A randomized controlled trial of an education and counselling intervention for families after stroke

Objectives: To determine whether education and counselling after stroke leads to improved family functioning and psychosocial outcomes for stroke patients and their spouses, and better functional and social outcomes for patients. Design: Two-group randomized controlled trial. Data were collected on admission to and discharge from rehabilitation, and again six months later. Setting: Rehabilitation units at Repatriation General Hospital and Griffith Hospital, in Adelaide, South Australia. Participants: Sixty-two stroke patients and their spouses, 32 in the intervention group and 30 in the control group. Intervention: Stroke information package and three visits from a social worker trained in family counselling. Outcome measures: Family functioning: McMaster Family Assessment Device (FAD); functional status: Barthel Index (BI); social recovery: Adelaide Activities Profile (AAP); depression: Geriatric Depression Scale (GDS); anxiety: Hospital Anxiety and Depression Scale (HADS); mastery: Mastery Scale (MS); health status: SF-36. Results: At six months the intervention group had better family functioning for both patients (mean FAD difference 0.19) and spouses (mean difference 0.09). A modest benefit in functional status for intervention patients (mean BI difference 1.3) was related to improved family functioning. Intervention patients reported better social recovery (mean AAP differences: domestic chores 5.7, household maintenance 4.6, social activities 11.5), but there were no significant effects on depression, anxiety, mastery or health status. Conclusions: An education and counselling intervention maintained family functioning, and in turn led to improved functional and social patient outcomes. This approach helps patients and their spouses to make the optimal adjustment to living with stroke.