Papers

Specialist nurse support for patients with stroke in the community: a randomised controlled trial

^a Department of Health Care for the Elderly, St Luke's Hospital, Bradford BD5 0NA

Correspondence to: Dr Forster.

Abstract

Objective: To evaluate whether specialist nurse visits enhance the social integration and perceived health of patients with stroke or alleviate stress in carers in longer term stroke care.
Design: Stratified randomised controlled trial; both groups assessed at time of recruitment and at 3, 6, and 12 months.
Setting: Patients with disability related to new stroke who lived in their own homes in the Bradford Metropolitan District.
Subjects: 240 patients aged 60 years or over, randomly allocated to control group (n = 120) or intervention group (n = 120).
Intervention: Visits by specialist outreach nurses over 12 months to provide information, advice, and support; minimum of six visits during the first six months. The control group received no visits.
Main outcome measures: The Barthel index (functional ability), the Frenchay activities index (social activity), the Nottingham health profile (perceived health status). Stress among carers was indicated by the general health questionnaire-28 (28 items). The nurses recorded their interventions in trial diaries.
Results: There were no significant differences in perceived health, social activities, or stress among carers between the treatment and control groups at any of the assessments points. A subgroup of mildly disabled patients with stroke (Barthel index 15-19) had an improved social outcome at six months (Frenchay activities index, median difference 3 (95% confidence interval 0 to 6; P = 0.03)) and for the full 12 months of follow up (analysis of covariance P = 0.01) compared with the control group.
Conclusions: The specialist nurse intervention resulted in a small improvement in social activities only for the mildly disabled patients. No proved strategy yet exists that can be recommended to address the psychosocial difficulties of patients with stroke and their families.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

This article has been cited by other articles:

