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Meta-Analysis
. 2010 May 12;2010(5):CD005066.
doi: 10.1002/14651858.CD005066.pub2.

Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis

Graham Ellis  1 , Jonathan Mant, Peter Langhorne, Martin Dennis, Simon Winner
Affiliations
Meta-Analysis

Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis

Graham Ellis et al. Cochrane Database Syst Rev. .

Abstract

Background: Many patients experience depression, social isolation and anxiety post stroke. These are associated with a poorer outcome. Ameliorating these problems may improve patient wellbeing.

Objectives: To evaluate the impact of a healthcare worker or volunteer whose multi-dimensional roles have been grouped under the title 'stroke liaison worker'.

Search strategy: We searched the Cochrane Stroke Group Trials Register (searched February 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to 2009), EMBASE (1980 to 2009) and four other databases. We performed a cited reference search, searched conference proceedings and trials registers, checked reference lists and contacted authors and trial investigators.

Selection criteria: Randomised controlled trials investigating the impact of a stroke liaison worker versus usual care.

Data collection and analysis: We invited trialists to participate in a review of individual patient data. Primary outcomes for patients were subjective health status and extended activities of daily living. Primary outcomes for carers were subjective health status including measures of carer strain.

Main results: We included 16 trials involving 4759 participants. Analysis did not show a significant overall difference for subjective health status (standardised mean difference (SMD) -0.03, 95% confidence interval (CI) -0.11 to 0.04, P = 0.34) or extended activities of daily living (SMD 0.04, 95% CI -0.03 to 0.11, P = 0.22). There was no overall significant effect for the outcome of carer subjective health status (SMD 0.04, 95% CI -0.05 to 0.14, P = 0.37). Patients with mild to moderate disability (Barthel 15 to 19) had a significant reduction in dependence (odds ratio (OR) 0.62, 95% CI 0.44 to 0.87, P = 0.006). This would equate to 10 fewer dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker. Similar results were seen for the outcome of death or dependence for the subgroup with Barthel 15 to 19 (OR 0.55, 95% CI 0.38 to 0.81, P = 0.002). This risk difference equates to 11 fewer dead or dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker.

Authors' conclusions: There is no evidence for the effectiveness of this multifaceted intervention in improving outcomes for all groups of patients or carers. Patients with mild to moderate disability benefit from a reduction in death and disability. Patients and carers do report improved satisfaction with some aspects of service provision.

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Conflict of interest statement

Graham Ellis: has been involved in trials evaluated in this review.

Jonathan Mant: received research funding from The Stroke Association, UK and was an investigator in one of the trials included in this review.

Peter Langhorne: none known.

Martin Dennis: was the chief investigator of one of the included randomised controlled trials. He is also a member of the Council, Executive and Research Committee of Chest Heart and Stroke Scotland, a charity which employs stroke liaison workers.

Simon Winner: has been involved in the design, conduct and publication of an eligible study for this review, resulting in the following publications:

  1. Mant J, Carter J, Wade D, Winner S. Family support for stroke: a randomised controlled trial. Lancet 2000;356:808‐13.

  2. Mant J, Winner S, Roche J, Wade DT. Family support for stroke: one year follow up of a randomised controlled trial. Journal of Neurology, Neurosurgery & Psychiatry 2005;76:1006‐8.

He has no other competing interests to declare.

