***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Despite its high prevalence in stroke survivors , there is little clinical research on bowel dysfunction in this population . This is the first r and omized controlled trial to evaluate treatment of constipation and fecal incontinence in stroke survivors . Methods — Stroke patients with constipation or fecal incontinence were identified by screening question naire ( 122 community , 24 stroke rehabilitation in patients ) and r and omized to intervention or routine care ( 73 per group ) . The intervention consisted of a 1-off structured nurse assessment ( history and rectal examination ) , leading to targeted patient/carer education with booklet and provision of diagnostic summary and treatment recommendations ( after consultation with geriatrician ) to patient ’s general practitioner (GP)±ward physician . Results — Percentage of bowel movements ( BMs ) per week grade d as “ normal ” by participants in a prospect i ve 1-week stool diary was significantly higher in intervention versus control patients at 6 months ( 72 % versus 55 % ; P=0.027 ) , as was mean number of BMs per week ( 5.2 versus 3.6 ; P=0.005 ) . There was no significant reduction in fecal incontinence , although numbers were small . At 12 months , intervention patients were more likely to be modifying their diets ( odds ratio [ OR ] , 3.1 [ 1.2 to 8.0 ] ) and fluid intake ( OR , 4.2 [ 1.4 to 12.2 ] ) to control their bowels and to have visited their GP for their bowel problem ( OR , 5.0 [ 1.4 to 17.5 ] ) . GP prescribing of laxatives and suppositories was significantly influenced at 12 months . Conclusions — A single clinical /educational nurse intervention in stroke patients  effectively improved symptoms of bowel dysfunction up to 6 months later , changed bowel-modifying lifestyle behaviors up to 12 months later , and influenced patient – GP interaction and physician prescribing patterns BACKGROUND AND PURPOSE We report the findings of a r and omized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program ( SEP ) for patients and their informal carers . METHODS Two hundred four patients admitted with acute stroke and their 176 informal carers were r and omized to receive an invitation to the SEP or to receive conventional stroke unit care . The SEP consisted of one 1-hour small group educational session for in patients followed by six 1-hour sessions after discharge . The primary outcome measure was patient- and carer-perceived health status ( SF-36 ) at 6 months after stroke . Knowledge of stroke , satisfaction with services , emotional outcome , disability , and h and icap and were secondary outcome measures . RESULTS Only 51 of 108 ( 47 % ) surviving patients r and omized to the SEP completed the program , as did 20 of 93 ( 22 % ) informal carers of surviving patients .  Perceived health status ( Short Form 36 [ SF-36 ] health survey ) scores were similar for SEP patients and controls . Informal carers in the control group scored better on the social functioning component of the SF-36 than the SEP group ( P=0.04 ) . Patients and informal carers in the SEP group scored higher on the stroke knowledge scale than controls ( patients , P=0.02 ; carers , P=0 . 01 ) . Patients in the SEP group were more satisfied with the information that they had received about stroke ( P=0.004 ) . There were no differences in emotional or functional outcomes between groups . CONCLUSIONS Although the SEP improved patient and informal carer knowledge about stroke and patient satisfaction with some components of stroke services , this was not associated with an improvement in their perceived health status . Indeed , the social functioning of informal carers r and omized to the SEP was less than in the control group OBJECTIVE The objective of this study was to evaluate the strengths and weaknesses of a group support program and a home visiting program for family caregivers of stroke patients . It also examined the best fit between intervention variant and family caregiver and patient characteristics . van den Heuvel 's previous effect study showed positive effects of the same intervention program , but unlike our present study differences between the two support variants could not be measured . METHODS Of 257 family caregivers who were included and r and omly assigned to an intervention variant or a control group , 127 family caregivers completed the intervention in either the group program or the home visiting program . RESULTS Evaluation data showed that both intervention variants had been helpful and feasible , but home visit participants missed peer contact and follow-up contacts were missed in both intervention programs . In comparison to the home visiting program , the group program participants showed more benefit especially with respect to informational and emotional components . Caregivers ' preference for type of intervention revealed that both types of intervention had its supporters . Those that preferred the group program could be clearly characterised : they were burdened , lived with a more psychologically h and icapped relative , were using active coping strategies more frequently or lived in a region which is considered