Psychother Psychosom Med Psychol 2007; 57(1): e1-e19
DOI: 10.1055/s-2006-951847
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Interventionskonzepte für Angehörige von Schlaganfallpatienten: Bedarf und Effektivität

Interventions for Caregivers of Stroke Patients: Need and EffectivenessGabriele  Wilz1 , Birgit  Böhm1
  • 1Technische Universität Berlin, Fachbereich für Klinische und Gesundheitspsychologie
Further Information

Publication History

eingereicht 18. Sept. 2005

akzeptiert 1. Sept. 2006

Publication Date:
12 January 2007 (online)

Zusammenfassung

Die meisten Schlaganfallpatienten werden nach ihrer Entlassung aus der Klinik durch Angehörige betreut. Für die Angehörigen bedeutet dies in den meisten Fällen langfristige Anforderungen sowie häufig auch gesundheitliche Belastungen. Es existieren verschiedene Angebote, welche die Angehörigen bei dieser Aufgabe unterstützen und somit zu ihrer Entlastung beitragen sollen. Bisher ist jedoch nicht ausreichend untersucht, inwieweit die verschiedenen Interventionskonzepte den Bedarf der Angehörigen tatsächlich erfüllen und wie effektiv die Interventionen hinsichtlich der Verringerung von Belastungsstörungen sind. Bisher können fünf verschiedene Typen von Interventionskonzepten zur Unterstützung der Angehörigen von Schlaganfallpatienten unterschieden werden: Spezielle Dienstleistungen, Psychoedukation, psychotherapeutische Interventionen, soziale Unterstützung durch Betroffene und Mehrkomponenteninterventionen. Auf der Basis von 42 Interventionsstudien wird versucht, eine vorläufige Aussage zur Effektivität von Interventionskonzepten zu treffen. Die Mehrkomponentenintervention mit psychotherapeutischen Strategien erweist sich diesbezüglich als empfehlenswerte Variante.

Abstract

After discharge from hospital most stroke patients are being cared for by relatives. In the majority of cases it does mean long-term demands for relatives and often it has also an effect on their health. There is a variety of possibilities for offering support to relatives in accomplishing their tasks and thus contribute to a relief of burden. There has not yet been enough research investigating how various intervention concepts really meet the needs of the relatives and how effective the interventions reduce the burden of the caregivers. Five types of intervention concepts for supporting relatives of stroke patients can be differentiated so far: special services, training, counselling, social support through other caregivers and multi-component interventions. On the basis of 42 intervention studies an attempt is being made to give a preliminary statement about the effectiveness of intervention models. The multi-component interventions combined with psychotherapeutic strategies seem to emerge as a recommendable concept.

