured included death or institutionalization; Barthel index; depression, anxiety, and caregiver cargo scales; and indexes of physical and social function and quality of life.

Data were available forward 267 patients and their caregivers. In sum of two units thirds of cases, the spouse was the principal caregiver, and 95 percent of patients received additional family support. The conventional care and intervention assign places tos were similar in all major regards on entry to the subject of attention and had median Barthel scores consistent with moderate disability. Rates of mortality and institutionalization and measures of functional activity were not significantly different in the conventional care and intervention groups

At three and 12 month patients whose caregivers had received training reported significantly improved quality of life, anxiety, and depression scores. For caregivers, training had a significant issue on burden of care, quality of life, and depression and anxiety scores. These benefits were independent of age, severity of blow disability, and avail-ability of other support. Overall, 58 percent of caregivers who received training were satisfied with rehabilitation compared with 45 percent of those in the conventional care assemblage The health care costs for patients with trained caregivers were significantly lower ($18087 compared with $24619) mainly because of reduc hospital charges A trend toward lower costlinesss of respite and other non-hospital care also was noted in the intervention group

The authors decide that caregiver training reduces the carrying capacitys and improves the quality of life for patients and caregivers without any adverse weight on patient out-comes. The families studied were predominantly middle class and highly motivated. The researchers call for further studies to establish the effectiveness of caregiver training in other patient populations following stroke

Kalra L et al. Training carers of blow patients: randomised controlled trial. BMJ May 8 2004;328:1099-101

COPYRIGHT 2005 American Academy of Family Physicians

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