***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 
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    Input: 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 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 Abstract Background Depression occurs in up to 50 % of patients after stroke and limits rehabilitation and recovery . Mood disorders are also highly prevalent in carers ; their mental health intertwined with the physical and mental wellbeing of the person they are caring for . We argue that working with families , rather than patients alone may improve the treatment of depression in both patients and their carers enhancing the mental wellbeing and quality of life of both . Methods A single blind cluster r and omised controlled trial to evaluate whether families after stroke who are treated with the Depression Recognition and Treatment package ( DepReT-Stroke ) in addition to treatment as usual ( TAU )  show improved mental well being compared to those families who receive only TAU .  We aim to recruit one hundred and twenty-six families ( 63 in each group ) . The DepReT-Stroke intervention will help families to consider the various treatment options for depression , make choices about which are likely to fit best with their lives and support them in the use of self-help therapies ( e.g. computerised Cognitive Behavioural Therapy or exercise ) . An essential component of the DepReT-Stroke package will be to help people adhere to their chosen treatment(s ) . The primary outcome will be the Mental Component Subscale of the SF-36 assessed at baseline and again six months post intervention . Effectiveness of the intervention will be determined using analysis of co-variance ; comparing the mean change in MCS scores from baseline to six months follow-up adjusting for the clustering effects of baseline scores and family . An economic evaluation of the intervention will help us determine whether the intervention represents a cost-effective use of re sources . Discussion Depression both for patients and their carers is common after stroke . Our Dep ression Re cognition and T reatment package ( DepReT-stroke ) may help clinicians be more effective at detecting and managing a common co-morbidity that limits rehabilitation and recovery . Trial Registration IS RCT N : IS RCT N32451749 Research Ethics Committee Reference Number : 10/H0310/23Grant Reference Number : ( NIHR ) PB-PG-0808 - Background More than 60 % of new strokes each year are " mild " in severity and this proportion is expected to rise in the years to come . Within our current health care system those with " mild " stroke are typically discharged home within days , without further referral to health or rehabilitation services other than advice to see their family physician . Those with mild stroke often have limited access to support from health professionals with stroke-specific knowledge who would typically provide critical information on topics such as secondary stroke prevention , community reintegration , medication counselling and problem solving with regard to specific concerns that arise . Isolation and lack of knowledge may lead to a worsening of health problems including stroke recurrence and unnecessary and costly health care utilization . The purpose of this study is to assess the effectiveness , for individuals who experience a first " mild " stroke , of a sustainable , low cost , multimodal support intervention ( comprising information , education and telephone support ) - " WE CALL " compared to a passive intervention ( providing the name and phone number of a re source person available if they feel the need to ) - " YOU CALL " , on two primary outcomes : unplanned-use of health services for negative events and quality of life . Method / Design We will recruit 384 adults who meet inclusion criteria for a first mild stroke across six Canadian sites . Baseline measures will be taken within the first month after stroke onset . Participants will be stratified according to comorbidity level and r and omised to one of two groups : YOU CALL or WE CALL . Both interventions will be offered over a six months period . Primary outcomes include unplanned use of heath services for negative event ( frequency calendar ) and quality of life ( EQ-5D and Quality of Life Index ) . Secondary outcomes include participation level ( LIFE-H ) , depression ( Beck Depression Inventory II ) and use of health services for health promotion or prevention ( frequency calendar ) . Blind assessors will gather data at mid-intervention , end of intervention and one year follow up . Discussion If effective , this multimodal intervention could be delivered in both urban and rural environments . For example , existing infrastructure such as regional stroke centers and existing secondary stroke prevention clinics , make this intervention , if effective , deliverable and sustainable . Trial Registration IS RCT BACKGROUND national policy recommends routine re- assessment of disabled patients and their carers at 6 months after stroke onset . The clinical and re source outcomes of this policy were investigated . DESIGN prospect i ve , single-blind , r and omised controlled trial in two centres . PARTICIPANTS a total of 265 patients with a disabling stroke and their carers . INTERVENTIONS a structured re- assessment system for patients and their carers at 6 months post-stroke or existing care . OUTCOME MEASURES primary : patient