Association of formal and informal care with health-related quality of life and depressive symptoms: findings from the Caring for Adults Recovering from the Effects of Stroke study.
Chelsea Liu, Janet Prvu-Bettger, Orla C Sheehan and 2 others
PMID 31402719WHAT IT FOUND
Stroke survivors receiving only informal care reported significantly higher depressive symptoms than those receiving no care.
Shared care involving both formal and informal sources showed no difference in depression or quality of life compared to no care, despite the shared care group having more severe strokes.
Key findings
01Stroke survivors who received only informal care had significantly higher depressive symptoms compared to those who received no care.
02After adjusting for age, race, and disability, there was no difference in physical or mental health outcomes or depressive symptoms between those receiving shared care and those receiving no care.
03Patients receiving shared care had more severe strokes and greater functional dependence at discharge than those receiving no care.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample size is very small (123 participants), limiting the power to detect differences between care groups. Informal care hours were self-reported by caregivers and subject to recall bias. The study could not account for privately paid caregivers, meaning some patients classified as receiving 'informal' care may have actually received formal services outside of Medicare claims. The 'no care' group was significantly less disabled at baseline than the 'shared care' group, making direct comparisons difficult despite statistical adjustment. The study is observational and cannot prove that any specific type of care caused the observed outcomes.
Declared interests
The authors report no conflicts of interest. The study was supported by the National Institute on Aging and the National Institute of Neurological Disorders and Stroke.
The easy way to misread this
Do not conclude that formal therapy is ineffective because the shared care group did not show better outcomes than the no-care group. The shared care group had much more severe strokes and disability at discharge, while the no-care group was largely independent. The comparison is between very different populations, not equivalent groups.