Effectiveness of a support intervention for family caregivers and stroke survivors<sup/>

Silva, Jaine Kareny da; Boery, Rita Narriman Silva de Oliveira

doi:10.1590/1518-8345.4991.3482

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 29 • 2021 • https://doi.org/10.1590/1518-8345.4991.3482 copy

Effectiveness of a support intervention for family caregivers and stroke survivors^* * Paper extracted from doctoral dissertation “Efetividade de uma intervenção de apoio para cuidadores familiares dos sobreviventes de acidente vascular cerebral”, presented to Universidade Estadual do Sudoeste da Bahia, Jequié, BA, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to analyze the effectiveness of a support intervention on the burden and stress of family caregivers and on the stroke survivors’ independence level, compared to the Control Group.

Method:

a quasi-experimental study conducted with 37 participants (Intervention Group, n=20; and Control Group, n=17). The intervention lasted 8 months. The outcomes of the caregivers (burden and stress) and of the survivors (independence level) were measured by the Zarit, Perceived Stress and Katz scales, at the following moments: pre-intervention, the fourth month of the intervention and post-intervention. The differences of these outcomes between groups and intra-group and the effect size were calculated using the Mann-Whitney and Friedman tests (Bonferroni adjustment by Wilcoxon) and the Kendall’s W coefficient.

Results:

the Intervention Group reduced burden (p=0.039) and stress (p=0.009), mainly, after 8 months of intervention, which was not observed in the Control Group. The independence level did not change between the groups or moments (p>0.05). The intervention presented moderate effect size (p=0.45 and p=0.54).

Conclusion:

the intervention was effective to reduce the burden and stress of family caregivers, but did not alter the stroke survivors’ independence level, when compared to the Control Group.

Descriptors:
Evidence-Based Nursing; Caregivers; Family; Stroke; Program; Social Support

Variables	Intervention Group (n=20)	Control Group (n=17)	P
Family caregiver
Age in years old^ * Continuous variables represented by median and interquartile range;*	51.50 (36.25 - 62.72)	46.00 (35.00 - 65.50)	0.156^† † P = Referring to the Mann-Whitney test, considering p<0.05;
Gender^‡ ‡ Categorical variables represented by number and percentage;			0.584^§ § P = Considering p<0.05, the chi-squared test was used when the expected frequency in the table cells was greater than five, and Fisher's exact test when the expected frequency was less than five; \|\|Minimum wage (the minimum wage varied over the three years of the study - 2017 to 2019 - between R$ 937.00 and R$ 998.00, and the value of the last year was considered, which corresponds to the value of the US dollar in 2019, which was R$ 3.6570), Brazil, 2017-2019;
Female	19 (95.0%)	15 (88.2%)
Male	1 (5.0%)	2 (11.8%)
Marital status^‡ ‡ Categorical variables represented by number and percentage;
With a partner	15 (75.0%)	11 (64.7%)	0.495^§ § P = Considering p<0.05, the chi-squared test was used when the expected frequency in the table cells was greater than five, and Fisher's exact test when the expected frequency was less than five; \|\|Minimum wage (the minimum wage varied over the three years of the study - 2017 to 2019 - between R$ 937.00 and R$ 998.00, and the value of the last year was considered, which corresponds to the value of the US dollar in 2019, which was R$ 3.6570), Brazil, 2017-2019;
No partner	5 (25.0%)	6 (35.3%)
Income^‡ ‡ Categorical variables represented by number and percentage; (minimum wages\|\|)
Less than one	15 (75.0%)	10 (58.8%)	0.295^§ § P = Considering p<0.05, the chi-squared test was used when the expected frequency in the table cells was greater than five, and Fisher's exact test when the expected frequency was less than five; \|\|Minimum wage (the minimum wage varied over the three years of the study - 2017 to 2019 - between R$ 937.00 and R$ 998.00, and the value of the last year was considered, which corresponds to the value of the US dollar in 2019, which was R$ 3.6570), Brazil, 2017-2019;
Greater than or equal to one	5 (25.0%)	7 (41.2%)
Work activity (Occupation)^‡ ‡ Categorical variables represented by number and percentage;
Works away from home	3 (15.0%)	4 (23.5%)	0.680^§ § P = Considering p<0.05, the chi-squared test was used when the expected frequency in the table cells was greater than five, and Fisher's exact test when the expected frequency was less than five; \|\|Minimum wage (the minimum wage varied over the three years of the study - 2017 to 2019 - between R$ 937.00 and R$ 998.00, and the value of the last year was considered, which corresponds to the value of the US dollar in 2019, which was R$ 3.6570), Brazil, 2017-2019;
Does not work	17 (85.0%)	13 (76.5%)
Schooling (years of study)^‡ ‡ Categorical variables represented by number and percentage;
Less than 10	3 (15.0%)	2 (11.8%)	0.012^§ § P = Considering p<0.05, the chi-squared test was used when the expected frequency in the table cells was greater than five, and Fisher's exact test when the expected frequency was less than five; \|\|Minimum wage (the minimum wage varied over the three years of the study - 2017 to 2019 - between R$ 937.00 and R$ 998.00, and the value of the last year was considered, which corresponds to the value of the US dollar in 2019, which was R$ 3.6570), Brazil, 2017-2019;
Greater than or equal to 10	17 (85.0%)	15 (88.2%)
Kinship^‡ ‡ Categorical variables represented by number and percentage;
Son/daughter and spouse	19 (95.0%)	15 (88.2%)	0.075^§ § P = Considering p<0.05, the chi-squared test was used when the expected frequency in the table cells was greater than five, and Fisher's exact test when the expected frequency was less than five; \|\|Minimum wage (the minimum wage varied over the three years of the study - 2017 to 2019 - between R$ 937.00 and R$ 998.00, and the value of the last year was considered, which corresponds to the value of the US dollar in 2019, which was R$ 3.6570), Brazil, 2017-2019;
Other	1 (5.0%)	2 (11.8%)
Lives^‡ ‡ Categorical variables represented by number and percentage; with the stroke^¶ ¶ Stroke = Cerebral Vascular Accident survivor			0.647^§ § P = Considering p<0.05, the chi-squared test was used when the expected frequency in the table cells was greater than five, and Fisher's exact test when the expected frequency was less than five; \|\|Minimum wage (the minimum wage varied over the three years of the study - 2017 to 2019 - between R$ 937.00 and R$ 998.00, and the value of the last year was considered, which corresponds to the value of the US dollar in 2019, which was R$ 3.6570), Brazil, 2017-2019;
Yes	18 (90.0%)	16 (94.1%)
No	2 (10.0%)	1 (5.9%)
Care time (months)^* * Continuous variables represented by median and interquartile range;	13.00 (6.00 -22.50)	14.00 (7.00 -32.00)	0.238^† † P = Referring to the Mann-Whitney test, considering p<0.05;
Hours of care per week^* * Continuous variables represented by median and interquartile range;	14.50 (8.75 - 11.00)	14.00 (11.00 - 19.00)	0.996^† † P = Referring to the Mann-Whitney test, considering p<0.05;
Family support ^‡ ‡ Categorical variables represented by number and percentage;
Yes	13 (65.0%)	7 (41.2%)	0.147^§ § P = Considering p<0.05, the chi-squared test was used when the expected frequency in the table cells was greater than five, and Fisher's exact test when the expected frequency was less than five; \|\|Minimum wage (the minimum wage varied over the three years of the study - 2017 to 2019 - between R$ 937.00 and R$ 998.00, and the value of the last year was considered, which corresponds to the value of the US dollar in 2019, which was R$ 3.6570), Brazil, 2017-2019;
No	7 (35.0%)	10 (58.8%)
Stroke^¶ ¶ Stroke = Cerebral Vascular Accident survivor
Age in years old^* * Continuous variables represented by median and interquartile range;	77.50 (63.00 - 85.00)	66.00 (53.00 - 81.50)	0.156^† † P = Referring to the Mann-Whitney test, considering p<0.05;
Gender^‡ ‡ Categorical variables represented by number and percentage;
Female	9 (45.0%)	7 (41.2%)	0.815^§ § P = Considering p<0.05, the chi-squared test was used when the expected frequency in the table cells was greater than five, and Fisher's exact test when the expected frequency was less than five; \|\|Minimum wage (the minimum wage varied over the three years of the study - 2017 to 2019 - between R$ 937.00 and R$ 998.00, and the value of the last year was considered, which corresponds to the value of the US dollar in 2019, which was R$ 3.6570), Brazil, 2017-2019;
Male	11 (55.0%)	10 (58.8%)
Outcome measures
Caregiver burden^ * Continuous variables represented by median and interquartile range;*	31.50 (18.50 - 43.00)	25.00 (15.60 - 38.50)	0.776^† † P = Referring to the Mann-Whitney test, considering p<0.05;
Caregiver stress^ * Continuous variables represented by median and interquartile range;*	27.00 (18.00 - 31.75)	24.00 (15.50 - 33.50)	0.714^† † P = Referring to the Mann-Whitney test, considering p<0.05;
Independence level^ * Continuous variables represented by median and interquartile range;*	4.00 (2.50 - 5.00)	3.00 (3.00 - 5.00)	0.505^† † P = Referring to the Mann-Whitney test, considering p<0.05;