Literatur

  • 1 Diener H C, Hacke W, Forsting M. Schlaganfall. Stuttgart; Georg Thieme 2004
  • 2 Bundesministerium für Bildung und Forschung .Forschung in der Rehabilitation. 2004 Verfügbar unter http://www.bmbf.de/pub/forschung_in_der_rehabilitation.pdf
  • 3 Brainin M, Dachenhausen A, Steiner M. Epidemiologie des Schlaganfalls.  Wiener Med Wochenschrift. 2003;  153 3-5
  • 4 Kotila M, Numminen H, Waltimo O, Kaste M. Depression after stroke. Results of the FINNSTROKE study.  Stroke. 1998;  29 368-372
  • 5 Young Y, Murray J, Forster A. Review of longer-term problems after disabling stroke.  Clin Gerontol. 2003;  13 55-65
  • 6 Bishop D S, Evans R L. Families and stroke: the clinical implications of research findings.  Top Stroke Rehabil. 1995;  2 20-31
  • 7 Palmer S, Glass T A. Family function and stroke recovery: a review.  Rehabil Psychol. 2003;  48 255-265
  • 8 O'Connell B, Baker L, Prosser A. The educational needs of caregivers of stroke survivors in acute and community settings.  J Neurosci Nurs. 2003;  35 21
  • 9 Kwakkel G, Wagenaar R C, Kollen B J, Lankhorst G J. Predicting disability in stroke - a critical review of the literature.  Age and Ageing. 1996;  5 479-489
  • 10 Black T M, Soltis T, Bartlett C. Using the functional independence measure instrument to predict stroke rehabilitation outcomes.  Rehabil Nurs. 1999;  24 19-114, 121
  • 11 Evans R L, Bishop D S, Matlock A L. et al . Family interaction and treatment adherence after stroke.  Arch Phys Med Rehabil. 1987;  8 513-517
  • 12 Grant J S, Elliott T, Giger J N, Bartolucci A A. Social problem-solving abilities, social support and adjustment among family caregivers of individuals with a stroke.  Rehabil Psychol. 2001;  46 44-57
  • 13 Schneekloth U, Müller U. Wirkungen der Pflegeversicherung. Schriftenreihe des Bundesministeriums für Gesundheit. Baden-Baden; 2000: 127
  • 14 O'Connell B, Baker L. Managing as carers of stroke survivors: strategies from the field.  Int J Nurs Pract. 2004;  10 121-126
  • 15 Evans R L, Connis R T, Bishop D S. et al . Stroke: a family dilemma.  Disabil Rehabil. 1994;  3 110-118
  • 16 Evans R L, Matlock A L, Bishop D S. et al . Family intervention after stroke: Does counselling or education help?.  Stroke. 1988;  19 1243-1249
  • 17 Evans R L, Griffith J, Haselkorn J. et al . Poststroke family function: an evaluation of the family's role in rehabilitation.  Rehabil Nurs. 1992;  17 127-132
  • 18 Low J TS, Payne S, Roderick P. The impact of stroke on informal carers: a literature review.  Soc Sci Med. 1999;  49 711-725
  • 19 Brooks D N. The head-injured family.  J Clin Exper Neuropsychol. 1991;  13 155-188
  • 20 Stein P N, Wayne A G, Hibbard M R. An examination of depression in the spouses of stroke patients.  Rehabil Psychol. 1992;  37, 2 121-130
  • 21 Tyman R V. The stress experienced by caregivers of stroke survivors: is it all in the mind, or is it also in the body?.  Clin Rehabil. 1994;  8 341-345
  • 22 Williams A M. Caregivers of persons with stroke: their physical and emotional well-being.  Qual Life Res. 1993;  2 213-220
  • 23 Segal M E, Schall R R. Life satisfaction and caregiving stress for individuals with stroke and their primary caregivers.  Rehabil Psychol. 1996;  4 303-320
  • 24 Dennis M, O'Rourke S, Lewis S. et al . A quantitative study of the emotional outcome of people caring for stroke survivors.  Stroke. 1998;  29 1867-1872
  • 25 Kitze K, Gründel I, Lehmann A. et al . Psychische Belastungen bei Angehörigen von Schlaganfallpatienten.  Die Rehabilitation. 2002;  6 401-407
  • 26 Berg A, Palomäki H, Lönnqvist J. et al . Depression among caregivers of stroke survivors.  Stroke. 2005;  36 636-639
