human
***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 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 Background and Purpose — The purpose of this study was to determine whether motivational interviewing , a patient-centered counseling technique , can benefit patients ' mood 3 months after stroke . Methods — A single-center , open , r and omized , controlled trial was conducted at a single hospital with a stroke unit . Subjects consisted of 411 consecutive patients on the stroke register who were over 18 years of age and who did not have severe cognitive and communication problems that would prevent them from taking part in an interview ; were not known to be moving out of the area after discharge ; and were not already receiving psychiatric or clinical psychology intervention . All patients received usual stroke care . Patients in the intervention group received 4 individual , weekly sessions of motivational interviewing with a trained therapist in addition to usual stroke care . The primary outcome was the proportion of patients with normal mood at 3 months poststroke measured by the 28-item General Health Question naire ( normal , < 5 ; low ≥5 ) using a mailed question naire . Results — Eighty-one of 207 ( 39.1 % ) patients in the control group and 100 of 204 ( 49.0 % ) patients in the intervention group had normal mood at follow up . A significant benefit of motivational interviewing over usual stroke care ( OR : 1.60 , 95 % CI : 1.04 to 2.46 , P=0.03 ) was found . Conclusion — Our results suggest motivational interviewing leads to an improvement in  patients ' mood 3 months after stroke 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 Objectives : To determine whether education and counselling after stroke leads to improved family functioning and psychosocial outcomes for stroke patients and their spouses , and better functional and social outcomes for patients . Design : Two-group r and omized controlled trial . Data were collected on admission to and discharge from rehabilitation , and again six months later . Setting : Rehabilitation units at Repatriation General Hospital and Griffith Hospital , in Adelaide , South Australia . Participants : Sixty-two stroke patients and their spouses , 32 in the intervention group and 30 in the control group . Intervention : Stroke information package and three visits from a social worker trained in family counselling . Outcome measures : Family functioning : McMaster Family Assessment Device ( FAD ) ; functional status : Barthel Index ( BI ) ; social recovery : Adelaide Activities Profile ( AAP ) ; depression : Geriatric Depression Scale ( GDS ) ; anxiety : Hospital Anxiety and Depression Scale ( HADS ) ; mastery : Mastery Scale ( MS ) ; health status : SF-36 . Results : At six months the intervention group had better family functioning for both patients ( mean FAD difference 0.19 ) and spouses ( mean difference 0.09 ) . A modest benefit in functional status for intervention patients ( mean BI difference 1.3 ) was related to improved family functioning . Intervention patients reported better social recovery ( mean AAP differences : domestic chores 5.7 , household maintenance 4.6 , social activities 11.5 ) , but there were no significant effects on depression , anxiety , mastery or health status . Conclusions : An education and counselling intervention maintained family functioning , and in turn led to improved functional and social patient outcomes . This approach helps patients and their spouses to make the optimal adjustment to living with stroke AIM The purpose of the study was to determine the effect of a support program on the resilience of female family caregivers of stroke patients . METHODS This is a r and omized controlled trial . The sample consisted 70 female family caregivers ( 34 experimental , 36 control group ) . Data were collected three times ( pretest-posttest , follow-up test ) . Data were collected using the demographical data form , the Family Index of Regenerativity and Adaptation-General . RESULTS A significant difference was determined between the experimental and control group 's follow-up test scores for relative and friend support , social support and family-coping coherence . A significant difference was determined between the experimental group 's mean pretest , posttest and follow-up test scores in terms of family strain , relative and friend support , social support , family coping-coherence , family hardiness and family distress . CONCLUSIONS These results suggest that the Support Program contributes to the improvement of the components of resilience of family caregivers of stroke patients 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 Objective : To evaluate the impact of a psychosocial intervention on instrumental activities of daily living , physical performance , cognition and mortality after stroke . Design : A r and omized clinical trial . Setting : Patients were recruited from hospitals and rehabilitation centres ; the intervention took place in subjects ' homes . Subjects : Two-hundred and ninety-one stroke survivors over age 45 . One-hundred and forty-six subjects were assigned to the intervention and 145 subjects were assigned to usual care .  