Outcome variables	T0^* * T0 = Pre-intervention; Median; IQR^§ § IQR = Interquartile range;	T1^† † T1 = During the intervention (4th month); Median; IQR^§ § IQR = Interquartile range;	T2^‡ ‡ T2 = Post-intervention; Median; IQR^§ § IQR = Interquartile range;	P	Effect size
Caregiver burden
IG^\|\| \|\| IG = Intervention Group;	33.50 (18.50-44.50)	25.50 (15.00-37.75)	25.00 (16.25-31.50)^¶ ¶ The post-intervention moment is different from the pre-intervention;	0.039^** \|\| IG = Intervention Group;	0.45
CG^†† †† CG = Control Group;	34.00 (25.25-39.25)	28.00 (17.50-35.50)	28.00 (23.00-42.75)	0.444	0.23
Caregiver stress
IG^\|\| \|\| IG = Intervention Group;	29.00 (18.00-33.50)	22.00 (12.50-29.75)^‡‡ ‡‡ The moment corresponding to the intervention is different from the pre-intervention;	15.50 (10.0-29.25)^¶ ¶ The post-intervention moment is different from the pre-intervention;	0.009^** \|\| IG = Intervention Group;	0.54
CG^†† †† CG = Control Group;	24.50 (17.50-33.75)	20.50 (16.25-26.75)	22.00 (13.00-27.00)	0.167	0.33
Katz^§§ §§ Katz = Stroke survivor's independence level
IG^\|\| \|\| IG = Intervention Group;	4.00 (2.25-4.75)	4.00 (1.25-5.00)	4.00 (0.25-5.00)	0.542	0.20
CG^†† †† CG = Control Group;	3.00 (2.25-5.00)	4.00 (3.00-5.00)	4.00 (2.25-5.00)	0.584	0.18

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[1] *
Paper extracted from doctoral dissertation “Efetividade de uma intervenção de apoio para cuidadores familiares dos sobreviventes de acidente vascular cerebral”, presented to Universidade Estadual do Sudoeste da Bahia, Jequié, BA, Brazil.