Development and Psychometric Properties of the Caregiver Burden Scale in Polish Caregivers of Stroke Patients.

Purpose: Most stroke patients require long-term care of their family members. Excessive care burden entails several negative consequences; therefore, the severity of the burden should be periodically assessed. For this purpose, valid multidimensional measures are needed. Our study, which is a part of a larger research project, aims to translate and evaluate the psychometric properties of the Polish Caregiver Burden Scale (CBS) in relation to construct validity and internal consistency in caregivers of the patients after stroke. Patients and Methods: The sample of this cross-sectional observational study consisted of 366 informal caregivers to consecutive first-ever stroke survivors. The five-factor Polish CBS and the Hospital Anxiety and Depression Scale (HADS) were administered during the home visits at three to six months after patients' hospitalisation. Exploratory (EFA), confirmatory (CFA) factor analyses and a net analysis were performed to investigate the internal structure and a factorial construct validity of the CBS. Correlation analyses between the CBS and the HADS were carried out to examine convergent validity. Cronbach's alpha and item-total correlation were applied to assess internal consistency. Results: Three out of five factors identified by EFA were similar to the original indices of the CBS, while the remaining two deviated from the original structure of the CBS. The CFA five-factor model represented an acceptable fit (confirmatory fit index, CFI = 0.96, root mean square error, RMSEA = 0.04) but only after a modification. All subscale scores of the CBS were positively correlated with the HADS, supporting the convergent validity. Cronbach's alpha coefficients for the overall scale (0.92) and all subscales (0.72-0.87) except one (0.69) and item-total correlation results indicated good internal consistency. Conclusion: The Polish version of the CBS showed acceptable internal consistency and good convergent validity. Factorial validity and structural integrity were partially supported. The interrelationships between the CBS subdomains, their partial mutual contamination, and the scale's non-orthogonal structure should be considered when interpreting the results of further studies using this version of the scale.

Depressive symptoms in stroke patients treated and non-treated with intravenous thrombolytic therapy: a 1-year follow-up study.

INTRODUCTION: This is a prospective study, first to compare the frequency of depressive symptoms in stroke survivors treated, and non-treated, with intravenous thrombolysis and second, to explore relationships between post-stroke depression (PSD) and stroke treatment modalities, taking into account other possible determinants of PSD, including post-traumatic stress symptoms. METHODS: Groups of 73 thrombolysed and 73 non-thrombolysed patients matched for age and gender were examined at 3 and 12 months after discharge. PSD was assessed using the Beck Depression Inventory. Post-traumatic stress symptoms (PTSS), disability and social support were assessed with the Impact of Event Scale-Revised, the Barthel Index and the Berlin Social Support Scale. RESULTS: At 3 months, PSD was present in 23.3% of the thrombolysed and 31.5% in the non-thrombolysed groups (p = 0.265). At 12 months, the frequencies were 29.2 and 20.6% (p = 0.229). Logistic regression of the combined group of thrombolysed and non-thrombolysed patients indicated that at 3 months, the adjusted predictors of PSD were disability (OR 24.35), presence of PTSS (OR 9.32), low social support (OR 3.68) and non-thrombolytic treatment (OR 3.19). At 12 months, the predictors were disability (OR 15.78) and low education (OR 3.61). LIMITATIONS: The use of a questionnaire for the detection of depression, the relatively small sample size and a significant drop-out rate could limit the interpretation of these results. CONCLUSIONS: (1) Thrombolysed and non-thrombolysed stroke survivors had similar frequency of depressive symptoms although the thrombolysed patients had more severe neurological deficits in the acute phase. It can be assumed that if thrombolysis had not been used, depressive symptoms would have been more frequent. (2) Lack of the rt-PA treatment was associated with three-time greater odds of screening for PSD at 3 months post-stroke, after adjustment for other PSD correlates. (3) Therefore, thrombolytic therapy seems to have a positive, but indirect, effect on patients' mood, especially in the first months after stroke. (4) All stroke patients, irrespective of the method of treatment, should be monitored for the presence of depression.

Clinical recovery and health-related quality of life in ischaemic stroke survivors receiving thrombolytic treatment: a 1-year follow-up study.