Intervention : Up to 16 meetings conducted over six months in the patient 's home ( approximately weekly for 12 weeks , followed by tri-weekly sessions for another 12 weeks ) . Sessions lasted approximately 1 hour and included , when possible , the entire support system ( stroke survivor , primary caregiver , additional family and friends , and professional caregivers ) . Main outcome measures : Instrumental activities of daily living , physical performance , and cognition were assessed six months post stroke ; mortality was assessed at an average of 47 months post stroke . Results : No significant differences in outcomes were observed between the intervention and usual care groups when analysing the total study population . Among non-frail participants ( n = 156 ) , subjects r and omized to treatment had better scores on instrumental activities of daily living ( mean score among treated = 12.4 ( st and ard deviation ( SD ) = 2.1 ) , mean score among usual care subjects = 11.3 ( SD = 2.9 ) , P-value for difference in means = 0.01 ) and reduced risk of mortality ( P = 0.03 ) than subjects r and omized to usual care . Conclusion : While there is evidence that the treatment benefited healthier subgroups , results also show evidence that the treatment was not effective , and possibly harmful , in frail subgroups This article describes a 3-year study testing the efficacy of a system of home-based , case-managed care for stroke survivors returning to the community following inpatient poststroke rehabilitation . The Stroke Transition after Inpatient Rehabilitation ( STAIR ) study was a r and omized , controlled trial of a postdischarge management strategy carried out in a group of 55 stroke patients , aged 65 or older , who did not have serious residual cognitive or language impairments and returned to the community following inpatient rehabilitation with the assistance of a primary caregiver . The program was shown to facilitate improvement in the general social activity level of the patients in the experimental group at 6 months compared to the control , and there was a trend for this effect to persist at 1 year . Strong relationships were identified between residual disability , social activity level , patients ' perceptions of efficacy , and caregiver stress Background and Purpose — Depression after stroke is prevalent , diminishing recovery and quality of life . Brief behavioral intervention , adjunctive to antidepressant therapy , has not been well evaluated for long-term efficacy in those with poststroke depression . Methods — One hundred one clinical ly depressed patients with ischemic stroke within 4 months of index stroke were r and omly assigned to an 8-week brief psychosocial – behavioral intervention plus antidepressant or usual care , including antidepressant . The primary end point was reduction in depressive symptom severity at 12 months after entry . Results — Hamilton Rating Scale for Depression raw score in the intervention group was significantly lower immediately posttreatment ( P<0.001 ) and at 12 months ( P=0.05 ) compared with control subjects . Remission ( Hamilton Rating Scale for Depression < 10 ) was significantly greater immediately posttreatment and at 12 months in the intervention group compared with the usual care control . The mean percent decrease ( 47%±26 % intervention versus 32%±36 % control , P=0.02 ) and the mean absolute decrease ( −9.2±5.7 intervention versus −6.2±6.4 control , P=0.023 ) in Hamilton Rating Scale for Depression at 12 months were clinical ly important and statistically significant in the intervention group compared with control . Conclusion — A brief psychosocial – behavioral intervention is highly effective in reducing depression in both the short and long term Current stroke rehabilitation tends to focus on the bio-medical course of disability , often responding to psychological and social issues only when they have been implicated in crises . Although this situation is costly , little evidence exists in relation to how psychological and social outcomes can be facilitated or how psychosocial decline can be prevented . In the area of adjustment following traumatic injury , there has been some suggestion that rehabilitation should focus on the expansion of re sources , skills and self-efficacy as this will enable individuals to cope more effectively with their medical condition and circumstances . The current study was a longitudinal r and omised controlled trial involving 100 people with stroke , 58 of whom were r and omly allocated to an intervention based on the notion of psychosocial skill expansion . All were patients of a major hospital in Queensl and , Australia . An existing self-management intervention ( The Chronic Disease Self-Management Course , Lorig et al. , 2001 ) was used to operationalise the concept of psychosocial skill expansion . The control group reported declines in functioning during the first year following stroke in the areas of family roles , activities of daily living , self-care and work productivity , that were not reported by the intervention group . Although the groups had reached similar levels by one year post-stroke , this intervention may have a protective function , presumably by improving capacity to manage the functional requirements of daily life . However , the intervention did not appear to have its impact through self-efficacy , as was expected , and failed to influence outcomes such as mood or social participation . Nevertheless , the intervention warrants further investigation , given that it appears to improve rehabilitation outcomes , at least in the short-term Background : Communication difficulties due to aphasia following stroke are particularly stressful to caregivers . Objective : To examine the impact of a psychoeducation programme on  caregivers ’ burden and stress and communication between the caregiver 
    Output:
    
