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Psychother Psychosom Med Psychol 2007; 57(1): e1-e19
DOI: 10.1055/s-2006-951847
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Interventionskonzepte für Angehörige von Schlaganfallpatienten: Bedarf und Effektivität

Interventions for Caregivers of Stroke Patients: Need and EffectivenessGabriele  Wilz1 , Birgit  Böhm1
  • 1Technische Universität Berlin, Fachbereich für Klinische und Gesundheitspsychologie
Further Information

Publication History

eingereicht 18. Sept. 2005

akzeptiert 1. Sept. 2006

Publication Date:
12 January 2007 (online)

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Zusammenfassung

Die meisten Schlaganfallpatienten werden nach ihrer Entlassung aus der Klinik durch Angehörige betreut. Für die Angehörigen bedeutet dies in den meisten Fällen langfristige Anforderungen sowie häufig auch gesundheitliche Belastungen. Es existieren verschiedene Angebote, welche die Angehörigen bei dieser Aufgabe unterstützen und somit zu ihrer Entlastung beitragen sollen. Bisher ist jedoch nicht ausreichend untersucht, inwieweit die verschiedenen Interventionskonzepte den Bedarf der Angehörigen tatsächlich erfüllen und wie effektiv die Interventionen hinsichtlich der Verringerung von Belastungsstörungen sind. Bisher können fünf verschiedene Typen von Interventionskonzepten zur Unterstützung der Angehörigen von Schlaganfallpatienten unterschieden werden: Spezielle Dienstleistungen, Psychoedukation, psychotherapeutische Interventionen, soziale Unterstützung durch Betroffene und Mehrkomponenteninterventionen. Auf der Basis von 42 Interventionsstudien wird versucht, eine vorläufige Aussage zur Effektivität von Interventionskonzepten zu treffen. Die Mehrkomponentenintervention mit psychotherapeutischen Strategien erweist sich diesbezüglich als empfehlenswerte Variante.

Abstract

After discharge from hospital most stroke patients are being cared for by relatives. In the majority of cases it does mean long-term demands for relatives and often it has also an effect on their health. There is a variety of possibilities for offering support to relatives in accomplishing their tasks and thus contribute to a relief of burden. There has not yet been enough research investigating how various intervention concepts really meet the needs of the relatives and how effective the interventions reduce the burden of the caregivers. Five types of intervention concepts for supporting relatives of stroke patients can be differentiated so far: special services, training, counselling, social support through other caregivers and multi-component interventions. On the basis of 42 intervention studies an attempt is being made to give a preliminary statement about the effectiveness of intervention models. The multi-component interventions combined with psychotherapeutic strategies seem to emerge as a recommendable concept.