to be more sociable . CONCLUSION The present study adds extensively to van den Heuvel 's effect study with respect to discriminative aspects of group and home intervention programs and their respective benefits for specific family caregiver groups . PRACTICE IMPLICATION S In order to suitably match an intervention type with specific caregiver characteristics the intervention provider should utilize caregiver self- selection or undertake professional screening of caregiver burden . Telephone contacts should be offered in addition to the interventions Background Self-management is seen as a primary mechanism to support the optimization of care for people with chronic diseases such as symptomatic vascular disease . There are no established and evidence -based stroke-specific chronic disease self-management programs . Our aim is to evaluate whether a stroke-specific program is safe and feasible as part of a Phase II r and omized-controlled clinical trial . Methods Stroke survivors are recruited from a variety of sources including : hospital stroke services , local paper advertisements . Stroke South Australia newsletter ( volunteer peer support organization ) , Divisions of General Practice , and community service providers across Adelaide , South Australia . Subjects are invited to participate in a multi-center , single-blind , r and omized , controlled trial . Eligible participants are r and omized to either ; st and ard care , st and ard care plus a six week generic chronic condition self-management group education program , or , st and ard care plus an eight week stroke specific self-management education group program .  Interventions are conducted after discharge from hospital . Participants are assessed at baseline , immediate post intervention and six months . Study Outcomes The primary outcome measures determine study feasibility and safety , measuring , recruitment , participation , compliance and adverse events . Secondary outcomes include : positive and active engagement in life measured by the Health Education Impact Question naire , improvements in quality of life measured by the Assessment of Quality of Life instrument , improvements in mood measured by the Irritability , Depression and Anxiety Scale , health re source utilization measured by a participant held diary and safety . Conclusion The results of this study will determine whether a definitive Phase III efficacy trial is justified BACKGROUND Attention is currently focused on family care of stroke survivors , but the effectiveness of support services is unclear . We did a single-blind , r and omised , controlled trial to assess the impact of family support  on stroke patients and their carers . METHODS Patients with acute stroke admitted to hospitals in Oxford , UK , were assigned family support or normal care within 6 weeks of stroke . After 6 months , we assessed , for carers , knowledge about stroke , Frenchay activities index , general health question naire-28 scores , caregiver strain index , Dartmouth co-op charts , short form 36 ( SF-36 ) , and satisfaction scores , and , for patients , knowledge about stroke and use of services , Barthel index , Rivermead mobility index , Frenchay activities index , London h and icap scale , hospital anxiety and depression scales , Dartmouth co-op charts , and satisfaction . FINDINGS 323 patients and 267 carers were followed up . Carers in the intervention group had significantly better Frenchay activities indices ( p=0.03 ) , SF-36 scores ( energy p=0.02 , mental health p=0.004 , pain p=0.03 , physical function p=0.025 , and general health perception p=0.02 ) , quality of life on the Dartmouth co-op chart ( p=0.01 ) , and satisfaction with underst and ing of stroke ( 82 vs 71 % , p=0.04 ) than those in the control group . Patients ' knowledge about stroke , disability , h and icap , quality of life , and satisfaction with services and underst and ing of stroke did not differ between groups . Fewer patients in the intervention group than in the control group saw a physiotherapist after discharge ( 44 vs 56 % , p=0.04 ) , but use of other services was similar . INTERPRETATION Family support significantly increased social activities and improved quality of life for carers , with no significant effects on patients Background : The involvement of  five specialist nurses  in providing a stroke support service  was evaluated quantitatively in a recent r and omized controlled trial . This complementary study used qualitative methods to evaluate trial outcomes more comprehensively . Aims : To identify whether the nurses ' intervention may have influenced the process of stroke recovery . Method : A purpose fully selected sub sample of 30 patients and 15 care-givers were interviewed within 1 - 3 months of their final quantitative assessment ( 12 months after recruitment to the r and omized trial ) . Fifteen of the patients and eight of the care-givers had received visits from a specialist nurse .  