independence ( Frenchay activities index ) and carer stress ( general health question naire 28 ) . Secondary : activities of daily living , mood state , satisfaction with services , carer strain index , health and social service re source use and costs . RESULTS independence at 12 months post-stroke was similar in both groups ( Frenchay activities index , adjusted mean difference 0.64 ; 95 % confidence interval -0.74 - 2.02 ) . Emotional distress in carers was similar in both groups ( general health question naire 28 , mean difference 0.02 ; 95 % confidence interval -0.95 - 1.00 ) . Results for the secondary outcome measures and total mean costs were similar for both groups . The intervention group patients used 301 fewer hospital bed days and 1,631 fewer care home bed days . CONCLUSIONS the structured , systematic re- assessment for patients and their carers was not associated with any clinical ly significant evidence of benefit at 12 months . Health and social care re source use and mean cost per patient were broadly similar in both groups . TRIAL REGISTRATION International St and ard R and omised Controlled Trial Register ; number : IS RCT N55412871 Objective : To investigate an intensified transition concept between neurological inpatient rehabilitation and home care for long-term effects on the care situation two and a half years after stroke patients ' discharge . Design : Controlled clinical trial allocating patients to intervention group ( intensified transition on ward II ) or control group  ( st and ard transition on ward I ) ;  patients were allocated to whichever ward had a vacancy . The last follow-up assessment was carried out on average 31 months after discharge . Intervention : The intensified transition concept consisted of therapeutic weekend care , bedside teaching and structured information for relatives during the second phase of the rehabilitation . Subjects : Seventy-one patients and their family carers were included , of which one case dropped out . Therefore 70 family carers - 35 individuals in each group - were available for assessment at long-term follow-up . Data collection : Family carers were asked via telephone whether the patient was still alive and if so , where he or she is living - at home or in a nursing home . Statistical methods : Binary logistic regression analysis with the care situation ( home care versus institutionalized care or deceased ) as dependent variable . Results : Two and a half years after discharge ( T3 ) in the intervention group significantly fewer patients were institutionalized ( 2 versus 5 ) or deceased ( 4 versus 11 ) ( P = 0.010 ) . Multivariate analysis showed that besides a higher functional life quality at discharge and lower patient 's age , the participation in the intensified transition programme is the third significant predictor for home care at T3 . Conclusion : Effects of an intensified transition programme can persist over a long-term period . They can sustain home care by reducing institutionalization and mortality 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 Background Stroke is one of the major causes of loss of independence , decreased quality of life and mortality among elderly people . About half of the elderly stroke patients discharged after rehabilitation in a nursing home still experience serious impairments in daily functioning one year post stroke , which can lead to difficulties in picking up and managing their social life . The aim of this study is to evaluate the effectiveness and feasibility of a new multidisciplinary transmural rehabilitation programme for older stroke patients . Methods A two group multicentre r and omised controlled trial is used to evaluate the effects of the rehabilitation programme . The programme consists of three care modules : 1 ) neurorehabilitation treatment for elderly stroke patients ; 2 ) empowerment training for patient and informal caregiver ; and 3 ) stroke education for patient and informal caregiver . The total programme has a duration of between two and six months , depending on the individual problems of the patient and informal caregiver . The control group receives usual care in the nursing home and after discharge .  Patients aged 65 years and over are eligible for study participation when they are admitted to a geriatric rehabilitation unit in a nursing home due to a recent stroke and are expected to be able to return to their original home environment after discharge . Data are gathered by face-to-face interviews , self-administered question naires , focus groups and registration forms . Primary outcomes for patients are activity level after stroke , functional dependence , perceived quality of life and social participation . Outcomes for informal caregivers are perceived care burden , objective care burden , quality of life and perceived health . Outcome measures of the process evaluation are implementation fidelity , programme deliverance and the opinion of the stroke professionals , patients and informal caregivers about the programme . Outcome measures of the economic evaluation are the healthcare utilisation 
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Conclusion : There is some limited evidence that interventions for family carers of stroke patients are effective and cost effective .
However , due to variation in the types of interventions examined , little can be concluded regarding implication s for clinical practice