Adopting Dyad-focused Strategy Training to Stroke Survivors and Their Caregivers

Adopting Dyad-focused Strategy Training to Stroke Survivors and Their Caregivers: Intervention Development and a Feasibility Study

The purpose of this study is to develop a dyad-focused intervention built upon the theoretical tenets of strategy training to help prepare stroke survivors and their caregivers to transit to community living. The study will involve two phases.

In phase one, the intervention protocol will be developed through literature review, expert panel meeting, and focus groups with rehabilitation therapists, stroke survivors, and caregivers. In phase two, a feasibility study will be conducted to evaluate the acceptability and suitability of this newly-developed intervention and outcome measures to stroke survivor-caregiver dyads.

A mixed-methods (quantitative and qualitative) design, including a repeated measures design, will be used in this feasibility study. Fifteen to twenty stroke survivor-caregiver dyads are expected to be recruited.

The participants will receive the dyad-focused strategy training intervention using the developed intervention protocol. Standardized assessments will be used to assess dyadic outcomes at baseline, post-intervention, and 3-month and 6-month follow-ups. Quantitative data will be analyzed descriptively.

Study Overview

• Status: Completed
• Conditions: Stroke
• Intervention / Treatment: Behavioral: Dyad-focused strategy training

Detailed Description

Stroke is the leading cause of death and adult disability. Transitioning from hospital to home is a challenging process for stroke survivors and their families, leading to frustration and adverse health outcomes for survivors and caregivers. To address both the survivor and caregiver needs, dyad-focused interventions are necessary to be implemented in the transitioning process. However, very few interventions were designed to address the needs of the dyad and place an equal emphasis on both survivors' and caregivers' outcomes.

The purpose of this study is to develop a dyad-focused intervention built upon the theoretical tenets of strategy training to help prepare stroke survivors and their caregivers to transit to community living. The study will involve two phases. In phase one, the intervention protocol will be developed through literature review, expert panel meeting, and focus groups with rehabilitation therapists, stroke survivors, and caregivers. In phase two, a feasibility study will be conducted to evaluate the acceptability and suitability of this newly-developed intervention and outcome measures to stroke survivor-caregiver dyads.

A mixed-methods (quantitative and qualitative) design, including a repeated measures design, will be used in this feasibility study. Fifteen to twenty stroke survivor-caregiver dyads are expected to be recruited. Adult stroke survivors who have been diagnosed with stroke, are about to be discharged from inpatient wards to home or has been discharged home within the past 3 months, have an identified adult caregiver who provides care or assistance of any kind and taking responsibility for the survivor and is available to participate in the intervention sessions with the survivor will be eligible to participate in the study. These participants will receive the dyad-focused strategy training intervention using the developed intervention protocol. Standardized assessments will be used to assess dyadic outcomes such as goal attainment, quality of life, self-efficacy, participation, depressive symptoms, and survivor-caregiver relationship at baseline, post-intervention, and 3-month and 6-month follow-ups. The feasibility indicators, such as recruitment rates and intervention attendance and adherence, will be evaluated by questionnaires, field notes, and qualitative interviews after the interventions are completed.

Quantitative data will be analyzed descriptively; while data obtained from the outcome measures will be examined using Wilcoxon signed rank test and effect size (r) to compare the differences between the pre- and post-intervention scores. Qualitative data will be analyzed using thematic analysis method.

• Study Type: Interventional
• Enrollment (Actual): 16
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Taipei, Taiwan
    • Taipei Medical University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

Stroke survivors include that the survivor:

1. ages 20 years and older;
2. has been diagnosed with stroke;
3. speaks Mandarin;
4. is about to be discharged from inpatient wards to home or has been discharged home within the past 3 months;
5. has an identified primary caregiver;
6. is able to provide informed consent.

Caregivers include that the caregiver:

1. ages 20 years and older;
2. speaks Mandarin;
3. is the primary caregiver recognized by the survivor (living with the survivor or providing daily care to the survivor for at least 10 hours per week);
4. is available to participate in the intervention sessions with the survivor;
5. is able to provide informed consent.

