How is carer strain related to the recovery of stroke survivors with right hemisphere dysfunction? Implications for practice

Abstract

Aim

Right hemisphere strokes are associated with neuro-behavioural impairments including hemi-inattention, impulsiveness and anosognosia, which can impede stroke recovery and adversely affect carer health. This study explored the impact of associated impairments on carer strain and depression through a mixed methods approach.

Method

Fifty-one carer-survivor dyads were recruited from inpatient rehabilitation units and followed-up for 6 months. Validated measures assessed survivors’ physical and cognitive function and carers’ strain and depression levels. Survey methods captured qualitative experiences of the caring role. Data collection occurred at baseline, discharge, 6 weeks post-discharge and 6 months. Multilevel-modelling and thematic data analysis, were employed.

Results

Carer strain median scores were within normal ranges of the Caregiver Strain Index scale. Carer strain was positively linked to carer depression, number of carers’ concerns reported and survivors’ anosognosia levels. Carer strain was negatively linked to the survivors’ functional and cognitive abilities. Carers’ experiences differed qualitatively with caring concerns increasing over time.

Conclusion

Carer strain worsens with increases in significant concerns about the rehabilitation process and poor survivor functioning skills, which potentially increase risk of depression in carers. Consequently, improving right-hemisphere stroke survivors’ recovery and nurturing the carer-survivor relationship are likely to enhance overall outcomes and caring experiences.

IMPLICATIONS FOR REHABILITATION

• In the context of right hemisphere stroke: Carer assessment should be comprehensive and include a measure of perceived ability to care.

• Less strained carers tend to report fewer caring concerns and have lower depression levels.

• Education, training and practical support should be tailored to carer identified needs, abilities and the caring context.

Keywords:

• Stroke
• caregivers
• strain
• cognition
• depression
• empathy

Disclosure statement

No potential conflict of interest was reported by the author(s).