• Forster, A., Young, J., Green, J., Patterson, C., Wanklyn, P., Smith, J., Murray, J., Wild, H., Bogle, S., Lowson, K. (2009). Structured re-assessment system at 6 months after a disabling stroke: a randomised controlled trial with resource use and cost study. Age Ageing 38: 576-583 [Abstract] [Full text]  
• Smith, J., Forster, A., Young, J., On behalf of the Cochrane Group for information pr, (2009). Cochrane review: information provision for stroke patients and their caregivers. Clin Rehabil 23: 195-206 [Abstract]  
• Lee, J., Soeken, K., Picot, S. J. (2007). A Meta-Analysis of Interventions for Informal Stroke Caregivers. West J Nurs Res 29: 344-356 [Abstract]  
• Redfern, J., McKevitt, C., Wolfe, C. D.A. (2006). Development of Complex Interventions in Stroke Care: A Systematic Review. Stroke 37: 2410-2419 [Abstract] [Full text]  
• Young, J. B., Robinson, M., Chell, S., Sanderson, D., Chaplin, S., Burns, E., Fear, J. (2005). A whole system study of intermediate care services for older people. Age Ageing 34: 577-583 [Abstract] [Full text]  
• Lui, M. H.L., Ross, F. M., Thompson, D. R. (2005). Supporting Family Caregivers in Stroke Care: A Review of the Evidence for Problem Solving. Stroke 36: 2514-2522 [Abstract] [Full text]  
• McCullagh, E., Brigstocke, G., Donaldson, N., Kalra, L. (2005). Determinants of Caregiving Burden and Quality of Life in Caregivers of Stroke Patients. Stroke 36: 2181-2186 [Abstract] [Full text]  
• Mant, J, Winner, S, Roche, J, Wade, D T (2005). Family support for stroke: one year follow up of a randomised controlled trial. J. Neurol. Neurosurg. Psychiatry 76: 1006-1008 [Abstract] [Full text]  
• Robinson, L., Francis, J., James, P., Tindle, N., Greenwell, K., Rodgers, H. (2005). Caring for carers of people with stroke: developing a complex intervention following the Medical Research Council framework. Clin Rehabil 19: 560-571 [Abstract]  
• Tang, W. K., Chan, S. S. M., Chiu, H. F. K., Ungvari, G. S., Wong, K. S., Kwok, T. C. Y., Mok, V., Wong, K. T., Richards, P. S., Ahuja, A. T. (2005). Poststroke Depression in Chinese Patients: Frequency, Psychosocial, Clinical, and Radiological Determinants. J Geriatr Psychiatry Neurol 18: 45-51 [Abstract]  
• Boter, H., for the HESTIA Study Group, (2004). Multicenter Randomized Controlled Trial of an Outreach Nursing Support Program for Recently Discharged Stroke Patients. Stroke 35: 2867-2872 [Abstract] [Full text]  
• Glass, T. A., Berkman, L. F., Hiltunen, E. F., Furie, K., Glymour, M. M., Fay, M. E., Ware, J. (2004). The Families In Recovery From Stroke Trial (FIRST): Primary Study Results. Psychosom. Med. 66: 889-897 [Abstract] [Full text]  
• Low, J T., Roderick, P., Payne, S. (2004). An exploration looking at the impact of domiciliary and day hospital delivery of stroke rehabilitation on informal carers. Clin Rehabil 18: 776-784 [Abstract]  
• Visser-Meily, J M A., Post, M. W M, Riphagen, I. I, Lindeman, E. (2004). Measures used to assess burden among caregivers of stroke patients: a review. Clin Rehabil 18: 601-623 [Abstract]  
• 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: 1099- [Abstract] [Full text]  
• Boter, H., Rinkel, G. J., de Haan, R. J (2004). Outreach nurse support after stroke: a descriptive study on patients' and carers' needs, and applied nursing interventions. Clin Rehabil 18: 156-163 [Abstract]  
• Jack, B., Oldham, J., Williams, A. (2003). A stakeholder evaluation of the impact of the palliative care clinical nurse specialist upon doctors and nurses, within an acute hospital setting. Palliat Med 17: 283-288 [Abstract]  
• Lincoln, N. B., Francis, V. M., Lilley, S. A., Sharma, J. C., Summerfield, M. (2003). Evaluation of a Stroke Family Support Organiser: A Randomized Controlled Trial. Stroke 34: 116-121 [Abstract] [Full text]  
• Sharples, L D, Edmunds, J, Bilton, D, Hollingworth, W, Caine, N, Keogan, M, Exley, A (2002). A randomised controlled crossover trial of nurse practitioner versus doctor led outpatient care in a bronchiectasis clinic. Thorax 57: 661-666 [Abstract] [Full text]  
• Andersen, H. E., Eriksen, K., Brown, A., Schultz-Larsen, K., Forchhammer, B. H. (2002). Follow-up services for stroke survivors after hospital discharge-a randomized control study. Clin Rehabil 16: 593-603 [Abstract]  
• Skilbeck, J., Corner, J., Bath, P., Beech, N., Clark, D., Hughes, P., Douglas, H.-R., Halliday, D., Haviland, J., Marples, R., Normand, C., Seymour, J., Webb, T. (2002). Clinical nurse specialists in palliative care. Part 1. A description of the Macmillan Nurse caseload. Palliat Med 16: 285-296 [Abstract]  
• Kerr, S. M, Smith, L. N (2001). Stroke: an exploration of the experience of informal caregiving. Clin Rehabil 15: 428-436 [Abstract]  
• Plant, H., Bredin, M., Krishnasamy, M., Corner, J. (2000). Working with resistance, tension and objectivity: Conducting a randomised controlled trial of a nursing intervention for breathlessness. Journal of Research in Nursing 5: 426-434 [Abstract]  
• Andersen, H. E., Schultz-Larsen, K., Kreiner, S., Forchhammer, B. H., Eriksen, K., Brown, A. (2000). Can Readmission After Stroke Be Prevented? : Results of a Randomized Clinical Study: A Postdischarge Follow-Up Service for Stroke Survivors. Stroke 31: 1038-1045 [Abstract] [Full text]  
• Ellis-Hill, C. S, Horn, S. (2000). Change in identity and self-concept: a new theoretical approach to recovery following a stroke. Clin Rehabil 14: 279-287 [Abstract]  
• Harding, J., Lincoln, N. B (2000). An observational study of the Stroke Association family support organizer service. Clin Rehabil 14: 315-323 [Abstract]  
• Dowswell, G., Lawler, J., Young, J. (2000). Unpacking the 'black box' of a nurse-led stroke support service. Clin Rehabil 14: 160-171 [Abstract]  
• Rodgers, H., Atkinson, C., Bond, S., Suddes, M., Dobson, R., Curless, R. (1999). Randomized Controlled Trial of a Comprehensive Stroke Education Program for Patients and Caregivers. Stroke 30: 2585-2591 [Abstract] [Full text]  
• Han, B., Haley, W. E. (1999). Family Caregiving for Patients With Stroke : Review and Analysis. Stroke 30: 1478-1485 [Abstract] [Full text]  
• Hobbs, R., Murray, E. T (1999). Specialist liaison nurses. BMJ 318: 683-684 [Full text]  
• Reimer, W. J. M. S. o., de Haan, R. J., Rijnders, P. T., Limburg, M., van den Bos, G. A. M. (1998). The Burden of Caregiving in Partners of Long-Term Stroke Survivors. Stroke 29: 1605-1611 [Abstract] [Full text]  
• Reimer, W. J. M. S. o., de Haan, R. J., Pijnenborg, J. M. A., Limburg, M., van den Bos, G. A. M. (1998). Assessment of Burden in Partners of Stroke Patients With the Sense of Competence Questionnaire. Stroke 29: 373-379 [Abstract] [Full text]  
• Dowswell, G., Lawler, J., Young, J., Forster, A., Hearn, J. (1997). A qualitative study of specialist nurse support for stroke patients and care-givers at home. Clin Rehabil 11: 293-301 [Abstract]  
• Pahor, M., Applegate, W. B (1997). Recent advances: Geriatric medicine. BMJ 315: 1071-1074 [Full text]  
• Gladman, J., Barer, D., Langhorne, P. (1996). Specialist rehabilitation after stroke. BMJ 312: 1623-1624 [Full text]