Abstract
With stroke being one of the leading causes of disability worldwide, families and social systems may face strain as they adjust to a caregiving role. This strain may be amplified in family systems living in rural areas due to limited access to resources. Thus, it is important for helping professionals such as couple, marriage, and family therapists to understand what facets of this disability are linked with caregiver strain as well as to explore and understand various interventions that may ease caregiver burden. Using existing data from 177 pairs of stroke patients and their family caregivers in rural Mainland China, the present study utilized a moderation analysis to examine (1) the association between stroke patient physical functioning, patient mental health, and their family caregiver burden and (2) how a developed patient rehabilitation intervention program for caregivers moderated the association between patient physical functioning as well as mental health and caregiver burden 6-month post intervention. Results suggested that better patient physical functioning were related to lower levels of caregiver burden (b = − 1.418, p < .001, β = − 0.33). However, the developed rehabilitation intervention program did not significantly moderate the association between stroke patient physical functioning as well as mental health and caregiver burden. These findings provide insight into correlates of stroke patients’ caregiver burden in rural China. Development of more effective rehabilitation programs and interventions for stroke patients and their family caregivers as well how couple, marriage, and family therapists may be uniquely qualified to contribute to such interventions is discussed.
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References
Aamar, R., Lamson, A., & Smith, D. (2015). Qualitative trends in psychosocial treatment for underserved patients with type 2 diabetes. Contemporary Family Therapy, 37(1), 33–44. https://doi.org/10.1007/s10591-015-9326-x.
Acock, A. (2005). Working with missing values. Journal of Marriage and Family, 67(4), 1012–1028. https://doi.org/10.1111/j.1741-3737.2005.00191.x.
Anderson, C., Rubenach, S., Mhurchu, C. N., Clark, M., Spencer, C., & Winsor, A. (2000). Home or hospital for stroke rehabilitation? Results of a randomized controlled trial. Stroke, 31(5), 1024–1031. https://doi.org/10.1161/01.STR.31.5.1024.
Aprile, I., Di Stasio, E., Romitelli, F., Lancellotti, S., Caliandro, P., Tonali, P., … Padua, L. (2008). Effects of rehabilitation on quality of life in patients with chronic stroke. Brain Injury, 22, 451–456. https://doi.org/10.1080/02699050802060639.
Bateson, G. (1972). Steps to an ecology of mind. New York: Ballantine.
Berg, A., Palomäki, H., Lönnqvist, J., Lehtihalmes, M., & Kaste, M. (2005). Depression among caregivers of stroke survivors. Stroke, 36, 639–643. https://doi.org/10.1161/01.STR.0000155690.04697.c0.
Bonita, R., Mendis, S., Truelsen, T., Bogousslavsky, J., Toole, J., & Yatsu, F. (2004). The global stroke initiative. The Lancet Neurology, 3, 391–393. https://doi.org/10.1016/S1474-4422(04)00800-2.
Cadilhac, D. A., Dewey, H. M., Vos, T., Carter, R., & Thrift, A. G. (2010). The health loss from ischemic stroke and intracerebral hemorrhage: Evidence from the North East Melbourne stroke incidence study (NEMESIS). Health and Quality of Life Outcomes, 8, 49–56. https://doi.org/10.1186/1477-7525-8-49.
Caro, C. C., Mendes, P. V. B., Costa, J. D., Nock, L. J., & Cruz, D. M. C. D. (2017). Independence and cognition post-stroke and its relationship to burden and quality of life of family caregivers. Topics in Stroke Rehabilitation, 24, 194–199. https://doi.org/10.1080/10749357.2016.1234224.
Chen, Y., Lu, J., Wong, K. S., Mok, V. C., Ungvari, G. S., & Tang, W. K. (2010). Health-related quality of life in the family caregivers of stroke survivors. International Journal of Rehabilitation Research, 33(3), 232–237. https://doi.org/10.1097/MRR.0b013e328338b04b.
Cheung, G., & Chan, C. (2002). The Satir model and cultural sensitivity: A Hong Kong reflection. Contemporary Family Therapy, 24(1), 199–215. https://doi.org/10.1023/A:101433802.
Choi-Kwon, S., Kim, H. S., Kwon, S. U., & Kim, J. S. (2005). Factors affecting the burden on caregivers of stroke survivors in South Korea. Archives of Physical Medicine and Rehabilitation, 86(5), 1043–1048. https://doi.org/10.1016/j.apmr.2004.09.013.
Chou, K. R., Jiann-Chyun, L., & Chu, H. (2002). The reliability and validity of the Chinese version of the caregiver burden inventory. Nursing research, 51(5), 324–331.
Clark, D. M., & Currie, K. C. (2009). Depression, anxiety, and their relationship with chronic diseases: A review of the epidemiology, risk, and treatment evidence. Medical Journal of Australia, 194, s54–s90.