Exclusion Criteria:

1. requires significant medical treatment (e.g., chemotherapy, radiation therapy, or hemo/peritoneal dialysis) that may impede them from participating in the study;
2. has severe aphasia;
3. is unable to participate in a 1-hour discussion session;
4. has a diagnosis of dementia, major depressive disorder, substance use or other psychiatric disorders that may impede them from continually participating in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Dyad- focused strategy training intervention; The dyad-focused strategy training intervention protocol will be developed to help dyads manage the needs that they have as transitioning to the community. The following theoretical frameworks and guidelines will be used to guide the development of the intervention: (1) the strategy training guideline outlined by Skidmore et al; (2) Bodenmann's framework of dyadic coping; and (3) Self-efficacy theory.

Behavioral: Dyad-focused strategy training; Rehabilitation therapists will be hired to deliver the intervention to the stroke survivors-caregiver dyads on a one-to-two base. The therapist will ask the dyad to identify their shared goals and provide them the global strategy "Goal-Plan-Do-Check" (also called guided discovery strategy), which involves (1) setting a goal to address the barriers, (2) developing a plan to address the goal, (3) doing the plan, and (4) checking if the plan worked or required revising. This procedure will be repeated iteratively until the dyad's goal is met, and the next goal can be moved on to.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pittsburgh Rehabilitation Participation Scale (PRPS)	The PRPS, a clinician-rated instrument, measures patients' participation on a 6-point Likert-type scale. A higher point reflects better participation in each intervention session.	During intervention, up to 2 months
Client Satisfaction Questionnaire (CSQ)	The CSQ is an 8-item measure of client satisfaction with the intervention. It allows clients to rate on a 4-point scale where 1 represents "Not at all" and 4 represents "Extremely ." A higher score reflects higher satisfaction and acceptability of the intervention.	Immediately after intervention
Qualitative data	Qualitative data will be collected through field notes taken by therapists after each intervention session and in-person qualitative interviews with participants and their therapists using semi-structured questionnaires.	After intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Goal Attainment Scaling (GAS)	GAS is a method of scoring the extent to which patients' individual goals are achieved in intervention. If the patient achieves the expected level, this is scored at 0. If they achieve a better than expected outcome, this is scored at +1 (somewhat better) or +2 (much better). If they achieve a worse than expected outcome this is scored at -1 (partially achieved), -2 (No change) or -3 (much worse). Goals will be weighted to take account of the relative importance of the goal to the individual and/or the anticipated difficulty of achieving it.	Change from baseline to immediately post-intervention
World Health Organization Quality of Life (WHOQOL-Brief) Taiwan version	The WHOQOL-BREF (Taiwan ver.) is a self-administered questionnaire comprising 28 questions on individuals' perceptions of their health and well-being over the previous two weeks. Responses to questions are on a 1-5 Likert scale where 1 represents "disagree" or "not at all" and 5 represents "completely agree" or "extremely".	Change from baseline to immediately post-intervention
World Health Organization Quality of Life (WHOQOL-Brief) Taiwan version	The WHOQOL-BREF (Taiwan ver.) is a self-administered questionnaire comprising 28 questions on individuals' perceptions of their health and well-being over the previous two weeks. Responses to questions are on a 1-5 Likert scale where 1 represents "disagree" or "not at all" and 5 represents "completely agree" or "extremely".	Change from post-intervention to 3-month follow-up
World Health Organization Quality of Life (WHOQOL-Brief) Taiwan version	The WHOQOL-BREF (Taiwan ver.) is a self-administered questionnaire comprising 28 questions on individuals' perceptions of their health and well-being over the previous two weeks. Responses to questions are on a 1-5 Likert scale where 1 represents "disagree" or "not at all" and 5 represents "completely agree" or "extremely".	Change from 3-month to 6-month follow-up
General Self-Efficacy Scale (GSES)	The GSES, sometimes seen as GSE, is a 10-item psychometric scale created to assess perceived self-efficacy regarding coping and adaptation abilities in daily activities and isolated stressful events. Responses to questions are on a 1-4 Likert scale where 1 represents "Not at all true" and 4 represents "Exactly true."	Change from baseline to immediately post-intervention
