Training carers of stroke patients: randomised controlled trial

BACKGROUND: Informal care givers support disabled stroke patients at home but receive little training for the caregiving role. OBJECTIVE: To evaluate the effectiveness of training care givers in reducing burden of stroke in patients and their care givers. DESIGN: A single, blind, randomised controlled trial. SETTING: Stroke rehabilitation unit. SUBJECTS: 300 stroke patients and their care givers. INTERVENTIONS: Training care givers in basic nursing and facilitation of personal care techniques. MAIN OUTCOME MEASURES: Cost to health and social services, caregiving burden, patients' and care givers' functional status (Barthel index, Frenchay activities index), psychological state (hospital anxiety and depression score), quality of life (EuroQol visual analogue scale) and patients' institutionalisation or mortality at one year. RESULTS: Patients were comparable for age (median 76 years; interquartile range 70-82 years), sex (53% men), and severity of stroke (median Barthel index 8; interquartile range 4-12). The costs of care over one year for patients whose care givers had received training were significantly lower (10,133 pounds sterling v 13,794 pounds sterling (18,087 dollars v 24,619 dollars; 15,204 euros v 20,697 euros); P = 0.001). Trained care givers experienced less caregiving burden (care giver burden score 32 v 41; P = 0.0001), anxiety (anxiety score 3 v 4; P = 0.0001) or depression (depression score 2 v 3; P = 0.0001) and had a higher quality of life (EuroQol score 80 v 70; P = 0.001). Patients' mortality, institutionalisation, and disability were not influenced by caregiver training. However, patients reported less anxiety (3 v 4.5; P < 0.0001) and depression (3 v 4; P < 0.0001) and better quality of life (65 v 60; P = 0.009) in the caregiver training group. CONCLUSION: Training care givers during patients' rehabilitation reduced costs and caregiver burden while improving psychosocial outcomes in care givers and patients at one year.