Article

This randomized trial compared 6- and 12-month outcomes of a home-based
psychoeducational program to mailed information provided to 159 survivors of
stroke (SS) and their spousal caregivers (CG). METHODS: SS (age 50+) and CG were
recruited as dyads post-discharge from inpatient rehabilitation. All dyads
received mailed information for 12 months. Dyads randomized to the home-based
group received an average of 36.7 h of psychoeducation over 6 months. Health
status, depression, stress, burden, coping, support, mutuality and function were
obtained on all dyads. Repeated measures analysis with linear mixed models was
used to compare the groups for change over time in the outcome variables.
RESULTS: Both groups demonstrated less depression and stress over time. Compared
to the mailed information group, SS in the home-based group demonstrated
significantly improved self-reported health and cognitive function; CG
demonstrated significantly improved self-reported health and coping strategies.
Mutuality and social support decreased in both groups. CONCLUSIONS: The
home-based intervention was effective in improving self-reported health, coping
skills in CG and cognitive functioning in SS. However, the finding that dyads in
both groups demonstrated decreased depression and stress suggests that providing
repeated doses of relevant, personalized information by mail may result in
positive changes. IMPLICATIONS FOR REHABILITATION: A stroke affects both the
stroke survivor and the spousal caregiver, so nurses and therapists should use
multicomponent strategies to provide education, support, counseling and linkages
to community resources to ease the transition from hospital to home. Stroke may
have a negative impact on the dyad's relationship with each other and also on the
availability of support people in their lives during the 12 months after hospital
discharge. Comprehensive stroke programs should encourage dyads to attend support
groups and to seek individual and group counseling, as needed. Establishing an
ongoing relationship with stroke survivors and their spouses and providing
relevant and engaging information by mail can reduce stress and depression over
12 months post-discharge at a minimal cost. Nurses and therapists should consider
home visits post-discharge to reinforce education and skills taught in the
hospital, increase self-reported health in stroke survivors and spousal CG,
increase coping skills and to link the couple to community resources.

Langue : ANGLAIS