***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 — A large proportion of disabled stroke survivors live at home and are supported by informal caregivers . Identification of determinants of caregiver burden will help to target caregiver interventions . Methods — Data on patient , caregiver , and health and social support characteristics were collected prospect ively over 1 year in 232 stroke survivors in a r and omized trial of caregiver training .  The contribution of these variables to caregiver burden score ( CBS ) and quality of life ( QOL ) measures at 3 months and 1 year was analyzed using regression models . Results — Stroke patients had a mean age of 74±11 years , and 120 ( 52 % ) were men . The mean age of caregivers was 65.7±12.5 years , 149 ( 64 % ) were females , and 116 ( 50 % ) had received caregiver training .  The mean CBS was 48±13 and 38±11 ( score range of bad to good 88 to 22 ) and QOL score was 75±16 and 75±15 ( score range of bad to good 0 to 100 ) at 3 months and 1 year , respectively . CBS and QOL correlated with each other and with patient ( age , dependency , and mood ) , caregiver ( age , gender , mood , and training ) , and support ( social services and family networks ) variables . Of these , only patient and caregiver emotional status , caregiver age and gender , and participation in caregiver training  were independent predictors of either outcome at 3 months . Patient dependency and family support were additional independent predictors at 1 year . Social services support predicted institutionalization but not caregiver outcomes . Conclusion — Advancing age and anxiety in patients and caregivers , high dependency , and poor family support identify caregivers at risk of adverse outcomes , which may be reduced by caregiver training 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 The goal of this pilot study was to compare the effectiveness of home and telephone social problem-solving partnerships on primary family caregiver outcomes and to determine whether certain caregiver and stroke survivor characteristics influenced these outcomes . Thirty primary family caregivers were assigned to either a home visit , telephone contact , or control group . A registered nurse trained caregivers in the intervention groups in a series of seven telephone calls or home visits during a 12-week period to use social problem-solving skills in managing caregiving problems . Primary family caregiver outcomes were compared before the intervention , during the intervention ( at 2 and 5 weeks after discharge ) , and after the intervention ( at 13 weeks after discharge ) . Compared to the home and control groups , the telephone group had a significant reduction in depression , more positive problem-solving skills , and greater caregiver preparedness during the intervention , and improved , but nonsignificant depression , problem-solving , and caregiver preparedness scores postintervention . Race , age , and education were significant for selected outcomes Background and Purpose — There is inconclusive evidence of the effectiveness of the Stroke Family Support Organiser ( FSO ) service . We report the results from a r and omized controlled trial of the service . Methods — Stroke patients admitted to hospital and their informal caregivers were r and omly allocated to receive the FSO service ( n=126 ) or st and ard care ( n=124 ) . Outcome assessment s were undertaken 4 and 9 months after recruitment with the General Health Question naire 12 , Carer Strain Index , Barthel Index , Extended Activities of Daily Living scale , and a specially design ed question naire to determine knowledge of stroke and satisfaction with services . Results — There were no significant differences between groups in patients ’ mood and independence in personal or instrumental activities of daily living or caregivers ’ mood , strain , or independence . Patients in the intervention group were significantly more knowledgeable about whom to contact for stroke information , reducing the risk of stroke , practical help , community services , and emotional support . Patients in the intervention group were also significantly more satisfied with the stroke information received . Caregivers in the intervention group were significantly more knowledgeable about whom to contact for information on stroke , reducing the risk of stroke , community services , and emotional support . Caregivers in the intervention group were also significantly more satisfied with stroke information . Conclusions — The FSO service had no significant effect on mood , independence in activities of daily living , or reduction in caregiver strain , but it did increase knowledge of stroke and satisfaction with that knowledge . The results may not be representative of all FSO services , and the sample was small relative to the heterogeneity of the participants . However , results suggest that the policies and training procedures of FSOs need to be evaluated to ensure that a cost-effective service is being provided to stroke patients and their caregivers BACKGROUND AND PURPOSE We wished to examine the effectiveness of an early hospital discharge and home-based rehabilitation scheme for patients with acute stroke . METHODS This was a r and omized , controlled trial comparing early hospital discharge and home-based rehabilitation with usual inpatient rehabilitation and follow-up care . The trial was carried out in 2 affiliated teaching hospitals in Adelaide , South Australia . Participants were 86 patients with acute stroke ( mean age , 75 years ) who were admitted to hospital and required rehabilitation . Forty-two patients received early hospital discharge and home-based rehabilitation ( median duration , 5 weeks ) , and 44 patients continued with conventional rehabilitation care after r and omization . The primary end point was self-reported general health status ( SF-36 ) at 6 months after r and omization . A variety of secondary outcome measures were also assessed . RESULTS Overall , clinical outcomes for patients did not differ significantly between the groups at 6 months after r and omization , but the total duration of hospital stay in the experimental group was significantly reduced ( 15 versus 30 days ; P<0.001 ) . Caregivers among the home-based rehabilitation group had significantly lower mental health SF-36 scores ( mean difference , 7 points ) . CONCLUSIONS A policy of early hospital discharge and home-based rehabilitation for patients with stroke can reduce the use of hospital rehabilitation beds without compromising clinical patient outcomes . However , there is a potential risk of poorer mental health on the part of caregivers . The choice of this management strategy may therefore depend on convenience and costs but also on further evaluations of the impact of stroke on caregivers Much attention has been placed on the need to develop and evaluate complex interventions targeting public health issues , such as reproductive