The Role of Caregiver Involvement in Upper-Limb Treatment in Individuals With Subacute Stroke

Background. Initial severity of upper-limb motor impairment and exercise intensity are important predictors of improved upper-limb function during stroke rehabilitation. Initial severity of motor impairment, however, is not modifiable by rehabilitation, and increased one-on-one treatment is not always feasible. Alternative methods to increase intensity and improve upper-limb function are needed. Objective. The purpose of this study was to examine caregiver involvement in upper-limb treatment as a method to improve upper-limb function. Design. This study was a secondary analysis of a multi-site randomized controlled trial for upper-limb recovery during subacute inpatient stroke rehabilitation. Methods. Data from 50 individuals with subacute stroke who were randomly assigned to the experimental group (upper-limb exercise) were used for the analysis. Outcome variables were measured at baseline and at completion of the 4-week intervention. Group comparisons between participants with caregiver support and participants without caregiver support were done using an analysis of variance. Using the Fugl-Meyer Upper-Limb Motor Impairment Scale and time spent in treatment (intensity) as covariates, a multivariate regression analysis was performed to determine the additive value of caregiver support on upper-limb function, as measured by change scores on the Chedoke Arm and Hand Activity Inventory and the Motor Activity Log. Results. Group comparisons revealed that participants with caregiver support had improved upper-limb function compared with those without caregiver support and were more likely to increase the amount of time spent doing exercise. The multiple regression analysis showed that Fugl-Meyer score, treatment intensity, and caregiver support were significant predictors of upper-limb improvement (R-2 = .240-.292). In the regression models, caregiver support accounted for 5% to 9% of upper-limb improvement. Limitations. Support was coded as a dichotomous variable, and thus the degree of support or qualitative nature of support was not captured. Conclusions. Involvement of caregivers was a determinant of improved upper-limb function over and above initial severity of motor impairment and exercise intensity. Further research is needed to determine the optimal qualitative and quantitative elements of caregiver involvement in stroke rehabilitation in order to maximize results.