  • 27 Kinney J M, Stephens M, Franks M M, Norris V K. Stress and satisfaction of family caregivers to older stroke patients.  J Appl Gerontol. 1995;  14 3-21
  • 28 Forsberg-Wärleby G, Möller A, Blomstrand C. Life satisfaction in spouses of patients with stroke during the first year after stroke.  J Rehabil Med. 2004;  36 4-11
  • 29 Patel A, Knapp M, Evans A. et al . Training caregivers of stroke patients: economic evaluation.  Brit Med J. 2004;  328 1102-1104
  • 30 Bundesministerium für Familie, Frauen, Senioren und Jugend .Dritter Bericht zur Lage der älteren Generation in der Bundesrepublik Deutschland: Alter und Gesellschaft. Deutscher Bundestag, Drucksache 14/5130 2001
  • 31 Reiss D, Gonzalez S, Kramer N. Family process, chronic illness, and death: on weakness of strong bonds.  Arch Gen Psych. 1986;  43 795-804
  • 32 Toseland R W, Rossiter C M, Labreque M S. The effectiveness of peerled and professionally led groups to support family caregivers.  Gerontol. 1989a;  29 465-471
  • 33 Toseland R W, Rossiter C M, Labreque M S. The effectiveness of three group intervention strategies to support family caregivers.  Am J Orthopsych. 1989b;  59, 3 420-429
  • 34 Korner-Bitensky N, Tarasuk J, Nelles J, Bouchard J M. The impact of interventions with families poststroke: a review.  Topics in Stroke Rehabil. 1998;  5, 3 69-85
  • 35 Lui M HL, Ross F M, Thompson D R. Supporting family caregivers in stroke care - a review of the evidence for problem solving.  Stroke. 2005;  36 2514-2522
  • 36 Wiles R, Pain H, Buckland S, McLellan L. Providing appropriate information to patients and carers following a stroke.  J Adv Nurs. 1998;  28 794-801
  • 37 Gründel I, Lehmann A, Cramon D Y von, Wilz G. Der Unterstützungsbedarf von Angehörigen während der stationären Rehabilitation von Schlaganfallpatienten.  Praxis Klin Verhaltensmed Rehabil. 2001;  56 280-288
  • 38 Sörensen S, Pinquart M, Duberstein P. How effective are interventions with caregivers? An updated metaanalysis.  Gerontol. 2002;  42 356-372
  • 39 Visser-Meily A, Heugten C van, Post M. et al . Intervention studies for caregivers of stroke survivors: a critical review.  Pat Educ Couns. 2005;  56 257-267
  • 40 Heuvel E TP Van den, Witte L P de, Nooyen-Haazen I. et al . Short term effects of a group support program and an individual support program for caregivers of stroke patients.  Pat Educ Couns. 2000;  40 109-120
  • 41 Heuvel E TP van den, Witte L P de, Stewart R E. et al . Long-term effects of a group support program and an individual support program for informal caregivers of stroke patients: which caregivers benefit the most?.  Pat Educ Couns. 2002;  47 291-299
  • 42 Visser-Meily A, Post M, Riphagen I, Lindemann E. Measures used to assess burden among caregivers of stroke patients: a review.  Clin Rehabil. 2004;  18 1-23
  • 43 Zarit S H, Zarit J M. The memory and behavior problems checklist and the burden interview. Pennstate University: Gerontology Center 1983, 1990
  • 44 Bullinger M, Kirchberger I. Der SF-36 Fragebogen zum Gesundheitszustand. Göttingen, Bern, Toronto, Seattle; Hogrefe 1998
  • 45 Goldberg D P, Hillier V F. A scaled version of the general health questionnaire.  Psychol Med. 1979;  9 139-145
  • 46 Larsen D L, Attkisson C C, Hargreaves W A, Nguyen T D. Assessment of client/patient satisfaction.  Eval Progr Plan. 1979;  2 197-207
  • 47 Beck A T, Hautzinger M, Bailer M. et al .Beck-Depressions-Inventar. Göttingen, Bern, Toronto, Seattle; Hogrefe 1995
  • 48 Margraf J, Ehlers A. Beck Angstinventar. Deutsche Version (BAI). Testhandbuch. Göttingen; Hogrefe in Vorbereitung
  • 49 Holroyd J. Questionnaire on resources and stress: for families with chronically ill or handicapped members. Clin Psychol Pub Comp Inc 1987