General Self-Efficacy Scale (GSES)	The GSES, sometimes seen as GSE, is a 10-item psychometric scale created to assess perceived self-efficacy regarding coping and adaptation abilities in daily activities and isolated stressful events. Responses to questions are on a 1-4 Likert scale where 1 represents "Not at all true" and 4 represents "Exactly true."	Change from post-intervention to 3-month follow-up
General Self-Efficacy Scale (GSES)	The GSES, sometimes seen as GSE, is a 10-item psychometric scale created to assess perceived self-efficacy regarding coping and adaptation abilities in daily activities and isolated stressful events. Responses to questions are on a 1-4 Likert scale where 1 represents "Not at all true" and 4 represents "Exactly true."	Change from 3-month to 6-month follow-up
Participation Measure- 3 Domains, 4 Dimensions (PM-3D4D)	The PM-3D4D is a 19-item measure that was designed to evaluate three domains of participation: Productivity, Social, and Community. Respondents are asked to rate each item on four dimensions: (1) 'Diversity of participation' (yes [1] vs. no [0]); (2) 'Frequency'(5- and 7-point scales, from "never" to "everyday or almost everyday"); (3) 'Desire for change' (yes [1] vs. no[0]); and (4) 'Perceived difficulty' (4-point scale, from "very difficult" [1] to "not difficult at all" [4]). Each dimensional score of the PM-3D4D can be separately summed for each domain. Psychometric properties of the PM-3D4D were established in rehabilitation populations.	Change from baseline to immediately post-intervention
Participation Measure- 3 Domains, 4 Dimensions (PM-3D4D)	The PM-3D4D is a 19-item measure that was designed to evaluate three domains of participation: Productivity, Social, and Community. Respondents are asked to rate each item on four dimensions: (1) 'Diversity of participation' (yes [1] vs. no [0]); (2) 'Frequency'(5- and 7-point scales, from "never" to "everyday or almost everyday"); (3) 'Desire for change' (yes [1] vs. no[0]); and (4) 'Perceived difficulty' (4-point scale, from "very difficult" [1] to "not difficult at all" [4]). Each dimensional score of the PM-3D4D can be separately summed for each domain. Psychometric properties of the PM-3D4D were established in rehabilitation populations.	Change from post-intervention to 3-month follow-up
Participation Measure- 3 Domains, 4 Dimensions (PM-3D4D)	The PM-3D4D is a 19-item measure that was designed to evaluate three domains of participation: Productivity, Social, and Community. Respondents are asked to rate each item on four dimensions: (1) 'Diversity of participation' (yes [1] vs. no [0]); (2) 'Frequency'(5- and 7-point scales, from "never" to "everyday or almost everyday"); (3) 'Desire for change' (yes [1] vs. no[0]); and (4) 'Perceived difficulty' (4-point scale, from "very difficult" [1] to "not difficult at all" [4]). Each dimensional score of the PM-3D4D can be separately summed for each domain. Psychometric properties of the PM-3D4D were established in rehabilitation populations.	Change from 3-month to 6-month follow-up
Hospital Anxiety and Depression Scale (HADS)	The HADS is a fourteen-item scale that generates seven items related to anxiety and seven related to depression. Each item on the questionnaire is scored from 0-3, which means that a person can score between 0 and 21 for either anxiety or depression. Higher scores mean a worse outcome.	Change from baseline to immediately post-intervention
Hospital Anxiety and Depression Scale (HADS)	The HADS is a fourteen-item scale that generates seven items related to anxiety and seven related to depression. Each item on the questionnaire is scored from 0-3, which means that a person can score between 0 and 21 for either anxiety or depression. Higher scores mean a worse outcome.	Change from post-intervention to 3-month follow-up
Hospital Anxiety and Depression Scale (HADS)	The HADS is a fourteen-item scale that generates seven items related to anxiety and seven related to depression. Each item on the questionnaire is scored from 0-3, which means that a person can score between 0 and 21 for either anxiety or depression. Higher scores mean a worse outcome.	Change from 3-month to 6-month follow-up
Dyadic Relationship Scale (DRS)	The DRS measures negative and positive dyadic interactions from the perspective of both patients and the family caregivers. The patient version (10 items) and the caregiver version (11 items) have two subscales: dyadic strain and positive dyadic interaction. Each item included a four-option response (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree). Higher scores on each of these scales indicate higher strain levels and positive interaction, respectively.	Change from baseline to immediately post-intervention