Figures

Figure 1
Figure 1
Subgroup definitions
Figure 2
Figure 2
Trial flow
Figure 3
Figure 3
Barthel Index at recruitment
Analysis 1.1
Analysis 1.1
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 1 Subjective health status.
Analysis 1.2
Analysis 1.2
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 2 Extended activities of daily living.
Analysis 1.3
Analysis 1.3
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 3 Death.
Analysis 1.4
Analysis 1.4
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 4 Place of residence.
Analysis 1.5
Analysis 1.5
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 5 Activities of daily living.
Analysis 1.6
Analysis 1.6
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 6 Dependence.
Analysis 1.7
Analysis 1.7
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 7 Dependence (defined as Barthel less than or equal to 19).
Analysis 1.8
Analysis 1.8
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 8 Mental health: generic.
Analysis 1.9
Analysis 1.9
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 9 Mental health: depression.
Analysis 1.10
Analysis 1.10
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 10 Mental health: anxiety.
Analysis 1.11
Analysis 1.11
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 11 Participation.
Analysis 1.12
Analysis 1.12
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 12 Caregiver subjective health status.
Analysis 1.13
Analysis 1.13
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 13 Caregiver extended activities of daily living.
Analysis 1.14
Analysis 1.14
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 14 Caregiver mental health.
Analysis 1.15
Analysis 1.15
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 15 'I have been treated with kindness and respect': patient.
Analysis 1.16
Analysis 1.16
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 16 'The staff attended well to my personal needs': patient.
Analysis 1.17
Analysis 1.17
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 17 'I was able to talk to the staff about any problems': patient.
Analysis 1.18
Analysis 1.18
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 18 'I received all the information I want about the causes and nature of my disease': patient.
Analysis 1.19
Analysis 1.19
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 19 'The staff have done everything to make me well': patient.
Analysis 1.20
Analysis 1.20
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 20 'I am happy with my recovery': patient.
Analysis 1.21
Analysis 1.21
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 21 'I am satisfied with the type of treatment I have received': patient.
Analysis 1.22
Analysis 1.22
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 22 'I was given all the information I needed about allowances': patient.
Analysis 1.23
Analysis 1.23
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 23 'Things were well prepared for my return home': patient.
Analysis 1.24
Analysis 1.24
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 24 'I get all the services I need': patient.
Analysis 1.25
Analysis 1.25
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 25 'I am satisfied with outpatient services': patient.
Analysis 1.26
Analysis 1.26
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 26 'I am satisfied with the practical help I have received': patient.
Analysis 1.27
Analysis 1.27
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 27 'I have had enough information about recovery: patient.
Analysis 1.28
Analysis 1.28
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 28 'Someone has really listened': patient.
Analysis 1.29
Analysis 1.29
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 29 'I have had enough emotional support': patient.
Analysis 1.30
Analysis 1.30
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 30 'I know who to contact': patient.
Analysis 1.31
Analysis 1.31
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 31 'I have not felt neglected': patient.
Analysis 1.32
Analysis 1.32
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 32 'The patient has been treated with kindness and respect': carer.
Analysis 1.33
Analysis 1.33
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 33 'The staff have attended to my needs': carer.
Analysis 1.34
Analysis 1.34
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 34 'I received all the information I needed about the nature and causes of the patient's illness': carer.
Analysis 1.35
Analysis 1.35
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 35 'The staff have done everything to make the patient well': carer.
Analysis 1.36
Analysis 1.36
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 36 'I am satisfied with the type of treatment the patient received': carer.
Analysis 1.37
Analysis 1.37
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 37 'They have had enough therapy': carer.
Analysis 1.38
Analysis 1.38
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 38 'I was given enough information about allowances available': carer.
Analysis 1.39
Analysis 1.39
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 39 'Things were well prepared for their return home': carer.
Analysis 1.40
Analysis 1.40
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 40 'I get all the support I need from services': carer.
Analysis 1.41
Analysis 1.41
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 41 'I have received enough practical help': carer.
Analysis 1.42
Analysis 1.42
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 42 'I have received enough information about recovery and rehabilitation': carer.
Analysis 1.43
Analysis 1.43
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 43 'Someone has really listened': carer.
Analysis 1.44
Analysis 1.44
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 44 'I have not felt neglected': carer.
Analysis 1.45
Analysis 1.45
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 45 'I have received enough emotional support': carer.
Analysis 1.46
Analysis 1.46
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 46 'I have received enough special equipment': carer.
Analysis 1.47
Analysis 1.47
Comparison 1 Stroke liaison workers versus usual care: intervention type, Outcome 47 'I know who to contact': carer.
Analysis 2.1
Analysis 2.1
Comparison 2 Stroke liaison workers versus usual care: emphasis, Outcome 1 Subjective health status.
Analysis 3.1
Analysis 3.1
Comparison 3 Stroke liaison workers versus usual care: patient functional status, Outcome 1 Barthel dependency.
Analysis 3.2
Analysis 3.2
Comparison 3 Stroke liaison workers versus usual care: patient functional status, Outcome 2 Death or dependence.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD005066

References

References to studies included in this review

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References to studies excluded from this review

    1. Allen KR, Hazelett S, Jarjoura D, Wickstrom GC, Hua K, Weinhardt J, et al. Effectiveness of a postdischarge care management model for stroke and transient ischaemic attack: a randomised controlled trial. Journal of Stroke and Cerebrovascular Diseases 2002;11:88‐98. - PubMed
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References to ongoing studies

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    1. LoTS‐Care Stroke System of Care Trial Team. Cluster randomised trial evaluation of a patient and carer‐centred system of longer‐term stroke care. Proceedings of the 17th European Stroke Conference. Nice, France, 13‐16 May 2008:Abs 80.
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Additional references

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    1. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project 1981‐86 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage. Journal of Neurology, Neurosurgery and Psychiatry 1990;53:16‐22. - PMC - PubMed
    1. Barker WH, Mullooly JP. Stroke in a defined elderly population, 1967‐85. Stroke 1997;28:284‐90. - PubMed
    1. Bonita R, Broad JB, Beaglehole R. Changes in stroke incidence and case‐fatality in Auckland, New Zealand, 1981‐91. Lancet 1993;342:1470‐3. - PubMed
    1. Boter H, Delden JJM, Haan RJ, Rinkel GJE, the Home Evaluation of Stroke Induced Aid Study Group. Modified informed consent procedure: consent to postponed information. BMJ 2003;327:284‐5. - PMC - PubMed

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