Schlüsselwörter

Schlaganfall - Angehörige - Interventionen - Evaluation

Key words

stroke - caregivers - interventions - evaluation

Literatur

  • 1 Diener H C, Hacke W, Forsting M. Schlaganfall. Stuttgart; Georg Thieme 2004
    Google Scholar
  • 2 Bundesministerium für Bildung und Forschung .Forschung in der Rehabilitation. 2004 Verfügbar unter http://www.bmbf.de/pub/forschung_in_der_rehabilitation.pdf
    Google Scholar
  • 3 Brainin M, Dachenhausen A, Steiner M. Epidemiologie des Schlaganfalls.  Wiener Med Wochenschrift. 2003;  153 3-5
    PubMedGoogle Scholar
  • 4 Kotila M, Numminen H, Waltimo O, Kaste M. Depression after stroke. Results of the FINNSTROKE study.  Stroke. 1998;  29 368-372
    CrossrefPubMedGoogle Scholar
  • 5 Young Y, Murray J, Forster A. Review of longer-term problems after disabling stroke.  Clin Gerontol. 2003;  13 55-65
    PubMedGoogle Scholar
  • 6 Bishop D S, Evans R L. Families and stroke: the clinical implications of research findings.  Top Stroke Rehabil. 1995;  2 20-31
    PubMedGoogle Scholar
  • 7 Palmer S, Glass T A. Family function and stroke recovery: a review.  Rehabil Psychol. 2003;  48 255-265
    PubMedGoogle Scholar
  • 8 O'Connell B, Baker L, Prosser A. The educational needs of caregivers of stroke survivors in acute and community settings.  J Neurosci Nurs. 2003;  35 21
    PubMedGoogle Scholar
  • 9 Kwakkel G, Wagenaar R C, Kollen B J, Lankhorst G J. Predicting disability in stroke - a critical review of the literature.  Age and Ageing. 1996;  5 479-489
    PubMedGoogle Scholar
  • 10 Black T M, Soltis T, Bartlett C. Using the functional independence measure instrument to predict stroke rehabilitation outcomes.  Rehabil Nurs. 1999;  24 19-114, 121
    PubMedGoogle Scholar
  • 11 Evans R L, Bishop D S, Matlock A L. et al . Family interaction and treatment adherence after stroke.  Arch Phys Med Rehabil. 1987;  8 513-517
    PubMedGoogle Scholar
  • 12 Grant J S, Elliott T, Giger J N, Bartolucci A A. Social problem-solving abilities, social support and adjustment among family caregivers of individuals with a stroke.  Rehabil Psychol. 2001;  46 44-57
    PubMedGoogle Scholar
  • 13 Schneekloth U, Müller U. Wirkungen der Pflegeversicherung. Schriftenreihe des Bundesministeriums für Gesundheit. Baden-Baden; 2000: 127
    Google Scholar
  • 14 O'Connell B, Baker L. Managing as carers of stroke survivors: strategies from the field.  Int J Nurs Pract. 2004;  10 121-126
    CrossrefPubMedGoogle Scholar
  • 15 Evans R L, Connis R T, Bishop D S. et al . Stroke: a family dilemma.  Disabil Rehabil. 1994;  3 110-118
    PubMedGoogle Scholar
  • 16 Evans R L, Matlock A L, Bishop D S. et al . Family intervention after stroke: Does counselling or education help?.  Stroke. 1988;  19 1243-1249
    PubMedGoogle Scholar
  • 17 Evans R L, Griffith J, Haselkorn J. et al . Poststroke family function: an evaluation of the family's role in rehabilitation.  Rehabil Nurs. 1992;  17 127-132
    PubMedGoogle Scholar
  • 18 Low J TS, Payne S, Roderick P. The impact of stroke on informal carers: a literature review.  Soc Sci Med. 1999;  49 711-725
    PubMedGoogle Scholar
  • 19 Brooks D N. The head-injured family.  J Clin Exper Neuropsychol. 1991;  13 155-188
    PubMedGoogle Scholar
  • 20 Stein P N, Wayne A G, Hibbard M R. An examination of depression in the spouses of stroke patients.  Rehabil Psychol. 1992;  37, 2 121-130
    PubMedGoogle Scholar
  • 21 Tyman R V. The stress experienced by caregivers of stroke survivors: is it all in the mind, or is it also in the body?.  Clin Rehabil. 1994;  8 341-345
    PubMedGoogle Scholar
  • 22 Williams A M. Caregivers of persons with stroke: their physical and emotional well-being.  Qual Life Res. 1993;  2 213-220
    CrossrefPubMedGoogle Scholar
  • 23 Segal M E, Schall R R. Life satisfaction and caregiving stress for individuals with stroke and their primary caregivers.  Rehabil Psychol. 1996;  4 303-320
    PubMedGoogle Scholar
  • 24 Dennis M, O'Rourke S, Lewis S. et al . A quantitative study of the emotional outcome of people caring for stroke survivors.  Stroke. 1998;  29 1867-1872
    PubMedGoogle Scholar
  • 25 Kitze K, Gründel I, Lehmann A. et al . Psychische Belastungen bei Angehörigen von Schlaganfallpatienten.  Die Rehabilitation. 2002;  6 401-407