  • 50 Evans R L, Pomeroy S, Weele T van der, Hammond M C. Reliability of a stroke care information test for family caretakers.  Int J Rehabil Res. 1985;  8 199-201
  • 51 Epstein N B, Baldwin L M, Bishop D S. Family Assessment Device (FAD). Brown University/Butler Hospital Fam Res Progr 1983
  • 52 Holbrook M, Skilbeck C E. An activities index for use with stroke patients.  Age Ageing. 1983;  12 166-170
  • 53 Pearlin L I, Mullan J T, Semple S J, Skaff M M. Caregiving and stress process: an overview of concepts and their measures.  Gerontol. 1990;  30, 5 583-594
  • 54 Janke W, Erdmann G, Kallus W. Stressverarbeitungsfragebogen (SVF). Göttingen; Hogrefe 2002
  • 55 Brähler E, Schumacher J, Scheer J W. Der Gießener Beschwerdebogen (GBB-24). Bern; Huber 1995
  • 56 Crewe N M. Training Course: stroke in your family.  Rehabil Rec. 1969;  10, 1 32-34
  • 57 Dzau R E, Boehme A R. Stroke rehabilitation: a family-team education program.  Arch Phys Med Rehabil. 1978;  59 236-239
  • 58 Evans R L, Held S. Evaluation of family stroke education.  Int J Rehabil Res. 1984;  7 47-51
  • 59 Borenstein P, Linell S, Währborg P. An innovative therapeutic program for aphasia patients and their relatives.  Scand J Rehabil Med. 1987;  19 51-56
  • 60 Pain H SB, McLellan D L. The use of individualized booklets after a stroke.  Clin Rehabil. 1990;  4 265-272
  • 61 Printz-Fedderson V. Group process effect on caregiver burden.  J Neurosci Nurs. 1990;  22 164-168
  • 62 Braithwaite V, McGown A. Caregivers emotional well-being and their capacity to learn about stroke.  J Adv Nurs. 1993;  18 195-202
  • 63 Oehring A K, Oakley J L. The young stroke patient: a need for specialized group support systems.  Topics in Stroke Rehabil. 1994;  1, 1 25-40
  • 64 Hinckley J J, Packard M EW, Bardach L G. Alternative family education programming for adults with chronic aphasia.  Topics in Stroke Rehabil. 1995;  2 53-63
  • 65 Forster A, Young J. Specialist nurse support for patients with stroke in the community: a randomized controlled trial.  Brit Med J. 1996;  312 1642-1644
  • 66 Dennis M, O'Rourke S, Slattery J. et al . Evaluation of a stroke family care worker: results of a randomised controlled trial.  Brit Med J. 1997;  314 1071-1077
  • 67 Goldberg G, Segal M E, Berk S N. et al . Stroke transition after inpatient rehabilitation.  Topics in Stroke Rehabil. 1997;  4 64-79
  • 68 Rudd A G, Wolfe C DA, Tilling K, Beech R R. Randomised controlled trial to evaluate early discharge scheme for patients with stroke.  Brit Med J. 1997;  315 1039-1044
  • 69 Mant J, Carter J, Wade D T, Winner S. The impact of an information pack on patients with stroke and their carers: a randomized controlled trail.  Clin Rehabil. 1998;  12 465-476
  • 70 Brown R, Pain K, Berwald C. et al . Distance education and caregiver support groups: comparison of traditional and telephone groups.  J Head Trauma Rehabil. 1999;  14, 3 257-268
  • 71 Grant J S. Social problem-solving partnerships with family caregivers.  Rehabil Nurs. 1999;  24 254-260
  • 72 Rodgers H, Atkinson C, Bond S. et al . Randomized controlled trial of a comprehensive stroke education program for patients and caregivers.  Stroke. 1999;  30 2585-2591
  • 73 Rodgers H, Bond S, Curless R. Inadequacies in the provision of information to stroke patients and their families.  Age Ageing. 2001;  30 129-133
  • 74 Glass T A, Dym B, Greenberg S. et al . Psychosocial intervention in stroke: families in recovery from stroke trial (FIRST).  Am J Orthopsych. 2000;  70, 2 169-181
  • 75 Anderson C S, Rubenach S, Mhurchu C N. et al . Home or hospital for stroke rehabilitation? Results of a randomized controlled trail. I. health outcomes at 6 months.  Stroke. 2000;  31 1024-1031
