A caregiver-mediated home-based intervention improves physical functioning and social participation in people with chronic stroke

Question: Does a caregiver-mediated home-based intervention improve physical functioning and social participation in people with chronic stroke? Design: Randomised controlled trial with blinded outcome assessment. Setting: Home-based intervention in Taiwan. Participants: Key inclusion criteria were: diagnosis of hemispheric stroke; > 6 months post-onset; Brunnstrom stage III-V; home dwelling; and having family, friends or co-workers as caregivers. Key exclusion criteria were: recurrent stroke; dementia; global or receptive aphasia; severe orthopaedic problems; and being medically unstable. Randomisation of 51 participants allocated 25 to the experimental group and 26 to the control group. Interventions: The experimental group was given weekly, personalised caregivermediated home-based intervention training by a physiotherapist for 12 weeks. The caregiver was asked to encourage the patient to perform the prescribed exercises and task-specific training at least twice weekly. The control group received weekly visits or telephone calls from the therapist without exercise or task-specific training interventions during the same period. Outcome measures: Stroke Impact Scale, Berg Balance Scale, 10-metre Walk Test, 6-minute Walk Test, Barthel Index, and Caregiver Burden Scale. Results: All 51 participants completed the study. At the end of the training, the experimental group had significantly more improvement than the control group in scores of the Stroke Impact Scale, including the composite physical (by 11.9 points, 95% CI 6.5 to 17.3), social participation (by 11.4 points, 95% CI 2.9 to 19.9), and general recovery scores (by 17.2 points, 95% CI 10.0 to 24.4). The experimental group also had significantly better outcomes than controls in the Berg Balance Scale (by 5.3 points, 95% CI 2.0 to 8.6), free-walking velocity (by 8.9 cm/s, 95% CI 2.1 to 15.7), 6-minute Walk Test (95% CI 26.3 m, 95% CI 8.2 to 44.4), and Barthel Index (by 6.6 points, 95% CI 1.8 to 11.5). There were no significant differences between the groups on the Caregiver Burden Scale score. Conclusion: The caregiver-mediated home-based intervention in this study improves physical functioning and social participation in people with chronic stroke.