Dyadic Relationship Scale (DRS)	The DRS measures negative and positive dyadic interactions from the perspective of both patients and the family caregivers. The patient version (10 items) and the caregiver version (11 items) have two subscales: dyadic strain and positive dyadic interaction. Each item included a four-option response (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree). Higher scores on each of these scales indicate higher strain levels and positive interaction, respectively.	Change from post-intervention to 3-month follow-up
Dyadic Relationship Scale (DRS)	The DRS measures negative and positive dyadic interactions from the perspective of both patients and the family caregivers. The patient version (10 items) and the caregiver version (11 items) have two subscales: dyadic strain and positive dyadic interaction. Each item included a four-option response (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree). Higher scores on each of these scales indicate higher strain levels and positive interaction, respectively.	Change from 3-month to 6-month follow-up
Activity Measure for Post-Acute Care (AM-PAC) Short Forms	The AM-PAC consists of three subscales that assess three activity domains: basic mobility, daily activity, and applied cognitive. The inpatient short consists of 6 items per domain, and the outpatient short consists of 15-19 per domain. Each item asks the respondent to rate the difficulty of performing specified activities using a 4-point scale. The summary scores for each subscale will be transformed into standardized scores on the t-score scale.	Change from baseline to immediately post-intervention
Activity Measure for Post-Acute Care (AM-PAC) Short Forms	The AM-PAC consists of three subscales that assess three activity domains: basic mobility, daily activity, and applied cognitive. The inpatient short consists of 6 items per domain, and the outpatient short consists of 15-19 per domain. Each item asks the respondent to rate the difficulty of performing specified activities using a 4-point scale. The summary scores for each subscale will be transformed into standardized scores on the t-score scale.	Change from post-intervention to 3-month follow-up
Activity Measure for Post-Acute Care Short Forms	The AM-PAC consists of three subscales that assess three activity domains: basic mobility, daily activity, and applied cognitive. The inpatient short consists of 6 items per domain, and the outpatient short consists of 15-19 per domain. Each item asks the respondent to rate the difficulty of performing specified activities using a 4-point scale. The summary scores for each subscale will be transformed into standardized scores on the t-score scale.	Change from 3-month to 6-month follow-up
Trail-Making Test (TMT A and B)	The TMT test measures sustained attention, sequencing, mental flexibility, and visual tracking. TMT-A requires the individual to link in an ascending order a series of 25 numbered circles distributed randomly on a test paper as quickly as possible. TMT-B is similar, although it requires the individual to link switching alternatively between a set of numbers (1-13) and a set of letters (A-L) in ascending order (1-A-2-B-3-C...). The Time to complete TMT A and B will be calculated, in which a longer completion time will indicate a poorer outcome.	Change from baseline to immediately post-intervention
Trail-Making Test (TMT A and B)	The TMT test measures sustained attention, sequencing, mental flexibility, and visual tracking. TMT-A requires the individual to link in an ascending order a series of 25 numbered circles distributed randomly on a test paper as quickly as possible. TMT-B is similar, although it requires the individual to link switching alternatively between a set of numbers (1-13) and a set of letters (A-L) in ascending order (1-A-2-B-3-C...). The Time to complete TMT A and B will be calculated, in which a longer completion time will indicate a poorer outcome.	Change from post-intervention to 3-month follow-up
Trail-Making Test (TMT A and B)	The TMT test measures sustained attention, sequencing, mental flexibility, and visual tracking. TMT-A requires the individual to link in an ascending order a series of 25 numbered circles distributed randomly on a test paper as quickly as possible. TMT-B is similar, although it requires the individual to link switching alternatively between a set of numbers (1-13) and a set of letters (A-L) in ascending order (1-A-2-B-3-C...). The Time to complete TMT A and B will be calculated, in which a longer completion time will indicate a poorer outcome.	Change from 3-month to 6-month follow-up
Stroop Test	The Stroop test assesses the ability to inhibit cognitive interference that occurs when processing a specific stimulus feature impedes the simultaneous processing of a second stimulus attribute. Participants will be asked to read out the word's ink color as accurately as soon as possible. The ink color of the word could be congruent or incongruent with the written color name. Each participant's time to complete the task will be calculated and recorded.	Change from baseline to immediately post-intervention