  • 76 Holmqvist L W, Koch L von, Pedro-Cuesta J de. Use of healthcare, impact on family caregivers and patient satisfaction of rehabilitation at home after stroke in southwest Stockholm.  Scand J Rehabil Med. 2000;  32 173-179
  • 77 Jones A L, Charlesworth J F, Hendra T J. Patient mood and carer strain during stroke rehabilitation in the community following early hospital discharge.  Disabil Rehabil. 2000;  22 490-494
  • 78 Mant J, Carter J, Wade D T, Winner S. Family support for stroke: a randomised controlled trial.  Lancet. 2000;  356 808-813
  • 79 McKinney M, Blake H, Treece K A. et al . Evaluation of cognitive assessment in stroke rehabilitation.  Clin Rehabil. 2002;  16 129-136
  • 80 Grant J S, Elliott T R, Weaver M. et al . Telephone intervention with family caregivers of stroke survivors after rehabilitation.  Stroke. 2002;  33 2060-2065
  • 81 Heier H H, Lämmler G, Steinhagen-Thiessen E. Evaluation eines psychoedukativen Kurses für Angehörige von Schlaganfallpatienten.  Zeitschr Neuropsychol. 2002;  13 201-209
  • 82 Sulch D, Melbourn A, Perez I, Kalra L. Integrated care pathways and quality of life on stroke rehabilitation unit.  Stroke. 2002;  33 1600-1604
  • 83 Clark M S, Rubenach S, Winsor A. A randomized controlled trial of an education and counselling intervention for families after stroke.  Clin Rehabil. 2003;  17 703-712
  • 84 Hartke R J, King R B. Telephone group intervention for older stroke caregivers.  Topics in Stroke Rehabil. 2003;  9 65-81
  • 85 Teng J, Mayo N E, Latimer E. et al . Costs and caregiver consequences of early supported discharge for stroke patients.  Stroke. 2003;  34 528-536
  • 86 Lincoln N B, Francis C M, Lilley S A. et al . Evaluation of a stroke family support organizer: a randomized controlled trial.  Stroke. 2003;  34 116-121
  • 87 Smith J, Forster A, Young J. A randomized trial to evaluate an education programme for patients and carers after stroke.  Clin Rehabil. 2004;  18 726-736
  • 88 Kalra L, Evans A, Perez I. et al . Training carers of stroke patients: a randomized controlled trial.  Brit Med J. 2004;  328 1099-1104
  • 89 Glass T A, Berkman L F, Hiltunen E F. et al . The families in recovery from stroke trial (FIRST): primary study results.  Psychsom Med. 2004;  66, 6 889-897
  • 90 Larson J, Franzen-Dahlin A, Billing E. et al . The impact of a nurseled support and education programme for spouses of stroke patients: a randomized controlled trial.  J Clin Nurs. 2005;  14, 8 995-1003
  • 91 Mant J, Winner S, Roche J, Wade D T. Family support for stroke: one year follow up of a randomised controlled trial.  J Neurol Neurosurg Psychiatry. 2005;  76, 7 1006-1008
  • 92 Forster A, Smith J, Young J. et al .Information provision for stroke patients and their caregivers. The Cochrane Database of Systematic Reviews 2001 Issue 3 Art. No.: CD001919. DOI: DOI: 10.1002/14651858.CD001919
  • 93 Gatz M, Bengtson V L, Blum M J. Caregiving families. In: Birren JE, Schaie KW (eds) Handbook of the Psychology of Aging. 3rd ed. New York; Academic Press 1990: 405-426
  • 94 Meichenbaum D. Cognitive behaviour modification: an integrative approach. New York; Plenum Press 1977
  • 95 Bakas T, Austin J K, Okonkwo K F. et al . Needs, concerns, strategies, and advice of stroke survivors the first 6 months after discharge.  J Neurosci Nurs. 2002;  34 242-251
  • 96 Schulz R, O'Brien A, Czaja S. et al . Dementia caregiver intervention research: in search of clinical significance.  Gerontol. 2002;  42 589-602
  • 97 Brodaty H, Green A B, Koschera A. Metaanalysis of psychosocial interventions for caregivers of people with dementia.  J Am Geriatr Soc. 2003;  51 657-664

Prof. Dr. Gabriele Wilz

Technische Universität Berlin, Fachbereich für Klinische und Gesundheitspsychologie

Franklinstraße 28/29

10587 Berlin

Email: gabriele.wilz@gp.tu-berlin.de