FAMILY FUNCTION, STROKE RECOVRY, AND CAREGIVER OUTCOMES

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Of the estimated four million stroke survivors in the United States, approximately 66% live with moderate to severe impairment. Family caregivers have a major role in stroke survivors' recovery including all aspects of rehabilitation; however, caregivers may experience negative psychological and physical outcomes including increased risk of mortality. The effects of factors such as family functioning and characteristics of the stroke survivor (e.g. memory and behavior problems) on caregiver outcomes and stroke survivors' physical recovery are not well understood. Because of the variable trajectory of the stroke recovery process, a prospective longitudinal design based on the strength-vulnerability model will be used to study outcomes in a sample of 170 caregiver-stroke survivor dyads during the first year post stroke. This innovative proposal is a complementary sub-study to a national clinical trial, "Extremity Constraint Induced Therapy Evaluation (EXCITE)" developed in response to RFA NR-4-00-003. The purposes of the sub-study are to: (1) determine relationships among family caregiver outcomes (depression, fatigue and overall health), family functioning, and stroke survivor physical function and memory/behavior problems over time, (2) determine predictors of caregiver outcomes approximately one year post-stroke, and (3) examine the interaction of family function and the EXCITE treatment group on stroke survivor functional recovery. Data will be collected at baseline (3-6 months post-stroke), and four and eight months later via in-person administration of questionnaires and a semi-structured interview. A cost-effective strategy will combine prospectively collected caregiver data with stroke survivor data collected for the EXCITE clinical trial. Identification of the most salient factors associated with caregiver depression, fatigue, and health status at different points in recovery is essential for future development and testing of interventions to improve outcomes of caregivers and stroke survivors.