A semi- structured interview was design ed to include questions on perceptions of the recovery process and evaluation of services received . Results : Some differences were evident between the accounts of control and intervention group subjects . The less tangible aspects of nurses ' interventions - concern , attention , empathy and interest , when combined with sound professional knowledge , had identifiable value to the patients and care-givers . It appeared that the nurses had employed considerable sensitivity and skill in identifying and responding to particular needs at appropriate times . Conclusion : The qualitative evaluation offers a different picture to the quantitative results of the r and omized controlled trial . In general , the findings of the qualitative study are more positive and encouraging than the quantitative results . The majority of patients and care-givers in the intervention group believed that they had benefited from the specialist nurse 's visits Purpose . We hypothesised that carers of stroke survivors who participate in the Web-based intervention , Caring∼Web © , would have higher well-being than non-Web users . We also postulated that those survivors whose carers participated in Caring∼Web would use fewer healthcare services . Method . A r and omised , two-group , repeated measures design was used . Subjects were recruited from four rehabilitation centres from which first-time stroke survivors were discharged to home in two Midwestern states . Of 144 carers screened , 103 carers of these survivors who were novice Internet users were assigned to a Web or non-Web user group . Seventy-three subjects completed the study . Intervention . Caring∼Web was a Web-based intervention of education and support provided to the Web user group for 1 year . A bi-monthly telephone survey collected data on all carers well-being ( perceived depression , life satisfaction ) and survivors healthcare service use ( self-reported provider and emergency department visits , hospital re-admissions , nursing home placement ) . Results . No statistical differences were found between the groups in carers well-being or in the number of provider visits for survivors . There were significant differences in emergency department visits ( p = 0.001 ) and hospital re-admissions ( p = 0.0005 ) related to the health of survivors . Conclusions . This Web-based intervention helped new carers make informed decisions about healthcare needs of stroke survivors , thus reducing service use Objectives To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity . Design Multicentre , multinational , r and omised clinical trial with masked outcome assessment . Setting Stroke units in Denmark , China , Pol and , and Estonia . Participants 314 patients with ischaemic stroke aged ≥40 years who were able to walk—157 ( mean age 69.7 years ) r and omised to the intervention , 157 ( mean age 69.4 years ) in the control group . Interventions Patients r and omised to the intervention were instructed in a detailed training programme before discharge and at five follow-up visits during 24 months . Control patients had follow-up visits with the same frequency but without instructions in physical activity . Main outcome measures Physical activity assessed with the Physical Activity Scale for the Elderly ( PASE ) at each visit . Secondary outcomes were clinical events . Results The estimated mean PASE scores were 69.1 in the intervention group and 64.0 in the control group ( difference 5.0 ( 95 % confidence interval −5.8 to 15.9 ) , P=0.36 . The intervention had no significant effect on mortality , recurrent stroke , myocardial infa rct ion , or falls and fractures . Conclusion Repeated encouragement and verbal instruction in being physically active did not lead to a significant increase in physical activity measured by the PASE score . More intensive strategies seem to be needed to promote physical activity after ischaemic stroke . Trial registration Clinical Trials Abstract Objectives : The purpose of this study was to examine demographic variables associated with anger and well-being in patients with stroke , to investigate the hypothesis that knowledge and behavior ( K&B ) therapy improves patients ’ emotional and physical well-being , and to discover psychological variables associated with therapeutic outcomes . Methods : Seventy-seven patients with hemiplegic stroke were r and omly assigned to either a control condition ( the conventional therapy ) or an experimental condition ( K&B therapy ) . Both the experimental and control groups received physical therapy , which included prescribed medications and rehabilitation training programs for body functions . 
    Output:
    
Qualitative analyses found no strong evidence of an effect on other outcomes .
Post-hoc subgroup analyses showed that active information had a significantly greater effect than passive information on patient mood but not on other outcomes .
There is evidence that information improves patient and carer knowledge of stroke , aspects of patient satisfaction , and reduces patient depression scores .
However , the reduction in depression scores was small and may not be clinical ly significant .
Although the best way to provide information is still unclear there is some evidence that strategies that actively involve patients and carers and include planned follow-up for clarification and reinforcement have a greater effect on patient mood