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

Brasil

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

Effectiveness of a support intervention for family caregivers and stroke survivors^*

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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