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Caregiver-Delivered Stroke Rehabilitation in Rural China.

Publication ,  Journal Article
Zhou, B; Zhang, J; Zhao, Y; Li, X; Anderson, CS; Xie, B; Wang, N; Zhang, Y; Tang, X; Prvu Bettger, J; Chen, S; Gu, W; Luo, R; Zhao, Q ...
Published in: Stroke
July 2019

Background and Purpose- Stroke disability is a major health burden in rural China where rehabilitation services are inadequate. We aimed to determine the effectiveness of a novel nurse-led, caregiver-delivered model of stroke rehabilitation in rural China. Methods- A multicenter prospective, randomized open, blinded outcome assessed, controlled trial was conducted in 3 rural county hospitals in China: Zhangwu, Liaoning Province (Northeast); Qingtongxia, Ningxia Hui Autonomous Region (Northwest); and Dianjiang, Chongqing Municipality (Southwest). Adult patients (age 18-79 years) with residual disability (Barthel Index score ≤80/100) after a recent acute stroke were randomized to a new service model or usual care. The new intervention was multifaceted and was based on a task-shifting / training-the-trainers model, supported by a custom-designed smartphone application, where patients and caregivers received evidence-based in-hospital education and stroke rehabilitation training (focus on mobility, self-care, and toileting), delivered by trained nurses before hospital discharge, and 3 postdischarge support telephone calls. Outcome assessments were undertaken before hospital discharge and at 3 and 6 months. Primary outcome was physical functioning (Barthel Index scores) at 6 months, assessed by research staff blind to treatment allocation, adjusted for baseline covariates in an intention-to-treat analysis. Secondary outcomes included measures of mobility, health-related quality of life, mood, and caregiver burden. The study included a process evaluation that assessed intervention fidelity. Results- From November 2014 to December 2016, 246 stroke patients were randomized to intervention (n=118) or control (n=128) groups. There was no statistically significant difference in adjusted 6-month Barthel Index scores between groups (70.1 versus 74.1, mean difference, -4.0 [95% CI, -10.0 to 2.9]), nor any differences across the other outcome measures. Process evaluation interviews revealed that the intervention was desirable and positively accepted by nurses, caregivers, and patients but was considered too complex despite efforts to simplify materials for the rural context. Key strategies identified for future studies included the use of community health workers, smartphone application enhancement, and simpler and more frequent training for nurses, caregivers, and patients. Conclusions- A novel nurse-led, digital supported, caregiver-delivered stroke rehabilitation program did not improve patient physical functioning after stroke in rural China. Further stroke rehabilitation research suitable for resource-poor settings is required, with several components being suggested through stakeholder interviews in our study. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02247921.

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

July 2019

Volume

50

Issue

7

Start / End Page

1825 / 1830

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Stroke Rehabilitation
  • Smartphone
  • Rural Population
  • Recovery of Function
  • Quality of Life
  • Prospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
 

Citation

APA
Chicago
ICMJE
MLA
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Zhou, B., Zhang, J., Zhao, Y., Li, X., Anderson, C. S., Xie, B., … Yan, L. L. (2019). Caregiver-Delivered Stroke Rehabilitation in Rural China. Stroke, 50(7), 1825–1830. https://doi.org/10.1161/STROKEAHA.118.021558
Zhou, Bo, Jing Zhang, Yi Zhao, Xian Li, Craig S. Anderson, Bin Xie, Ninghua Wang, et al. “Caregiver-Delivered Stroke Rehabilitation in Rural China.Stroke 50, no. 7 (July 2019): 1825–30. https://doi.org/10.1161/STROKEAHA.118.021558.
Zhou B, Zhang J, Zhao Y, Li X, Anderson CS, Xie B, et al. Caregiver-Delivered Stroke Rehabilitation in Rural China. Stroke. 2019 Jul;50(7):1825–30.
Zhou, Bo, et al. “Caregiver-Delivered Stroke Rehabilitation in Rural China.Stroke, vol. 50, no. 7, July 2019, pp. 1825–30. Pubmed, doi:10.1161/STROKEAHA.118.021558.
Zhou B, Zhang J, Zhao Y, Li X, Anderson CS, Xie B, Wang N, Zhang Y, Tang X, Prvu Bettger J, Chen S, Gu W, Luo R, Zhao Q, Sun Z, Lindley RI, Lamb SE, Wu Y, Shi J, Yan LL. Caregiver-Delivered Stroke Rehabilitation in Rural China. Stroke. 2019 Jul;50(7):1825–1830.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

July 2019

Volume

50

Issue

7

Start / End Page

1825 / 1830

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Stroke Rehabilitation
  • Smartphone
  • Rural Population
  • Recovery of Function
  • Quality of Life
  • Prospective Studies
  • Neurology & Neurosurgery
  • Middle Aged