agent
***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 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 Background and Purpose — The purpose of this study was to determine whether motivational interviewing , a patient-centered counseling technique , can benefit patients ' mood 3 months after stroke . Methods — A single-center , open , r and omized , controlled trial was conducted at a single hospital with a stroke unit . Subjects consisted of 411 consecutive patients on the stroke register who were over 18 years of age and who did not have severe cognitive and communication problems that would prevent them from taking part in an interview ; were not known to be moving out of the area after discharge ; and were not already receiving psychiatric or clinical psychology intervention . All patients received usual stroke care . Patients in the intervention group received 4 individual , weekly sessions of motivational interviewing with a trained therapist in addition to usual stroke care . The primary outcome was the proportion of patients with normal mood at 3 months poststroke measured by the 28-item General Health Question naire ( normal , < 5 ; low ≥5 ) using a mailed question naire . Results — Eighty-one of 207 ( 39.1 % ) patients in the control group and 100 of 204 ( 49.0 % ) patients in the intervention group had normal mood at follow up . A significant benefit of motivational interviewing over usual stroke care ( OR : 1.60 , 95 % CI : 1.04 to 2.46 , P=0.03 ) was found . Conclusion — Our results suggest motivational interviewing leads to an improvement in  patients ' mood 3 months after stroke 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 Objectives : To determine whether education and counselling after stroke leads to improved family functioning and psychosocial outcomes for stroke patients and their spouses , and better functional and social outcomes for patients . Design : Two-group r and omized controlled trial . Data were collected on admission to and discharge from rehabilitation , and again six months later . Setting : Rehabilitation units at Repatriation General Hospital and Griffith Hospital , in Adelaide , South Australia . Participants : Sixty-two stroke patients and their spouses , 32 in the intervention group and 30 in the control group . Intervention : Stroke information package and three visits from a social worker trained in family counselling . Outcome measures : Family functioning : McMaster Family Assessment Device ( FAD ) ; functional status : Barthel Index ( BI ) ; social recovery : Adelaide Activities Profile ( AAP ) ; depression : Geriatric Depression Scale ( GDS ) ; anxiety : Hospital Anxiety and Depression Scale ( HADS ) ; mastery : Mastery Scale ( MS ) ; health status : SF-36 . Results : At six months the intervention group had better family functioning for both patients ( mean FAD difference 0.19 ) and spouses ( mean difference 0.09 ) . A modest benefit in functional status for intervention patients ( mean BI difference 1.3 ) was related to improved family functioning . Intervention patients reported better social recovery ( mean AAP differences : domestic chores 5.7 , household maintenance 4.6 , social activities 11.5 ) , but there were no significant effects on depression , anxiety , mastery or health status . Conclusions : An education and counselling intervention maintained family functioning , and in turn led to improved functional and social patient outcomes . This approach helps patients and their spouses to make the optimal adjustment to living with stroke AIM The purpose of the study was to determine the effect of a support program on the resilience of female family caregivers of stroke patients . METHODS This is a r and omized controlled trial . The sample consisted 70 female family caregivers ( 34 experimental , 36 control group ) . Data were collected three times ( pretest-posttest , follow-up test ) . Data were collected using the demographical data form , the Family Index of Regenerativity and Adaptation-General . RESULTS A significant difference was determined between the experimental and control group 's follow-up test scores for relative and friend support , social support and family-coping coherence . A significant difference was determined between the experimental group 's mean pretest , posttest and follow-up test scores in terms of family strain , relative and friend support , social support , family coping-coherence , family hardiness and family distress . CONCLUSIONS These results suggest that the Support Program contributes to the improvement of the components of resilience of family caregivers of stroke patients 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 Objective : To evaluate the impact of a psychosocial intervention on instrumental activities of daily living , physical performance , cognition and mortality after stroke . Design : A r and omized clinical trial . Setting : Patients were recruited from hospitals and rehabilitation centres ; the intervention took place in subjects ' homes . Subjects : Two-hundred and ninety-one stroke survivors over age 45 . One-hundred and forty-six subjects were assigned to the intervention and 145 subjects were assigned to usual care .  