Stroop Test	The Stroop test assesses the ability to inhibit cognitive interference that occurs when processing a specific stimulus feature impedes the simultaneous processing of a second stimulus attribute. Participants will be asked to read out the word's ink color as accurately as soon as possible. The ink color of the word could be congruent or incongruent with the written color name. Each participant's time to complete the task will be calculated and recorded.	Change from post-intervention to 3-month follow-up
Stroop Test	The Stroop test assesses the ability to inhibit cognitive interference that occurs when processing a specific stimulus feature impedes the simultaneous processing of a second stimulus attribute. Participants will be asked to read out the word's ink color as accurately as soon as possible. The ink color of the word could be congruent or incongruent with the written color name. Each participant's time to complete the task will be calculated and recorded.	Change from 3-month to 6-month follow-up
Montreal Cognitive Assessment (MoCA)	MoCA is a 30-question test. It checks different cognitive or thinking abilities to help people quickly assess a patient's cognitive health. The score ranges from 0 to 30. A score of 26 and higher is considered normal.	Change from baseline to immediately post-intervention
Montreal Cognitive Assessment (MoCA)	MoCA is a 30-question test. It checks different cognitive or thinking abilities to help people quickly assess a patient's cognitive health. The score ranges from 0 to 30. A score of 26 and higher is considered normal.	Change from post-intervention to 3-month follow-up
Montreal Cognitive Assessment (MoCA)	MoCA is a 30-question test. It checks different cognitive or thinking abilities to help people quickly assess a patient's cognitive health. The score ranges from 0 to 30. A score of 26 and higher is considered normal.	Change from 3-month to 6-month follow-up
Preparedness for Caregiving Scale (CPS)	The CPS is a caregiver self-rated instrument that consists of eight items that ask caregivers how well prepared they believe they are for multiple domains of caregiving. Responses rate on a 5 point scale with scores ranging from 0 (not at all prepared) to 4 (very well prepared). The scale is scored by calculating the mean of all items answered with a score range of 0 to 4. The higher the score, the more prepared the caregiver feels for caregiving; the lower the score, the less prepared the caregiver feels.	Change from baseline to immediately post-intervention
Preparedness for Caregiving Scale (CPS)	The CPS is a caregiver self-rated instrument that consists of eight items that ask caregivers how well prepared they believe they are for multiple domains of caregiving. Responses rate on a 5 point scale with scores ranging from 0 (not at all prepared) to 4 (very well prepared). The scale is scored by calculating the mean of all items answered with a score range of 0 to 4. The higher the score, the more prepared the caregiver feels for caregiving; the lower the score, the less prepared the caregiver feels.	Change from post-intervention to 3-month follow-up
Preparedness for Caregiving Scale (CPS)	The CPS is a caregiver self-rated instrument that consists of eight items that ask caregivers how well prepared they believe they are for multiple domains of caregiving. Responses rate on a 5 point scale with scores ranging from 0 (not at all prepared) to 4 (very well prepared). The scale is scored by calculating the mean of all items answered with a score range of 0 to 4. The higher the score, the more prepared the caregiver feels for caregiving; the lower the score, the less prepared the caregiver feels.	Change from 3-month to 6-month follow-up
The Zarit Burden Interview (ZBI)	The ZBI, a caregiver self-report measure, contains 22 items to assess the caring burden. Each item on the interview is a statement which the caregiver is asked to endorse using a 5-point scale. Response options range from 0 (Never) to 4 (Nearly Always). A higher score means a worse outcome.	Change from baseline to immediately post-intervention
The Zarit Burden Interview (ZBI)	The ZBI, a caregiver self-report measure, contains 22 items to assess the caring burden. Each item on the interview is a statement which the caregiver is asked to endorse using a 5-point scale. Response options range from 0 (Never) to 4 (Nearly Always). A higher score means a worse outcome.	Change from post-intervention to 3-month follow-up
The Zarit Burden Interview (ZBI)	The ZBI, a caregiver self-report measure, contains 22 items to assess the caring burden. Each item on the interview is a statement which the caregiver is asked to endorse using a 5-point scale. Response options range from 0 (Never) to 4 (Nearly Always). A higher score means a worse outcome.	Change from 3-month to 6-month follow-up

