Stroke: stroke family care workers may improve psychosocial outcomes.

Clinical bottom line (level 1b-)

  1. Patients who had an acute stroke and were given a stroke family care worker, may be more likely to be less socially adjusted, than those given standard care.
  2. Carers in the stroke family care worker group may be less likely to be hassled and anxious, and have a better general health, than those in the standard care group.
  3. There was no clear difference in patient Frenchay activities score, general health, depression, anxiety or Barthel Index score.
Dennis et al: British Medical Journal 1997; 314: 1071-1077
Expires November 2002

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: teaching hospital, UK

417 patients (aged mean 68 years, ?% male) stroke (first or recurrent) within previous 30 days

Excluded if
  • stroke occurred on a background of another major illness which was likely to dominate the pattern of care (eg. advanced cancer or renal failure)
  • likely to die within a few days
  • lived more than 25 miles (40 km) from the hospital


    • Control Group: (n = 207, 185 analysed): standard care
    Experimental Group: (n = 210, 187 analysed): stroke family care worker- identified unmet needs and aimed to fulfil these using any available resource

    100% followed for 6 months

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    patient assessed median Frenchay activities index 38.0
    ()     		37.0
    ()     		-1.00
    (-4.00 to 3.00)
    patient assessed median general health questionnaire 5.50
    ()     		7.00
    ()     		-1.50
    (-3.00 to 1.00)
    patient assessed median on social adjustment scale 1.60
    ()     		1.70
    ()     		-0.10
    (-0.07 to -0.10)
    patient assessed median on hospital depression subscale 3.00
    ()     		4.50
    ()     		-1.50
    (-2.00 to 0.00)
    patient assessed median on hospital anxiety subscale 5.00
    ()     		5.00
    ()     		0.00
    (-1.00 to 2.00)
    patient assessed median on Barthel index 19.0
    ()     		19.0
    ()     		0.00
    (-1.00 to 1.00)
    carer assessed median on general health questionnaire 7.50
    ()     		4.00
    ()     		3.50
    (0.70 to 7.00)
    carer assessed median on care giving hassles scale 8.00
    ()     		4.00
    ()     		4.00
    (0.00 to 9.00)
    cares assessed median on hospital anxiety subscale 7.50
    ()     		7.00
    ()     		0.50
    (0.00 to 3.00)

  • There was no difference in carer assessed Frenchay activities index, social adjustment scale or hospital depression subscale.

    • Comments

    1. Additional, altered or other training may make stroke care workers more effective, but the programme these workers used was not highly efficient.

    Citation

    1. Dennis M, O'Rourke S, Slattery J, et al: Evaluation of a stroke family care worker: results of a randomised controlled trial. British Medical Journal 1997; 314: 1071-1077
    Contributor: Clare Wotton and Musab Hayatli, November 1999
    Reviewer: Daniel Sontheimer

    Clinical Question.
    Patient acute stroke
    Intervention or Exposure stroke family care worker
    Comparison standard care
    Outcome patients' wellbeing