Collins, L. M., Schafer, J. L., & Kam, C. M. (2001). A comparison of inclusive and restrictive strategies in modern missing data procedures. Psychological Methods, 6(4), 330–351. https://doi.org/10.1037/1082-989X.6.4.330.
Coombs, U. E. (2007). Spousal caregiving for stroke survivors. Journal of Neuroscience Nursing, 39(2), 112–119.
Dai, Y. T., Lou, M. F., Yip, P. K., & Huang, G. S. (2000). Risk factors and incidence of postoperative delirium in elderly Chinese patients. Gerontology, 46(1), 28–35. https://doi.org/10.1159/000022130.
Dowswell, G., Lawler, J., & Young, J. (2000). Unpacking the ‘black box’ of a nurse-led stroke support service. Clinical Rehabilitation, 14(2), 160–171. https://doi.org/10.1191/026921500672130349.
Epstein, N. B., Berger, A. T., Fang, J. J., Messina, L. A., Smith, J. R., Lloyd, T. D., … Liu, Q. X. (2012). Applying western-developed family therapy models in China. Journal of Family Psychotherapy, 23(3), 217–237. https://doi.org/10.1080/08975353.2012.705661.
Forbat, L., McManus, E., & Haraldsdottir, E. (2012). Clinical implications for supporting caregivers at the end-of-life: Findings from a qualitative study. Contemporary Family Therapy, 34, 282–292. https://doi.org/10.1007/s10591-012-9194-6.
Greveson, G., & James, O. (1991). Improving long-term outcome after stroke—The views of patients and carers. Health Trends, 23(4), 161–162.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1–55. https://doi.org/10.1080/10705519909540118.
Kalra, L., Evans, A., Perez, I., Melbourn, A., Patel, A., Knapp, M., & Donaldson, N. (2004). Training carers of stroke patients: Randomised controlled trial. BMJ, 328(7448), 1099–1101.
Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd edn.). New York: Guilford.
Langhorne, P., Bernhardt, J., & Kwakkel, G. (2011). Stroke rehabilitation. The Lancet, 377(9778), 1693–1702. https://doi.org/10.1016/S0140-6736(11)60325-5.
Lee, J., Soeken, K., & Picot, S. J. (2007). A meta-analysis of interventions for informal stroke caregivers. Western Journal of Nursing Research, 29(3), 344–356. https://doi.org/10.1177/0193945906296564.
Liu, H., Li, S., Xiao, Q., & Feldman, M. (2014). Social support and psychological well-being under social change in urban and rural China. Social Indicators Research, 119(2), 979–996. https://doi.org/10.1007/s11205-013-0534-1.
Lo, R. S., Cheng, J. O., Wong, E. M., Tang, W. K., Wong, L. K., Woo, J., & Kwok, T. (2008). Handicap and its determinants of change in stroke survivors. Stroke, 39(1), 148–153. https://doi.org/10.1161/STROKEAHA.107.491399.
Lui, M. H., Lee, D. T., & Mackenzie, A. E. (2000). Community care of older Chinese people in Hong Kong: A selective review. Australasian Journal on Ageing, 19(4), 180–184. https://doi.org/10.1111/j.1741-6612.2000.tb00232.x.
Mackenzie, A. E., Holroyd, E. E., & Lui, M. H. (1998). Community nurses’ assessment of the needs of Hong Kong family carers who are looking after stroke patients. International Journal of Nursing Studies, 35(3), 132–140. https://doi.org/10.1016/S0020-7489(98)00008-X.
Mahoney, F. L., & Barthel, D. W. (1965). Functional evaluation: The Barthel index. Maryland State Medical Journal, 14, 61–65.
Mak, A. K., Mackenzie, A., & Lui, M. H. (2007). Changing needs of Chinese family caregivers of stroke survivors. Journal of Clinical Nursing, 16(5), 971–979. https://doi.org/10.1111/j.1365-2702.2006.01754.x.
McCullagh, E., Brigstocke, G., Donaldson, N., & Kalra, L. (2005). Determinants of caregiving burden and quality of life in caregivers of stroke patients. Stroke, 36(10), 2181–2186. https://doi.org/10.1161/01.STR.0000181755.23914.53.
Minuchin, S. (1974). Families and family therapy. Cambridge: Harvard University Press.
Muthén, L. K., & Muthén, B. O. (2012). Mplus 7.0 [Computer software]. Los Angeles: Author.
Novak, M., & Guest, C. (1989). Application of a multidimensional caregiver burden inventory. The Gerontologist, 29(6), 798–803.
Ostwald, S. K., Hepburn, K. W., Caron, W., Burns, T., & Mantell, R. (1999). Reducing caregiver burden: A randomized psychoeducational intervention for caregivers of persons with dementia. The Gerontologist, 39(3), 299–309. https://doi.org/10.1093/geront/39.3.299.
Satir, V. (1983). Conjoint family therapy (3rd edn.). Palo Alto: Science and Behavior Books.
