Associations of Participation-Focused Strategies and Rehabilitation Service Use With Caregiver Stress After Pediatric Critical Illness.
Jessica M Jarvis, Karen Choong, Mary A Khetani
PMID 30578773WHAT IT FOUND
After PICU discharge, caregivers whose children received PICU rehabilitation and reported home participation strategies had stress that declined over 6 months.
Strategies alone were not shown to lower stress. This is not proof that rehabilitation caused the change.
Key findings
01Mean caregiver stress frequency decreased from 134.0 at PICU discharge to 101.9 at 6 months, and mean stress difficulty decreased from 118.6 to 93.3 over the same period.
02The interaction of participation-focused strategies, PICU rehabilitation, and time was associated with lower stress: stress frequency decreased by 21.31 and stress difficulty decreased by 24.46 at each observation for caregivers with strategies whose child received PICU rehabilitation.
03The participation-strategies-by-time interaction was associated with higher caregiver stress frequency, increasing by 15.01 for each unit increase in time.
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
This was an observational secondary analysis of a cohort, not a randomised trial, so it cannot show that rehabilitation caused caregiver stress to fall. PICU rehabilitation was combined across physical, occupational, and speech therapy, so the contribution of any single discipline cannot be separated. Rehabilitation service use was only yes or no; it did not capture session frequency, duration, caregiver satisfaction, or services after discharge. The study excluded 12 caregivers who were missing all three waves of stress or strategy data, and 114 strategy descriptions were excluded as unclear or not strategies. It did not measure socioeconomic status, family cohesion, or caregiver mental health before admission, which could influence both strategies and stress. Most participants were caregivers of children with a pre-existing condition, 119 of 168, so results may not apply equally to previously healthy children.
Declared interests
The supplied text does not include a conflict-of-interest declaration. The publication types list NIH extramural research support.
The easy way to misread this
Do not conclude that PICU rehabilitation caused caregiver stress to fall. The study only observed associations, and it combined physical, occupational, and speech therapy into one yes or no service-use variable, so it cannot show which service or how much was needed.