Intended for healthcare professionals


Training carers of stroke patients: randomised controlled trial

BMJ 2004; 328 doi: (Published 06 May 2004) Cite this as: BMJ 2004;328:1099
  1. Lalit Kalra, professor of stroke medicine (lalit.kalra{at},
  2. Andrew Evans, clinical lecturer in stroke medicine1,
  3. Inigo Perez, research fellow1,
  4. Anne Melbourn, stroke nurse2,
  5. Anita Patel, lecturer in health economics3,
  6. Martin Knapp, professor of health economics3,
  7. Nora Donaldson, senior lecturer in medical statistics4
  1. 1Department of Medicine, Guy's, King's and St Thomas's School of Medicine, London SE5 9PJ
  2. 2Orpington Hospital, Bromley Hospitals NHS Trust, Bromley BR6 9JU
  3. 3Centre for Economics of Mental Health, Institute of Psychiatry, London SE5 8AF
  4. 4Biostatistics Unit, Research and Development Department, King's College Hospital, London SE5 9RS
  1. Correspondence to: L Kalra
  • Accepted 5 March 2004


BackgroundInformal care givers support disabled stroke patients at home but receive little training for the caregiving role.

ObjectiveTo evaluate the effectiveness of training care givers in reducing burden of stroke in patients and their care givers.

DesignA single, blind, randomised controlled trial.

SettingStroke rehabilitation unit.

Subjects300 stroke patients and their care givers.

InterventionsTraining care givers in basic nursing and facilitation of personal care techniques.

Main outcome measuresCost 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.

ResultsPatients 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; € 15 204 v€20 697); P = 0.001). Trained care givers experienced less caregiving burden (care giver burden score 32 v41; P = 0.0001), anxiety (anxiety score 3 v4; P = 0.0001) or depression (depression score 2 v3; P = 0.0001) and had a higher quality of life (EuroQol score 80 v70; P = 0.001). Patients' mortality, institutionalisation, and disability were not influenced by caregiver training. However, patients reported less anxiety (3 v4.5; P < 0.0001) and depression (3 v4; P < 0.0001) and better quality of life (65 v60; P = 0.009) in the caregiver training group.

ConclusionTraining care givers during patients' rehabilitation reduced costs and caregiver burden while improving psychosocial outcomes in care givers and patients at one year.


  • Contributors LK was responsible for the conception, design, initiation, and overall coordination of the study; and for analysis and interpretation of data, drafting of the paper, and its intellectual content. AE and AP were responsible for analysis and interpretation of data and writing of the paper. IP and AM were involved with data collection, collation, and writing of the paper. MK was involved in the conception and design of the study, interpretation of data and critical review of the paper. ND provided statistical input to the design, data analysis, interpretation and writing of the paper. LK is the guarantor

  • Funding NHS R&D Executive's Primary Secondary Interface Priority Programme (Project No: F-4/1997)

  • Conflict of interest None.

  • Ethical approval Bromley Research Ethics Committee (LREC/106)

  • Accepted 5 March 2004
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