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. 2013 May 8;3(5):e002538.
doi: 10.1136/bmjopen-2012-002538.

Randomised controlled trial of an education and support package for stroke patients and their carers

Sally Eames  1 , Tammy Hoffmann, Linda Worrall, Stephen Read, Andrew Wong
Affiliations

Randomised controlled trial of an education and support package for stroke patients and their carers

Sally Eames et al. BMJ Open. .

Abstract

Objective: Tailoring stroke information and providing reinforcement opportunities are two strategies proposed to enhance the effectiveness of education. This study aimed to evaluate the effects of an education package which utilised both strategies on the knowledge, health and psychosocial outcomes of stroke patients and carers.

Design: Multisite, randomised trial comparing usual care with an education and support package.

Setting: Two acute stroke units.

Participants: Patients and their carers (N=138) were randomised (control n=67, intervention n=71) of which data for 119 participants (control n=59, intervention n=60) were analysed.

Intervention: The package consisted of a computer-generated, tailored written information booklet and verbal reinforcement provided prior to, and for 3 months following, discharge.

Outcome measures: Outcome measures were administered prior to hospital discharge and at 3-month follow-up by blinded assessors. The primary outcome was stroke knowledge (score range: 0-25). Secondary outcomes were: self-efficacy (1-10), anxiety and depression (0-21), ratings of importance of information (1-10), feelings of being informed (1-10), satisfaction with information (1-10), caregiver burden (carers) (0-13) and quality of life (patients) (1-5).

Results: Intervention group participants reported better: self-efficacy for accessing stroke information (adjusted mean difference (MD) of 1.0, 95% CI 0.3 to 1.7, p=0.004); feeling informed (MD 0.9, 95% CI 0.2 to 1.6, p=0.008); and satisfaction with medical (MD 2.0, 95% CI 1.1 to 2.8, p<0.001); practical (MD 1.1, 95% CI 0.3 to 1.9, p=0.008), services and benefits (MD 0.9, 95% CI 0.1 to 1.8, p=0.036) and secondary prevention information (MD 1.7, 95% CI 0.9 to 2.5, p<0.001). There was no significant effect on other outcomes.

Conclusions: Intervention group participants had improved self-efficacy for accessing stroke information and satisfaction with information, but other outcomes were not significantly affected. Evaluation of a more intensive intervention in a trial with a larger sample size is required to establish the value of an educational intervention that uses tailoring and reinforcement strategies. ACTRN12608000469314.

Keywords: Education & training (see Medical Education & Training); Rehabilitation medicine; Stroke < neurology.

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Figures

Figure 1
Figure 1
Flow chart of participants.
See this image and copyright information in PMC

References

    1. National Stroke Foundation Clinical guidelines for stroke management 2010. Melbourne: National Stroke Foundation, 2010
    1. Intercollegiate Stroke Working Party National guidelines for stroke: Third Edition. London: Royal College of Physicians, 2008
    1. American Heart Association Council on Cardiovascular Nursing and the Stroke Council Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke 2010;41:2402–48 - PubMed
    1. Hafsteinsdóttir TB, Vergunst M, Lindeman E, et al. Educational needs of patients with a stroke and their caregivers: a systematic review of the literature. Patient Educ Couns 2011;85:14–25 - PubMed
    1. Murray J, Young J, Forster A, et al. Developing a primary care-based stroke model: the prevalence of longer-term problems experienced by patients and carers. Br J Gen Pract 2003;53:803–7 - PMC - PubMed