Family-led caregiving for stroke patients ineffective

One of the world’s largest stroke rehabilitation trials in India has found that family-led rehabilitation is ineffective.

The trial, carried out on 1,250 Indian stroke patients for six months, raises serious questions about the efficacy of doing physiotherapy at home by a family member to improve the condition of stroke patients.

As the community rehabilitation is believed to have cut down stroke-related disability in low and middle-income countries, the researchers set out to check out the efficacy of caregiving by a family member, who was trained to do some of the simple physiotherapies at home.

The goal was to find out if the stroke survivors were able to do something on their own after six months.

“But there was no difference in the degree of recovery or quality of life of people who received this extra treatment,” said the lead author of the study Richard Lindley from the The George Institute for Global Health and the University of Sydney.

“Our results suggest that effective rehabilitation need to be provided by professionals, may impose major challenges to poor communities with limited financial resources,” he added.

It is estimated that 1.6 million people suffer a stroke in India every year with early case fatality rates ranging from 27-41%. This equates to 1.5 million people suffering a stroke each year, and a further 5,00,000 people, each year, living with stroke disability.

Between January 2014 and February 2016, the researchers studied 1,250 randomly picked patients from 14 hospitals including the BGS Global Hospital in Bengaluru.
They were divided into two groups — one that received the care at home and the other control group that followed the standard drill.

After six months, it was found 47% patients in both groups were either dead or dependent. There was no significant difference in death (12% versus 14%) and rehospitalisation cases (14% vs 13%), said the study published in The Lancet.

“Caregiving at home was ineffective. The main reason is only 30 minutes of physiotherapy at home while the rehabilitation should be 1-2 hours daily,” Jeyaraj Pandian, the lead Indian neurologist from Christian Medical College, Ludhiana,  told DH.

As there are only 35 stroke units in India, mostly in the cities, the study highlighted the need to create many such facilities, particularly in rural areas, to protect the people from the potentially prohibitive costs of treatment, he said.