Schulz, K. F., Altman, D. G., & Moher, D. (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. Journal of Clinical Epidemiology, 63(8), 834–840. https://doi.org/10.1016/j.jclinepi.2010.02.005.
Settineri, S., Rizzo, A., Liotta, M., & Mento, C. (2014). Caregiver’s burden and quality of life: Caring for physical and mental illness. International Journal of Psychological Research, 7(1), 30–39.
Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and quasi-experimental designs for generalized causal inference. Belmont: Wadsworth.
Sit, J. W., Wong, T. K., Clinton, M., Li, L. S., & Fong, Y. M. (2004). Stroke care in the home: The impact of social support on the general health of family caregivers. Journal of Clinical Nursing, 13(7), 816–824. https://doi.org/10.1111/j.1365-2702.2004.00943.x.
Sörensen, S., Pinquart, M., & Duberstein, P. (2002). How effective are interventions with caregivers? An updated meta-analysis. The gerontologist, 42(3), 356–372. https://doi.org/10.1093/geront/42.3.356.
Stata Corporation. (2015). Stata 14 [Computer software]. College Station: Stata Corporation.
Steinmetz, S. K. (1988). Elder abuse by family caregivers: Processes and intervention strategies. Contemporary Family Therapy, 10, 256–271. https://doi.org/10.1007/BF00891617.
Tang, Y. Y., & Chen, S. P. (2002). Health promotion behaviors in Chinese family caregivers of patients with stroke. Health Promotion International, 17(4), 329–339. https://doi.org/10.1093/heapro/17.4.329.
Thommessen, B., Wyller, T. B., Bautz-Holter, E., & Laake, K. (2001). Acute phase predictors of subsequent psychosocial burden in carers of elderly stroke patients. Cerebrovascular Diseases, 11(3), 201–206. https://doi.org/10.1159/000047639.
Toseland, R. W., Rossiter, C. M., Peak, T., & Smith, G. C. (1990). Comparative effectiveness of individual and group interventions to support family caregivers. Social Work, 35(3), 209–217. https://doi.org/10.1093/sw/35.3.209.
van den Heuvel, E. T., Witte, L. P. D., Schure, L. M., Sanderman, R., & Jong, B. M. D. (2001). Risk factors for burn-out in caregivers of stroke patients, and possibilities for intervention. Clinical Rehabilitation, 15(6), 669–677. https://doi.org/10.1191/0269215501cr446oa.
Visser-Meily, A., Post, M., Schepers, V., & Lindeman, E. (2005). Spouses’ quality of life 1 year after stroke: Prediction at the start of clinical rehabilitation. Cerebrovascular Diseases, 20(6), 443–448. https://doi.org/10.1159/000088983.
Wang, W., Jiang, B., Sun, H., Ru, X., Sun, D., Wang, L., … Chen, Z. (2017). Prevalence, incidence, and mortality of stroke in China. Circulation, 135(8), 759–771. https://doi.org/10.1161/CIRCULATIONAHA.116.025250.
World Health Organization. (2017). Global Health Estimates 2015: Deaths by cause, age, sex, by country and by region, 2000–2015. Geneva, Swaziland. Retrieved from http://www.who.int/healthinfo/global_burden_disease/GlobalCOD_method_2000_2015.pdf?ua=1.
Yan, L. L., Chen, S., Zhou, B., Zhang, J., Xie, B., Luo, R.,.. . Shi, J. (2016). A randomized controlled trial on rehabilitation through caregiver-delivered nurse-organized service programs for disabled stroke patients in rural China (the RECOVER trial): Design and rationale. International Journal of Stroke: Official Journal of the International Stroke Society, 11(7), 823–830. https://doi.org/10.1177/1747493016654290.
Zhang, Y. L., Liang, W., Chen, Z. M., Zhang, H. M., Zhang, J. H., Weng, X. Q., … Zhang, Y. L. (2013). Validity and reliability of Patient Health Questionnaire-9 and Patient Health Questionnaire-2 to screen for depression among college students in China. Asia-Pacific Psychiatry, 5(4), 268–275. https://doi.org/10.1111/appy.12103.
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Funding was provided by China Medical Board (Grant No. 13-161), The Amsterdam Health and Technology Institute, The China International Center on Chronic Disease Prevention and Duke University.
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The study was approved by China Medical University, Ningxia Medical University, and Chongqing Medical University’s ethics committees and was registered at Clinicaltrials.gov (NCT02247921).
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Peng, Y., Brown, C.C., Zhang, J. et al. An Examination of a Simplified Stroke Rehabilitation Program for Reducing Family Caregiver’s Burden for Stroke Patients in Rural China. Contemp Fam Ther 41, 168–179 (2019). https://doi.org/10.1007/s10591-018-9482-x
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DOI: https://doi.org/10.1007/s10591-018-9482-x