The aims of this study were to examine prospectively the course of neurological and functional recovery and health related quality of life (HRQoL) in ischaemic stroke patients after intravenous thrombolysis, to assess the 1-year outcome and to determine the early predictors. A group of 53 consecutive patients were assessed at admission to the acute stroke unit (T0), before their discharge (T1), and at 3 (T2) and 12 (T3) months after hospital discharge. The National Institutes of Health Stroke Scale (NIHSS), the Barthel Index (BI) and the Stroke Specific Quality of Life Scale (SSQoL) were used to evaluate stroke severity, functional disability and health related quality of life (HRQoL). A good outcome was defined as simultaneous improvement in all three scales. At T0, 83 % of the patients had severe or moderate neurological impairment. Additionally, 77 % demonstrated very severe or severe disability when assessed by the BI. 74 and 79 % of the patients reported an acceptable HRQoL at 3 and 12 months following discharge, respectively. Neurological and functional status improved significantly over time with most changes occurring during hospitalization and the subsequent 3 months. At T3, 75.5 % of the patients had the good outcome which had been independently predicted by the level of stroke related disability at T0. A majority of the stroke survivors treated with thrombolysis achieved a good outcome. The measurement of stroke specific HRQoL, as a tool for gathering information from the patient, should be incorporated in the assessment of post-stroke recovery and outcome.

Burden in caregivers of long-term stroke survivors: Prevalence and determinants at 6 months and 5 years after stroke.

OBJECTIVES: To assess the prevalence of considerable burden among caregivers of stroke survivors at 6 months (Time 1) and 5 years after stroke (Time 2), to analyse changes in burden severity over time and to identify factors associated with the burden. METHODS: Eighty eight patient/caregiver pairs were assessed. Caregiver burden was measured with the Caregiver Burden Scale. Socio-demographic, stroke-related and psychological characteristics were analysed as potential determinants of the burden. Exact multiple logistic regression was used to identify the predictive factors. RESULTS: Considerable burden was reported by 44% of the caregivers at Time 1 and 30% at Time 2. The burden was independently associated with caregivers' sense of coherence and amount of time spent caregiving at Time 1, and with caregivers' anxiety at Time 2. CONCLUSIONS: A significant proportion of the caregivers experienced considerable burden in the post-acute and chronic phases of stroke, although this proportion declined over time. Several characteristics were associated with the increased burden at different time points. All the independent predictors related to aspects of the carers. PRACTICE IMPLICATIONS: Programmes including education about coping strategies and time management, as well as respite care provision, could be beneficial and might help to reduce the burden of caregiving.

Caregiving burden and its determinants in Polish caregivers of stroke survivors.

INTRODUCTION: Despite the growing body of literature on the consequences of providing non-professional care to stroke survivors, the determinants of caregiving burden are still not fully recognized. Identification of significant determinants can facilitate caregiver intervention programs. The aim of this study was to evaluate the level of burden borne by caregivers of stroke patients and to identify the most important determinants of burden at 6 months after hospitalization. MATERIAL AND METHODS: Data were collected from 150 pairs of stroke patients/caregivers. Caregiver burden was assessed on the Caregiver Burden scale (CB). Several characteristics were measured as potential predictors of the burden. Special attention was paid to the caregiver's sense of coherence (SOC) and anxiety. Regression analysis was employed to test the hypothesized relationships between these variables and the burden. RESULTS: Forty-seven percentage of the caregivers reported a substantial burden (severe or moderate). Caregiver SOC (p < 0.001), anxiety (p < 0.001) and the patients' functional status (p < 0.001) were the most important predictors of the overall burden and the most consistent predictors of the majority of aspects included in the CB scale. Caregiver health, patient's gender, time spent caregiving and social support were also factors related to the burden. The identified predictors explained 67% of the variance in the overall burden. CONCLUSIONS: Clinicians and other professionals should focus on the coping abilities of caregivers, their emotional state and the level of patients' dependency, as these are the vital and modifiable factors affecting caregiver burden following stroke.

Consequences of stroke in the light of objective and subjective indices: a review of recent literature.

Despite a significant progress in prevention, treatment and management in the past decades, stroke remains the most common disabling chronic condition in adult population. It may be a source of serious temporary or permanent consequences. These consequences should be recognised and measured for defining and implementation of remedial interventions and for optimum utilisation of health care resources. The aim of this work was to present sequels of stroke, taking into account objective and subjective indices, as documented in the recent literature of the subject. Selected data on mortality and survival following stroke were presented, the up-to-date literature was reviewed and register-based prospective studies were presented on quality of life (QoL) in post-stroke patients. Systematic reviews and meta-analyses of randomised controlled trials (RCTs) were summed up, related to efficacy of interventions aimed at improving QoL of the patients. Moreover, the studies were reviewed on burden and QoL experienced by caregivers of post-stroke patients and results were summed up of RCT synthesis aimed at reducing the burden and at improving QoL in the caregivers. The analysed studies indicated that stroke exerts a long-term, negative effect on patients' QoL, promoting a decrease in this measure and burdening a significant proportion of the family caregivers. The applied till now different interventions and programmes targeted at the patients and at their carers analysed in RCTs showed no or modest effects on improving of QoL or reducing the caregiver's burden.

