(WITHDRAWN) Stroke Survivors' Transition Home and the Survivor-Caregiver Relationship

Background and Purpose: Most stroke patients return home either directly from the hospital or from inpatient rehabilitation. Once home, family and friends provide the majority of care. A variety of stroke survivor and caregiver outcomes have been examined, however less attention has been given to date on the effect of caregiving on the survivor-caregiver relationship itself. This study uses secondary data from the Michigan Stroke Transitions Trial (MISTT) to examine stroke survivors’ and caregivers’ perception of their relationship 90 days after discharge home.

Methods: MISTT was an open-parallel, 3-group randomized, controlled trial that recruited both acute stroke patients and their caregivers. Caregivers were English-speaking adults identified by the patient as “the person most likely to be helping at home” with help defined as any medical, emotional, social, or environmental activity or support (e.g., help with self-care activities, transportation, medication management, housework). Data were collected by trained phone interviewers at 7 and 90 days after discharge home. This study uses data from 169 survivor-caregiver dyads. The dependent variable is the Dyad Relationship Scale at 90 days, an 11-item scale that measures survivor and caregiver strain and positive interactions within the context of the caregiving relationship. Predictors were measured at both 7 and 90 days and include the PROMIS Global 10, a measure of survivor mental and physical functioning, the PHQ9, and PROMIS measures of informational and emotional support. The APIM for distinguishable dyads was the conceptual model for analysis to examine how both members of the dyad affect the outcome. Mixed model analyses were conducted using the mixed command in Stata v.16.

Results: Across all models, stroke survivors reported significantly less strain and more positive interactions than caregivers. There were significant actor effects for all predictors. Specifically, individuals with a better assessment of the survivor’s mental and physical functioning and those with more informational and emotional support reported less strain and more positive interactions within the caregiving context at 90 days. The PHQ9 was the only predictor with both significant actor and partner effects. Individuals with more depressive symptoms at 7 days and those whose partner had more depressive symptoms at 7 days reported more strain at 90 days. Role (survivor vs. caregiver) significantly moderated the actor effect of the assessment of patient functioning on positive interactions with a steeper slope for caregivers than survivors.

Conclusions and Implications: Outcomes from this study suggest that the effect on the dyad relationship is different for stroke survivors and caregivers with survivors experiencing more positive interactions and caregivers experiencing more strain. Furthermore, with the exception of depressive symptoms, only the individual’s assessment of the survivor’s functioning and support influence their outcomes. In the case of depression, however, not only the individual’s depressive symptoms, but their partner’s has an effect. These results highlight the importance of assessing needs for both survivors and caregivers at discharge and providing support to the dyad as a unit as well as patients and caregivers individually.