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
HEAL Patient-Provider Connection	HEAL Patient-Provider Connection is a self-report measure that assesses the relationship between a patient and a health care provider. It contains seven items. Responses to questions are on a 1-5 Likert scale where 1 represents "Not at all" and 4 represents "Extremely ."	After the fifth intervention session, an average of 3 weeks
HEAL Treatment Expectancy	HEAL Treatment Expectancy is a self-report measure that assesses patients' expectations from the intervention. It contains six items. Responses to questions are on a 1-5 Likert scale where 1 represents "Not at all" and 4 represents "Extremely ."	After the first intervention session, an average of 1 week
National Institutes of Health Stroke Scale	The NIHSS is a 15-item neurologic examination stroke scale used to evaluate the effect of stroke on the levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss. The score will be calculated to quantify stroke severity.	At baseline
Modified Rankin Scale (MRS)	The MRS measures the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. The scale runs from 0-6 ( Health without symptoms to death).	Change from baseline to immediately post-intervention
Modified Rankin Scale (MRS)	The MRS measures the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. The scale runs from 0-6 ( Health without symptoms to death).	Change from post-intervention to 3-month follow-up
Modified Rankin Scale (MRS)	The MRS measures the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. The scale runs from 0-6 ( Health without symptoms to death).	Change from 3-month to 6-month follow-up
HEAL Positive Outlook questionnaire (Short form)	HEAL positive outlook questionnaire is a self-report measure that assesses participants' positive attitudes. The short form contains six items. Responses to questions are on a 1-5 Likert scale where 1 represents "Not at all" and 4 represents "Extremely ."	Change from baseline to immediately post-intervention
HEAL Positive Outlook questionnaire (Short form)	HEAL positive outlook questionnaire is a self-report measure that assesses participants' positive attitudes. The short form contains six items. Responses to questions are on a 1-5 Likert scale where 1 represents "Not at all" and 4 represents "Extremely ."	Change from post-intervention to 3-month follow-up
HEAL Positive Outlook questionnaire (Short form)	HEAL positive outlook questionnaire is a self-report measure that assesses participants' positive attitudes. The short form contains six items. Responses to questions are on a 1-5 Likert scale where 1 represents "Not at all" and 4 represents "Extremely ."	Change from 3-month to 6-month follow-up