health . However , and as has been the case in the recent past , even well- design ed trials will be flawed unless meticulous attention is paid to ensuring the most appropriate intervention is design ed and developed . This requires a well-re source d and carefully planned feasibility study , incorporating both formative and process evaluation , with particular attention being paid to the context of the proposed intervention . In this paper , we describe the way in which a feasibility study helped re design and shape a complex intervention targeting adolescent sexual health in rural Zimbabwe . By using a mixture of in-depth interviews , focus groups and participant observation with pupils , parents , teachers and education officers , we were able to show that the intervention as originally conceived was unlikely to be deliverable . Process evaluation findings from the feasibility study led to substantial changes to both the content and delivery of the proposed intervention , which is now subject to testing for effectiveness in a large community r and omized trial Abstract Purpose : This study evaluated the effectiveness of telephone groups for older , spousal caregivers of stroke survivors . Method : The 88 caregivers were mostly white females who were 70 years old on average and who had been providing care for an average of 3 years . Participants were r and omized to treatment or control conditions , followed for 6 months , and assessed for depression , burden , loneliness , stress , and competence . Treatment participants engaged in an eight-session psychoeducational telephone group . Results : Treatment participants showed decreased stress over time but were not significantly different from control participants in the amount of change in stress . Control participants showed a significant increase in burden during the study ; treatment participants showed a significant increase in competence Background and Purpose — Social problem-solving therapy shows promise as an intervention to improve the well-being of  family caregivers .  There is some evidence that training in problem solving may be effectively delivered by telephone . The purpose of this study was to quantify the impact of social problem-solving telephone partnerships on primary family caregiver outcomes after stroke survivors are discharged home from a rehabilitation facility . Methods — Using a r and omized 3-group repeated- measures experimental design , 74 stroke survivors with an admitting diagnosis of ischemic stroke and their primary family caregivers were entered into the study . The intervention consisted of an initial 3-hour home visit between a trained nurse and the family caregiver within 1 week after discharge to begin problem-solving skill training . This initial session was followed by weekly ( the first month ) and biweekly ( the second and third month ) telephone contacts . Results — Compared with the sham intervention and control groups , family caregivers who participated in the social problem-solving telephone partnership intervention group had better problem-solving skills ; greater caregiver preparedness ; less depression ; and significant improvement in measures of vitality , social functioning , mental health , and role limitations related to emotional problems . There were no significant differences among the groups in caregiver burden . Satisfaction with healthcare services decreased over time in the control group while remaining comparable in the intervention and sham intervention groups . Conclusion — These results indicate that problem-solving training may be useful for family caregivers of stroke survivors after discharge from rehabilitative facilities Abstract Background Training care givers reduces their burden and improves psychosocial outcomes in care givers and patients at one year . However , the cost effectiveness of this approach has not been investigated . Objective To evaluate the cost effectiveness of caregiver training by examining health and social care costs , informal care costs , and quality adjusted life years in care givers . Design A single , blind , r and omised controlled trial . Setting Stroke rehabilitation unit . Subjects 300 stroke patients and their care givers . Interventions Caregiver training in basic nursing and facilitation of personal care techniques compared with no caregiver training . Main outcome measures Health and social care costs , informal care costs , and quality adjusted life years in care givers over one year after stroke . Results Total health and social care costs over one year for patients whose care givers received training were significantly lower ( mean difference -£4043 ( $ 7249 ; € , 95 % confidence interval -£6544 to -£1595 ) . Inclusion of informal care costs , which were similar between the two groups , did not alter this conclusion . The cost difference was largely due to differences in length of hospital stay . The EQ-5D did not detect changes in quality adjusted life years in care givers . Conclusion Compared with no training , caregiver training during rehabilitation of patients  reduced costs of care while improving overall quality of life in care givers at one year Objective : To investigate whether spouses ' psychological well-being changed between the first weeks after their partner 's stroke and four months and one year later , and to study the relationship between spouses ’ psychological well-being and objective characteristics of the stroke patients . Design : Prospect i ve , longitudinal study . Setting : Hospital care and follow-ups . Subjects : Sixty-seven consecutively enrolled spouses to first-ever stroke patients B/ 75 years . Main measures : The  Psychological General Well-Being ( PGWB ) Index . Clinical examination of the stroke patients . The Barthel Index . Results : The spouses ' psychological well-being was significantly lower in the first weeks after their partner 's stroke as compared with norms . At four months , it had increased significantly . Between four months and one year , individual changes were observed in both positive and negative directions ; thus , the mean level of the group remained constant . The spouses ’ psychological well-being in the first weeks was significantly related to the patients ’ sensorimotor impairments , while it was related at four months to cognitive impairment and the patients ’ abilities in self-care . At one year , psychological well-being was related to remaining sensorimotor and cognitive impairments . A significant relationship was also seen between the spouses ’ and the stroke patients ’ emotional health . Conclusions : The spouses ' psychological well-being increased after the first chaotic weeks . The presence of visible impairments initially seemed to affect spouses ’ emotional health , while cognitive and emotional impairments became more evident in everyday life . 
    Output:
    
The presence of a conceptual basis for interventions does not appear to influence effectiveness