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Berg A, Palomäki H, Lönnqvist J. et al . Depression among caregivers of stroke survivors.  Stroke. 2005;  36 636-639
    PubMedGoogle Scholar
  • 27 Kinney J M, Stephens M, Franks M M, Norris V K. Stress and satisfaction of family caregivers to older stroke patients.  J Appl Gerontol. 1995;  14 3-21
    PubMedGoogle Scholar
  • 28 Forsberg-Wärleby G, Möller A, Blomstrand C. Life satisfaction in spouses of patients with stroke during the first year after stroke.  J Rehabil Med. 2004;  36 4-11
    PubMedGoogle Scholar
  • 29 Patel A, Knapp M, Evans A. et al . Training caregivers of stroke patients: economic evaluation.  Brit Med J. 2004;  328 1102-1104
    CrossrefPubMedGoogle Scholar
  • 30 Bundesministerium für Familie, Frauen, Senioren und Jugend .Dritter Bericht zur Lage der älteren Generation in der Bundesrepublik Deutschland: Alter und Gesellschaft. Deutscher Bundestag, Drucksache 14/5130 2001
    Google Scholar
  • 31 Reiss D, Gonzalez S, Kramer N. Family process, chronic illness, and death: on weakness of strong bonds.  Arch Gen Psych. 1986;  43 795-804
    PubMedGoogle Scholar
  • 32 Toseland R W, Rossiter C M, Labreque M S. The effectiveness of peerled and professionally led groups to support family caregivers.  Gerontol. 1989a;  29 465-471
    PubMedGoogle Scholar
  • 33 Toseland R W, Rossiter C M, Labreque M S. The effectiveness of three group intervention strategies to support family caregivers.  Am J Orthopsych. 1989b;  59, 3 420-429
    PubMedGoogle Scholar
  • 34 Korner-Bitensky N, Tarasuk J, Nelles J, Bouchard J M. The impact of interventions with families poststroke: a review.  Topics in Stroke Rehabil. 1998;  5, 3 69-85
    PubMedGoogle Scholar
  • 35 Lui M HL, Ross F M, Thompson D R. Supporting family caregivers in stroke care - a review of the evidence for problem solving.  Stroke. 2005;  36 2514-2522
    CrossrefPubMedGoogle Scholar
  • 36 Wiles R, Pain H, Buckland S, McLellan L. Providing appropriate information to patients and carers following a stroke.  J Adv Nurs. 1998;  28 794-801
    CrossrefPubMedGoogle Scholar
  • 37 Gründel I, Lehmann A, Cramon D Y von, Wilz G. Der Unterstützungsbedarf von Angehörigen während der stationären Rehabilitation von Schlaganfallpatienten.  Praxis Klin Verhaltensmed Rehabil. 2001;  56 280-288
    PubMedGoogle Scholar
  • 38 Sörensen S, Pinquart M, Duberstein P. How effective are interventions with caregivers? An updated metaanalysis.  Gerontol. 2002;  42 356-372
    PubMedGoogle Scholar
  • 39 Visser-Meily A, Heugten C van, Post M. et al . Intervention studies for caregivers of stroke survivors: a critical review.  Pat Educ Couns. 2005;  56 257-267
    PubMedGoogle Scholar
  • 40 Heuvel E TP Van den, Witte L P de, Nooyen-Haazen I. et al . Short term effects of a group support program and an individual support program for caregivers of stroke patients.  Pat Educ Couns. 2000;  40 109-120
    PubMedGoogle Scholar
  • 41 Heuvel E TP van den, Witte L P de, Stewart R E. et al . Long-term effects of a group support program and an individual support program for informal caregivers of stroke patients: which caregivers benefit the most?.  Pat Educ Couns. 2002;  47 291-299
    PubMedGoogle Scholar
  • 42 Visser-Meily A, Post M, Riphagen I, Lindemann E. Measures used to assess burden among caregivers of stroke patients: a review.  Clin Rehabil. 2004;  18 1-23
    CrossrefPubMedGoogle Scholar
  • 43 Zarit S H, Zarit J M. The memory and behavior problems checklist and the burden interview. Pennstate University: Gerontology Center 1983, 1990
    Google Scholar
  • 44 Bullinger M, Kirchberger I. Der SF-36 Fragebogen zum Gesundheitszustand. Göttingen, Bern, Toronto, Seattle; Hogrefe 1998
    Google Scholar
  • 45 Goldberg D P, Hillier V F. A scaled version of the general health questionnaire.  Psychol Med. 1979;  9 139-145
    CrossrefPubMedGoogle Scholar
  • 46 Larsen D L, Attkisson C C, Hargreaves W A, Nguyen T D. Assessment of client/patient satisfaction.  Eval Progr Plan. 1979;  2 197-207
    CrossrefPubMedGoogle Scholar
  • 47 Beck A T, Hautzinger M, Bailer M. et al .Beck-Depressions-Inventar. Göttingen, Bern, Toronto, Seattle; Hogrefe 1995
    Google Scholar
