Information provision for stroke patients and their caregivers

Studies have shown that stroke survivors and their carers often report they have not been given enough information about stroke and feel unprepared for life after discharge from hospital. However, the best way to provide information after stroke is unclear. The authors of this review looked at the evidence for the effectiveness of providing information to patients, or carers of patients, who have had a stroke or transient ischaemic attack (TIA), sometimes called a mini-stroke. They examined randomised trials (studies) in which one group of stroke patients or carers who were given the intervention being tested (such as a course of lectures) was compared with a group of stroke patients or carers who received standard care. Twenty-one studies, involving 2289 patients and 1290 carers, are now included in this updated review. Overall, the studies showed that providing information to patients and carers improved their knowledge of stroke and increased patient satisfaction with some, but not all, of the information they received about stroke. There was also an effect on reducing patient depression, although the reduction was small and may not be enough to seem meaningful to patients. When information was provided in a way that more actively involved patients and carers, for example by offering repeated opportunities to ask questions, it had more effect on patient mood than information which was given on one occasion only. There is not much evidence that providing information had effects on other aspects of patient or carer stroke recovery such as independence or social activities.

Authors' conclusions: 

There is evidence that information improves patient and carer knowledge of stroke, aspects of patient satisfaction, and reduces patient depression scores. However, the reduction in depression scores was small and may not be clinically significant. Although the best way to provide information is still unclear there is some evidence that strategies that actively involve patients and carers and include planned follow-up for clarification and reinforcement have a greater effect on patient mood.

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Background: 

Research shows that stroke patients and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues.

Objectives: 

To assess the effectiveness of information provision strategies in improving the outcome for stroke patients or their identified caregivers, or both.

Search strategy: 

For this update we searched the Cochrane Stroke Group Trials Register (June 2012), the Cochrane Central Register of Controlled trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the NHS Economic Evaluation Database (EED), and the Health Technology Assessment (HTA) Database (The Cochrane Library June, 2012), MEDLINE (1966 to June 2012), EMBASE (1980 to June 2012), CINAHL (1982 to June 2012) and PsycINFO (1974 to June 2012). We also searched ongoing trials registers, scanned bibliographies of relevant articles and books and contacted researchers.

Selection criteria: 

Randomised trials involving patients or carers of patients with a clinical diagnosis of stroke or transient ischaemic attack (TIA) where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone.

Data collection and analysis: 

Two review authors independently assessed trial eligibility and methodological quality and extracted data. Primary outcomes were knowledge about stroke and stroke services, and impact on mood.

Main results: 

We have added four new trials to this update. This review now includes 21 trials involving 2289 patient and 1290 carer participants. Nine trials evaluated a passive and 12 trials an active information intervention. Meta-analyses showed a significant effect in favour of the intervention on patient knowledge (standardised mean difference (SMD) 0.29, 95% confidence interval (CI) 0.12 to 0.46, P < 0.001), carer knowledge (SMD 0.74, 95% CI 0.06 to 1.43, P = 0.03), one aspect of patient satisfaction (odds ratio (OR) 2.07, 95% CI 1.33 to 3.23, P = 0.001), and patient depression scores (mean difference (MD) -0.52, 95% CI -0.93 to -0.10, P = 0.01). There was no significant effect (P > 0.05) on number of cases of anxiety or depression in patients, carer mood or satisfaction, or death. Qualitative analyses found no strong evidence of an effect on other outcomes. Post-hoc subgroup analyses showed that active information had a significantly greater effect than passive information on patient mood but not on other outcomes.

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