Roles of Changing Physical Function and Caregiver Burden on Quality of Life in Stroke

Research has shown that stroke has a significant impact on the stroke survivor’s quality of life (QOL). Less well known is the negative impact on the stroke caregiver’s QOL. Yet, poor QOL in caregivers is associated with rehospitalization of the stroke survivor and increased healthcare costs. Given the severe disability and limitations in activities of daily living present in stroke, caregivers have been found to experience high levels of burden (ie, the overall impact of the physical, psychological, and social demands of caregiving) and unpreparedness. Caregivers experiencing high levels of burden report lower QOL. Although research has found that QOL of survivors and their caregivers is interdependent in stroke, to our knowledge, only one study has used a statistical approach that controls for this interdependence within stroke dyads. The majority of studies either have conducted separate analyses for survivor and caregiver or have used traditional methods (eg, Pearson correlation) that greatly limit the ability to examine the transactional nature of the caregiving dyad. Moreover, only 3 studies were found that examined QOL in stroke survivors and caregivers over time. For example, Chuluunbaatar et al conducted separate analyses of survivor and caregiver QOL over a year and found that although physical and overall QOL did not improve in stroke survivors, environmental QOL did. In caregivers, psychological and environmental QOL improved over time, whereas physical QOL decreased. Survivor physical functioning and caregiver burden may change over time, but patterns of these changes and their influence on the dyad’s QOL are unknown. Background and Purpose—The purpose of this study was to examine changes in stroke survivor and caregiver quality of life (QOL) and to determine whether changes in survivor physical functioning and caregiver burden (ie, the impact of the physical, psychological, and social demands of caregiving) influence changes in QOL. Methods—Longitudinal design with 226 stroke survivor–caregiver dyads enrolled at survivor discharge from rehabilitation hospitals. Data collection was performed over 12 months. We measured survivor physical functioning, caregiver burden, and QOL (physical, psychological, social, and environmental) in both survivor and caregiver. Multilevel modeling was used to control for the interdependence of the data. Results—Survivors (50% male sex) and caregivers (66% female sex) were 70.8 (SD=11.9) and 52.4 (SD=13.1) years old, respectively. Over the 12 months, stroke survivor’s physical (γ=1.59; P<0.001) and psychological (γ=0.86; P<0.05) QOL significantly improved; social and environmental QOL did not P>0.05. Caregiver QOL, on average, did not significantly change over time P>0.05. Improvements in survivor physical functioning were associated with increases in survivor and caregiver physical and psychological QOL and survivor environmental QOL. Decreases in caregiver burden were significantly associated with improvements in caregiver physical, psychological, and environmental QOL but not with survivor QOL. Conclusions—QOL of stroke survivors and caregivers covaries and is greatly impacted by the physical function changes of the survivor. Dyadic approaches to stroke rehabilitation that acknowledge the interdependence of dyads are needed. (Stroke. 2017;48:733-739. DOI: 10.1161/STROKEAHA.116.014989.)