Intervention : Up to 16 meetings conducted over six months in the patient 's home ( approximately weekly for 12 weeks , followed by tri-weekly sessions for another 12 weeks ) . Sessions lasted approximately 1 hour and included , when possible , the entire support system ( stroke survivor , primary caregiver , additional family and friends , and professional caregivers ) . Main outcome measures : Instrumental activities of daily living , physical performance , and cognition were assessed six months post stroke ; mortality was assessed at an average of 47 months post stroke . Results : No significant differences in outcomes were observed between the intervention and usual care groups when analysing the total study population . Among non-frail participants ( n = 156 ) , subjects r and omized to treatment had better scores on instrumental activities of daily living ( mean score among treated = 12.4 ( st and ard deviation ( SD ) = 2.1 ) , mean score among usual care subjects = 11.3 ( SD = 2.9 ) , P-value for difference in means = 0.01 ) and reduced risk of mortality ( P = 0.03 ) than subjects r and omized to usual care . Conclusion : While there is evidence that the treatment benefited healthier subgroups , results also show evidence that the treatment was not effective , and possibly harmful , in frail subgroups This article describes a 3-year study testing the efficacy of a system of home-based , case-managed care for stroke survivors returning to the community following inpatient poststroke rehabilitation . The Stroke Transition after Inpatient Rehabilitation ( STAIR ) study was a r and omized , controlled trial of a postdischarge management strategy carried out in a group of 55 stroke patients , aged 65 or older , who did not have serious residual cognitive or language impairments and returned to the community following inpatient rehabilitation with the assistance of a primary caregiver . The program was shown to facilitate improvement in the general social activity level of the patients in the experimental group at 6 months compared to the control , and there was a trend for this effect to persist at 1 year . Strong relationships were identified between residual disability , social activity level , patients ' perceptions of efficacy , and caregiver stress Background and Purpose — Depression after stroke is prevalent , diminishing recovery and quality of life . Brief behavioral intervention , adjunctive to antidepressant therapy , has not been well evaluated for long-term efficacy in those with poststroke depression . Methods — One hundred one clinical ly depressed patients with ischemic stroke within 4 months of index stroke were r and omly assigned to an 8-week brief psychosocial – behavioral intervention plus antidepressant or usual care , including antidepressant . The primary end point was reduction in depressive symptom severity at 12 months after entry . Results — Hamilton Rating Scale for Depression raw score in the intervention group was significantly lower immediately posttreatment ( P<0.001 ) and at 12 months ( P=0.05 ) compared with control subjects . Remission ( Hamilton Rating Scale for Depression < 10 ) was significantly greater immediately posttreatment and at 12 months in the intervention group compared with the usual care control . The mean percent decrease ( 47%±26 % intervention versus 32%±36 % control , P=0.02 ) and the mean absolute decrease ( −9.2±5.7 intervention versus −6.2±6.4 control , P=0.023 ) in Hamilton Rating Scale for Depression at 12 months were clinical ly important and statistically significant in the intervention group compared with control . Conclusion — A brief psychosocial – behavioral intervention is highly effective in reducing depression in both the short and long term Current stroke rehabilitation tends to focus on the bio-medical course of disability , often responding to psychological and social issues only when they have been implicated in crises . Although this situation is costly , little evidence exists in relation to how psychological and social outcomes can be facilitated or how psychosocial decline can be prevented . In the area of adjustment following traumatic injury , there has been some suggestion that rehabilitation should focus on the expansion of re sources , skills and self-efficacy as this will enable individuals to cope more effectively with their medical condition and circumstances . The current study was a longitudinal r and omised controlled trial involving 100 people with stroke , 58 of whom were r and omly allocated to an intervention based on the notion of psychosocial skill expansion . All were patients of a major hospital in Queensl and , Australia . An existing self-management intervention ( The Chronic Disease Self-Management Course , Lorig et al. , 2001 ) was used to operationalise the concept of psychosocial skill expansion . The control group reported declines in functioning during the first year following stroke in the areas of family roles , activities of daily living , self-care and work productivity , that were not reported by the intervention group . Although the groups had reached similar levels by one year post-stroke , this intervention may have a protective function , presumably by improving capacity to manage the functional requirements of daily life . However , the intervention did not appear to have its impact through self-efficacy , as was expected , and failed to influence outcomes such as mood or social participation . Nevertheless , the intervention warrants further investigation , given that it appears to improve rehabilitation outcomes , at least in the short-term Background : Communication difficulties due to aphasia following stroke are particularly stressful to caregivers . Objective : To examine the impact of a psychoeducation programme on  caregivers ’ burden and stress and communication between the caregiver 
    Output:
    