Study lacks information on social and economic aspects of care

Editor—Ideally, Martin Dennis and colleagues should have completed their “systematic review of previous and ongoing trials of similar interventions” before (rather than after) their randomised controlled trial evaluating the effectiveness of a stroke family care worker.1 It would be interesting to know if there are any published reports that support the outcomes they selected to evaluate the impact of one member of the care team or if there is any evidence that one worker could significantly improve the physical, social, and psychological wellbeing of 210 patients who had had a stroke in a community that has a “well organised stroke service with excellent social work support.”

The aims of the new post of stroke family care worker are not stated explicitly, so we assume from the paragraph identifying the intervention that they were to “identify unmet needs,” “[fulfil] these using any available resources,” “access health services,” and “[offer] some counselling.” Were any of these processes measured? Figure 3 shows a significant difference in the treatment group for the three most relevant questions about the effectiveness of the worker—on receiving information about recovery and rehabilitation, having someone listen to and understand the patient's needs since leaving hospital, and knowing who to contact about problems. It would be helpful to have more information in figure 1, such as a cross tabulation of patient contacts with the number of needs discovered, services accessed, and outcomes. How many patients were contacted in person and by telephone, and how was the worker introduced to patients? What evidence supports the suggestion that the care worker provided “support rather than improving patients' coping skills” and induced “a passive response … which led to depression and poor social adjustment?”

Is it ethical (or cost effective) to ask patients to complete so many questionnaires? While some data on …