Societal burden of stroke rehabilitation: Costs and health outcomes after admission to stroke rehabilitation.

OBJECTIVE: To estimate societal costs and changes in health-related quality of life in stroke patients, up to one year after start of medical specialist rehabilitation. DESIGN: Observational. PATIENTS: Consecutive patients who received medical specialist rehabilitation in the Stroke Cohort Outcomes of REhabilitation (SCORE) study. METHODS: Participants completed questionnaires on health-related quality of life (EuroQol EQ-5D-3L), absenteeism, out-of-pocket costs and healthcare use at start and end of rehabilitation and 6 and 12 months after start. Clinical characteristics and rehabilitation costs were extracted from the medical and financial records, respectively. RESULTS: From 2014 to 2016 a total of 313 stroke patients completed the study. Mean age was 59 (standard deviation (SD) 12) years, 185 (59%) were male, and 244 (78%) inpatients. Mean costs for inpatient and outpatient rehabilitation were US$70,601 and US$27,473, respectively. For inpatients, utility (an expression of quality of life) increased significantly between baseline and 6 months (EQ-5D-3L 0.66-0.73, p = 0.01; visual analogue scale 0.77-0.82, p < 0.001) and between baseline and 12 months (visual analogue scale 0.77-0.81, p < 0.001). CONCLUSION: One-year societal costs from after the start of rehabilitation in stroke patients were considerable. Future research should also include costs prior to rehabilitation. For inpatients, health-related quality of life, expressed in terms of utility, improved significantly over time.

Caregiver burden after stroke: changes over time?

Introduction and aim: Many caregivers of stroke patients experience a high burden. This study aims to describe the course of burden in individual caregivers in the first year after stroke.Methods: This study is part of the Stroke Cohort Outcomes of REhabilitation study, a multicentre, longitudinal cohort study including consecutive stroke patients admitted to two rehabilitation facilities. Caregivers were asked to complete the Caregiver Strain Index and questions on their sociodemographic characteristics 6 and 12 months post admission. Patients' sociodemographic and clinical characteristics were extracted from medical records.Results: A total of 129 caregivers were included, 72 completed the Caregiver Strain Index twice. Of them, 19 (26.4%) were men, median age 59 (range 27-78) years. A consistently high or low burden was reported by 15 (20.8%) and 49 (68.1%), respectively, whereas 8 (11.1%) reported a high burden at either 6 (n = 3) or 12 months (n = 5).Discussion: In the majority of caregivers of stroke patients the perceived caregiver burden is consistent over time. However, as in 11.1% caregiver burden changes from 6 to 12 months, caregiver burden should be measured repeatedly until 12 months after stroke. Caregivers living together with a patient who suffered a haemorrhagic stroke seem to be more at risk for a high burden.Implications for rehabilitationMany caregivers of stroke patients experience a high burden.The Caregiver Strain Index score at 6 months is a good predictor for the score at 12 months.In some caregivers the high burden is not yet present at 6 months, therefore monitoring caregiver burden throughout the first year after stroke seems warranted.Caregivers living together with a patient who suffered a haemorrhagic stroke seem to be more at risk for a high burden.

Depression is an independent determinant of life satisfaction early after stroke.

OBJECTIVE: Life satisfaction is reduced in stroke patients. However, as a rule, rehabilitation goals are not aimed at life satisfaction, but at activities and participation. In order to optimize life satisfaction in stroke patients, rehabilitation should take into account the determinants of life satisfaction. The aim of this study was therefore to determine what factors are independent determinants of life satisfaction in a large group of patients early after stroke. METHODS: Stroke-surviving patients were examined by a specialized nurse 6 weeks after discharge from hospital or rehabilitation setting. A standardized history and several screening lists, including the Lisat-9, were completed. Step-wise regression was used to identify independent determinants of life satisfaction. RESULTS: A total of 284 stroke-surviving patients were included in the study. Of these, 117 answered all of the Lisat-9 questions. Most patients (66.5%) rated their life as a whole as "satisfying" or "very satisfying". More depressive symptoms were independently associated with lower life satisfaction (p < 0.001). CONCLUSION: Most stroke-surviving patients are satisfied with their life early after a stroke. The score on the Hospital Anxiety and Depression Scale depression items is independently associated with life satisfaction. Physicians should therefore pay close attention to the mood of these patients.

Anxiety and low life satisfaction associate with high caregiver strain early after stroke.

OBJECTIVE: Caregivers play an important role in the well-being of stroke patients, and are known to experience considerable strain 3 months or more after patient discharge. The aim of this study was to determine the prevalence and determinants of caregiver strain early after discharge. METHODS: Six weeks after discharge from the hospital or rehabilitation setting stroke-surviving patients and their caregivers were seen by a specialized nurse. Several screening lists, including the Caregiver Strain Index (CSI), were completed. Step-wise logistic regression was used to analyse which determinants independently contribute to caregiver strain. RESULTS: A total of 284 stroke-surviving patients were included in the study. Of the 179 caregivers who completed the CSI, 23 (12.8%) experienced considerable strain. A higher level of anxiety symptoms and lower life satisfaction in patients are independently associated with higher caregiver strain (p = 0.000007 and p = 0.0031, respectively). CONCLUSION: High strain is experienced by 12.8% of caregivers shortly after discharge of a stroke-surviving patient. More anxiety symptoms and lower life satisfaction in patients are independently associated with a higher level of strain in caregivers. Treating patient anxiety at an early stage might therefore lead to a decrease in long-term caregiver strain.