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Training carers of stroke patients: randomised controlled trial [with consumer summary]
Kalra L, Evans A, Perez I, Melbourn A, Patel A, Knapp M, Donaldson N
BMJ 2004 May 8;328(7448):1099-1103
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

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 to 82 years), sex (53% men), and severity of stroke (median Barthel Index 8; interquartile range 4 to 12). The costs of care over one year for patients whose care givers had received training were significantly lower (Great British Pounds 10,133 versus Great British Pounds 13,794 ($18,087 versus $24,619; Euro 15,204 versus Euro 20,697); p = 0.001). Trained care givers experienced less caregiving burden (care giver burden score 32 versus 41; p = 0.0001), anxiety (anxiety score 3 versus 4; p = 0.0001) or depression (depression score 2 versus 3; p = 0.0001) and had a higher quality of life (EuroQol score 80 versus 70; p = 0.001). Patients' mortality, institutionalisation, and disability were not influenced by caregiver training. However, patients reported less anxiety (3 versus 4.5; p < 0.0001) and depression (3 versus 4; p < 0.0001) and better quality of life (65 versus 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.
Reproduced with permission from the BMJ Publishing Group.

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