[Social functioning and quality of life in schizophrenia patients --relationship with symptomatic remission and duration of illness]. / Funkcjonowanie spoleczne i jakosc zycia u chorych na schizofrenie--zaleznosc z remisja objawowa i czasem trwania choroby.

AIM: The assessment of social functioning and subjective quality of life in relation to symptomatic remission in schizophrenia patients after a first psychiatric hospitalization, as well as the analysis of connection between intensity of psychopathological symptoms and the level of functioning and quality of life, taking into account the status of remission and duration of illness. METHODS: Sixty-four patients were assessed, at 13 months (1st examination) and at mean 8 years (2nd examination) after the first hospitalization, and compared with two control groups of healthy persons. The following scales were used: Positive and Negative Syndrome Scale (PANSS), Social Functioning Scale (SFS), WHO Quality of Life (WHOQoL--Bref) scale and Global Assessment Scale (GAS). RESULTS: At first examination, the score of SFS domains was not significantly different between patients in remission and without remission while the score of most domains of WHOQoL was significantly higher in patients with remission. At second examination, the scores of both SFS and WHOQoL were significantly higher in patients with remission and did not differ significantly from healthy persons. In both examinations, significant correlations between PANSS and SFS and WHOQoL scores were found, especially in patients without remission. CONCLUSIONS: At mean 8 years after first psychiatric hospitalization, 2/3 of the patients with schizophrenia did not get a symptomatic remission and had worse social functioning and quality of life compared to patients with remission and to healthy controls. Psychopathological symptoms correlated significantly with social functioning and quality of life, especially among patients without remission.

Caregiver burden after stroke: towards a structural model.

BACKGROUND AND PURPOSE: Stroke may impose a severe burden on both the patients and their caregivers. Although there is substantial literature relating to the adverse impact of stroke on patients, considerably less is known about its impact on their caregivers. The aim of this study was to analyse predictive factors of the overall burden in caregivers of stroke victims and to verify the structural model of burden, built on the basis of theoretical and empirical assumptions. MATERIAL AND METHODS: One hundred and fifty pairs of patients and their caregivers were evaluated. The Caregiver Burden Scale (CB), Hospital Anxiety and Depression Scale (HADS), Sense of Coherence Scale (SOC), Social Support Scale, Geriatric Depression Scale, Barthel Index and Scandinavian Stroke Scale were all used to evaluate caregiver burden and the characteristics of patients and caregivers. RESULTS: The caregivers experienced a moderate burden (mean CB = 2.08) and emotional distress (mean total HADS = 14.1). Path analysis showed that higher burden was associated with a lower SOC score, higher emotional distress, and lower patient's functional status. Higher emotional distress, in turn, was associated with lower SOC and lower patient's functional status. These results show that the burden and the degree of emotional disturbance are two distinct negative consequences of caregiving. CONCLUSIONS: The negative consequences of caregiving depend mainly on the caregiver's intra-psychic factors and the patient's disability. Professional interventions should be targeted at enhancing caregivers' ability to cope with stress, improving their caregiving skills and reducing the physical dependence of patients.

[Stroke incidence, case fatality and mortality--current trends and future prognosis]. / Zapadalnosc, smiertelnosc i umieralnosc z powodu udarów mózgu--aktualne tendencje i prognozy na przyszlosc.

In Europe, since the 40's of the previous century the tendency of decreasing number of stroke cases has been observed. In Poland, epidemiological data concerning the stroke have shown relatively stable index of stroke incidence and stroke mortality rates in the last few decades. The decline concerns mostly early poststroke mortality which results directly in the increase of the number of people who have recovered from stroke. However, the index of post-stroke mortality is still higher in Poland than in other European countries and the USA. The prognosis referring to the incidence in next years, caused by demographic alterations related to the increasing number of elderly people, is not optimistic. Significant increase of population at the age of 65 and more is going to contribute to the increase of the number of new stroke cases in Poland and other European countries. This fact becomes a challenge both for hospitals, care-giver agencies and patients' families.