Collaborators and Investigators

• Sponsor: Taipei Medical University
• Investigators: Principal Investigator: Feng-Hang Chang, Taipei Medical University

Publications and helpful links

General Publications

• Juengst SB, Osborne CL, Holavanahalli R, Silva V, Kew CL, Nabasny A, Bell KR. Feasibility Study of Problem-Solving Training for Care Partners of Adults With Traumatic Brain Injury, Spinal Cord Injury, Burn Injury, or Stroke During the Inpatient Hospital Stay. Arch Rehabil Res Clin Transl. 2019 Jun 27;1(3-4):100009. doi: 10.1016/j.arrct.2019.100009. eCollection 2019 Dec.
• Haley WE, Roth DL, Hovater M, Clay OJ. Long-term impact of stroke on family caregiver well-being: a population-based case-control study. Neurology. 2015 Mar 31;84(13):1323-9. doi: 10.1212/WNL.0000000000001418. Epub 2015 Mar 4.
• Moon M. The Unprepared Caregiver. Gerontologist. 2017 Feb;57(1):26-31. doi: 10.1093/geront/gnw080. Epub 2016 Apr 21.
• Hare R, Rogers H, Lester H, McManus R, Mant J. What do stroke patients and their carers want from community services? Fam Pract. 2006 Feb;23(1):131-6. doi: 10.1093/fampra/cmi098. Epub 2005 Nov 24.
• Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD, Katz RC, Lamberty K, Reker D. Management of Adult Stroke Rehabilitation Care: a clinical practice guideline. Stroke. 2005 Sep;36(9):e100-43. doi: 10.1161/01.STR.0000180861.54180.FF. No abstract available.
• Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P, Billinger SA; American Heart Association Council on Cardiovascular Nursing and the Stroke Council. Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke. 2010 Oct;41(10):2402-48. doi: 10.1161/STR.0b013e3181e7512b. Epub 2010 Sep 2. No abstract available.
• Jolly M, Thakkar A, Mikolaitis RA, Block JA. Caregiving, dyadic quality of life and dyadic relationships in lupus. Lupus. 2015 Aug;24(9):918-26. doi: 10.1177/0961203314567749. Epub 2015 Feb 5.
• Israelsson J, Persson C, Bremer A, Stromberg A, Arestedt K. Dyadic effects of type D personality and perceived control on health-related quality of life in cardiac arrest survivors and their spouses using the actor-partner interdependence model. Eur J Cardiovasc Nurs. 2020 Apr;19(4):351-358. doi: 10.1177/1474515119890466. Epub 2019 Nov 22.
• Boehmer U, Stokes JE, Bazzi AR, Clark MA. Dyadic quality of life among heterosexual and sexual minority breast cancer survivors and their caregivers. Support Care Cancer. 2020 Jun;28(6):2769-2778. doi: 10.1007/s00520-019-05148-7. Epub 2019 Nov 14.
• Barata NE. Dyadic Relationship and Quality of Life Patients with Chronic Kidney Disease. J Bras Nefrol. 2015 Jul-Sep;37(3):315-22. doi: 10.5935/0101-2800.20150051. English, Portuguese.
• Lau BH, Wong DFK, Fung YL, Zhou J, Chan CLW, Chow AYM. Facing death alone or together? Investigating the interdependence of death anxiety, dysfunctional attitudes, and quality of life in patient-caregiver dyads confronting lung cancer. Psychooncology. 2018 Aug;27(8):2045-2051. doi: 10.1002/pon.4773. Epub 2018 Jun 14.
• Al-Rawashdeh S, Alshraifeen A, Rababa M, Ashour A. Hope predicted quality of life in dyads of community-dwelling patients receiving hemodialysis and their family caregivers. Qual Life Res. 2020 Jan;29(1):81-89. doi: 10.1007/s11136-019-02378-4. Epub 2019 Dec 2.
• Sterba KR, Zapka J, Cranos C, Laursen A, Day TA. Quality of Life in Head and Neck Cancer Patient-Caregiver Dyads: A Systematic Review. Cancer Nurs. 2016 May-Jun;39(3):238-50. doi: 10.1097/NCC.0000000000000281.
• Santos M, Sousa C, Pereira M, Pereira MG. Quality of life in patients with multiple sclerosis: A study with patients and caregivers. Disabil Health J. 2019 Oct;12(4):628-634. doi: 10.1016/j.dhjo.2019.03.007. Epub 2019 Mar 28.
• Zeren F, Gursoy E, Colak E. The Quality of Life and Dyadic Adjustment of Couples Receiving Infertility Treatment. Afr J Reprod Health. 2019 Mar;23(1):117-127. doi: 10.29063/ajrh2019/v23i1.12.
• Durante A, Paturzo M, Mottola A, Alvaro R, Vaughan Dickson V, Vellone E. Caregiver Contribution to Self-care in Patients With Heart Failure: A Qualitative Descriptive Study. J Cardiovasc Nurs. 2019 Mar/Apr;34(2):E28-E35. doi: 10.1097/JCN.0000000000000560.
• Pucciarelli G, Ausili D, Rebora P, Arisido MW, Simeone S, Alvaro R, Vellone E. Formal and informal care after stroke: A longitudinal analysis of survivors' post rehabilitation hospital discharge. J Adv Nurs. 2019 Nov;75(11):2495-2505. doi: 10.1111/jan.13998. Epub 2019 Apr 22.
• Pucciarelli G, Lee CS, Lyons KS, Simeone S, Alvaro R, Vellone E. Quality of Life Trajectories Among Stroke Survivors and the Related Changes in Caregiver Outcomes: A Growth Mixture Study. Arch Phys Med Rehabil. 2019 Mar;100(3):433-440.e1. doi: 10.1016/j.apmr.2018.07.428. Epub 2018 Aug 18.
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Study record dates

Study Major Dates

• Study Start (Actual): November 16, 2021
• Primary Completion (Actual): May 30, 2023
• Study Completion (Actual): June 30, 2023

Study Registration Dates

• First Submitted: December 10, 2021
• First Submitted That Met QC Criteria: January 6, 2022
• First Posted (Actual): January 11, 2022

Study Record Updates

• Last Update Posted (Actual): April 10, 2024
• Last Update Submitted That Met QC Criteria: April 9, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Rehabilitation; Stroke; Caregiver
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Stroke
• Other Study ID Numbers: N202106087

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No