BMJ  2004;328:1099 (8 May), doi:10.1136/bmj.328.7448.1099

Paper

Training carers of stroke patients: randomised controlled trial

Lalit Kalra, professor of stroke medicine1, Andrew Evans, clinical lecturer in stroke medicine1, Inigo Perez, research fellow1, Anne Melbourn, stroke nurse2, Anita Patel, lecturer in health economics3, Martin Knapp, professor of health economics3, Nora Donaldson, senior lecturer in medical statistics4

1 Department of Medicine, Guy's, King's and St Thomas's School of Medicine, London SE5 9PJ, 2 Orpington Hospital, Bromley Hospitals NHS Trust, Bromley BR6 9JU, 3 Centre for Economics of Mental Health, Institute of Psychiatry, London SE5 8AF, 4 Biostatistics Unit, Research and Development Department, King's College Hospital, London SE5 9RS

Correspondence to: L Kalra lalit.kalra{at}kcl.ac.uk

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 v £13 794 ($18 087 v $24 619; {euro}15 204 v {euro}20 697); 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.


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