Article

OBJECTIVE: To evaluate the relationship between caregiver nature and
availability, and rehabilitation outcomes in subacute stroke. DESIGN: Retrospective cohort study. SETTING: Four community rehabilitation hospitals.
PARTICIPANTS: Patients with subacute, first-time stroke (N=4042; 48.5% men; mean
age +/- SD, 70.12+/-10.4y; 51.5% women; mean age +/- SD, 72.54 +/-10.0y).
INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rehabilitation
effectiveness, defined as the percentage of potential improvement eventually
achieved with rehabilitation; and rehabilitation efficiency, defined as the rate
of functional improvement during rehabilitation. RESULTS: In our cohort, 96.7%
had available caregiver(s), of which 42.0% were primarily supported by foreign
domestic workers (FDWs), 25.9% by spouses, 19.3% by first-degree relatives, 7.8%
by other relatives, and 5.1% by other caregivers. Using quantile regression, we
found that having a caregiver was independently associated with rehabilitation
efficiency (beta=-3.83; 95% confidence interval [CI], -6.99 to -0.66; P=.018).
The relationship between caregiver availability and rehabilitation effectiveness
was modified by patient sex in that the negative association was significantly
greater in men (beta=-22.81; 95% CI, -32.70 to -12.94; P<.001) than women
(beta=-5.64; 95% CI, -14.72 to 3.44; P=.223). Having a FDW as a caregiver
compared with a spousal caregiver was negatively associated with rehabilitation
effectiveness (beta=-3.95; 95% CI, -6.94 to -0.95; P=.01) and rehabilitation
efficiency (beta=-1.83; 95% CI, -3.14 to -0.53; P=.006). The number of potential
caregivers was only significantly associated with rehabilitation effectiveness at
the bivariate level (P=.006). CONCLUSIONS: Caregiver identity, and possibly
availability, appears to negatively affect rehabilitation outcomes in subacute
stroke. A better understanding of these relationships has potential implications
on clinical practice and policy directions.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS