[Show abstract][Hide abstract] ABSTRACT: Caring for a person who has experienced stroke can be a formidable task placing considerable demands upon the informal caregiver. Although the impact of caring on mental health has been well established, less convincing associations between caregiving and declining physical health have been reported. In order to examine the impact of caregiving over time on the physical health of individuals providing informal care for individuals with stroke, we conducted a review of the published literature.
Literature searches of three electronic databases were conducted for the years 1996-2008 to identify studies providing longitudinal data based on repeated quantitative assessment of physical health. Pooled analyses were conducted.
Sixteen studies were identified for inclusion. On the basis of pooled analyses, perceived physical health appeared stable over time. When comparisons to normative values were possible, the experience of health did not differ substantially from age- and sex-matched norms. Associations between physical health and psychological distress or well-being were identified.
Informal caregiving does not result, necessarily, in reduced physical health. Further study is required to examine the timing and nature of the relationship between psychological distress and physical health to inform provision of services intended to maintain caregiver health and well being.
No preview · Article · Jan 2010 · Disability and Rehabilitation
[Show abstract][Hide abstract] ABSTRACT: To apply a tool that purports to differentiate between efficacy and effectiveness studies to stroke rehabilitation trials and to evaluate its applicability and reliability.
Three raters developed item operational definitions before independently applying the seven-item scale to 151 randomized controlled trials (RCT), published during or after 1997, that evaluated either a pharmacologic (P, n=78) or a nonpharmacologic (NP, n=73) intervention. Inter-rater reliability was assessed for both individual items and total scores, separately for P and NP trials.
Item inter-rater reliability (multiple-rater kappa) ranged from 0.00 (95% CI [confidence interval]: -0.13, 0.13) to 0.85 (95% CI: 0.73, 0.98) and from 0.21 (95% CI: 0.08, 0.34) to 0.79 (95% CI: 0.66, 0.92) for P and NP RCTs, respectively. For the total score (dichotomized), kappa values were 0.43 (95% CI: 0.31, 0.56) and 0.51 (95% CI: 0.37, 0.64) for P and NP trials, respectively.
The tool provides a solid foundation on which to base further discussion of the differential criteria of efficacy-effectiveness trial design. Scale items should be properly operationalized depending on the research question of interest and evaluated for reliability before the scale is used for definitively judging a given study's design or the external validity of its results.
No preview · Article · Oct 2009 · Journal of clinical epidemiology
[Show abstract][Hide abstract] ABSTRACT: The objective of this two-phase study was to assess the adequacy of the reporting of concealed allocation (CA) in randomized controlled trials (RCTs) evaluating interventions associated with stroke rehabilitation.
In phase I of the study, 50 RCTs included in a systematic review were selected to establish agreement between two raters. Two investigators determined if the method described to conceal the randomization schedule was adequate, inadequate, or not reported. In phase II, using a larger sample size (n=165), the differences in the proportion of studies with and without adequate CA are reported for two comparisons: (1) pharmacological vs. nonpharmacological trials and (2) multicentered vs. single-site studies.
In both phases I and II, CA was described adequately in one-third of all studies sampled. The agreement between raters was 88% (small ka, Cyrillic=0.79; 95% confidence interval: 0.65, 0.94). No significant differences in the adequacy of reporting for CA were found with respect to study type (pharmacological vs. nonpharmacological), whereas multicentered trials reported adequacy of CA more frequently.
Although concealment of group allocation is an important feature of trial design, it was frequently not reported in many RCTs associated with stroke rehabilitation.
No preview · Article · Jul 2009 · Journal of clinical epidemiology