  • 48 Margraf J, Ehlers A. Beck Angstinventar. Deutsche Version (BAI). Testhandbuch. Göttingen; Hogrefe in Vorbereitung
    Google Scholar
  • 49 Holroyd J. Questionnaire on resources and stress: for families with chronically ill or handicapped members. Clin Psychol Pub Comp Inc 1987
    Google Scholar
  • 50 Evans R L, Pomeroy S, Weele T van der, Hammond M C. Reliability of a stroke care information test for family caretakers.  Int J Rehabil Res. 1985;  8 199-201
    PubMedGoogle Scholar
  • 51 Epstein N B, Baldwin L M, Bishop D S. Family Assessment Device (FAD). Brown University/Butler Hospital Fam Res Progr 1983
    Google Scholar
  • 52 Holbrook M, Skilbeck C E. An activities index for use with stroke patients.  Age Ageing. 1983;  12 166-170
    PubMedGoogle Scholar
  • 53 Pearlin L I, Mullan J T, Semple S J, Skaff M M. Caregiving and stress process: an overview of concepts and their measures.  Gerontol. 1990;  30, 5 583-594
    CrossrefPubMedGoogle Scholar
  • 54 Janke W, Erdmann G, Kallus W. Stressverarbeitungsfragebogen (SVF). Göttingen; Hogrefe 2002
    Google Scholar
  • 55 Brähler E, Schumacher J, Scheer J W. Der Gießener Beschwerdebogen (GBB-24). Bern; Huber 1995
    Google Scholar
  • 56 Crewe N M. Training Course: stroke in your family.  Rehabil Rec. 1969;  10, 1 32-34
    PubMedGoogle Scholar
  • 57 Dzau R E, Boehme A R. Stroke rehabilitation: a family-team education program.  Arch Phys Med Rehabil. 1978;  59 236-239
    PubMedGoogle Scholar
  • 58 Evans R L, Held S. Evaluation of family stroke education.  Int J Rehabil Res. 1984;  7 47-51
    PubMedGoogle Scholar
  • 59 Borenstein P, Linell S, Währborg P. An innovative therapeutic program for aphasia patients and their relatives.  Scand J Rehabil Med. 1987;  19 51-56
    PubMedGoogle Scholar
  • 60 Pain H SB, McLellan D L. The use of individualized booklets after a stroke.  Clin Rehabil. 1990;  4 265-272
    PubMedGoogle Scholar
  • 61 Printz-Fedderson V. Group process effect on caregiver burden.  J Neurosci Nurs. 1990;  22 164-168
    PubMedGoogle Scholar
  • 62 Braithwaite V, McGown A. Caregivers emotional well-being and their capacity to learn about stroke.  J Adv Nurs. 1993;  18 195-202
    CrossrefPubMedGoogle Scholar
  • 63 Oehring A K, Oakley J L. The young stroke patient: a need for specialized group support systems.  Topics in Stroke Rehabil. 1994;  1, 1 25-40
    PubMedGoogle Scholar
  • 64 Hinckley J J, Packard M EW, Bardach L G. Alternative family education programming for adults with chronic aphasia.  Topics in Stroke Rehabil. 1995;  2 53-63
    PubMedGoogle Scholar
  • 65 Forster A, Young J. Specialist nurse support for patients with stroke in the community: a randomized controlled trial.  Brit Med J. 1996;  312 1642-1644
    PubMedGoogle Scholar
  • 66 Dennis M, O'Rourke S, Slattery J. et al . Evaluation of a stroke family care worker: results of a randomised controlled trial.  Brit Med J. 1997;  314 1071-1077
    PubMedGoogle Scholar
  • 67 Goldberg G, Segal M E, Berk S N. et al . Stroke transition after inpatient rehabilitation.  Topics in Stroke Rehabil. 1997;  4 64-79
    PubMedGoogle Scholar
  • 68 Rudd A G, Wolfe C DA, Tilling K, Beech R R. Randomised controlled trial to evaluate early discharge scheme for patients with stroke.  Brit Med J. 1997;  315 1039-1044
    PubMedGoogle Scholar
  • 69 Mant J, Carter J, Wade D T, Winner S. The impact of an information pack on patients with stroke and their carers: a randomized controlled trail.  Clin Rehabil. 1998;  12 465-476
    CrossrefPubMedGoogle Scholar
  • 70 Brown R, Pain K, Berwald C. et al . Distance education and caregiver support groups: comparison of traditional and telephone groups.  J Head Trauma Rehabil. 1999;  14, 3 257-268
    CrossrefPubMedGoogle Scholar
  • 71 Grant J S. Social problem-solving partnerships with family caregivers.  Rehabil Nurs. 1999;  24 254-260
    PubMedGoogle Scholar
  • 72 Rodgers H, Atkinson C, Bond S. et al . Randomized controlled trial of a comprehensive stroke education program for patients and caregivers.  Stroke. 1999;  30 2585-2591
    PubMedGoogle Scholar
  • 73 Rodgers H, Bond S, Curless R. Inadequacies in the provision of information to stroke patients and their families.  Age Ageing. 2001;  30 129-133
    CrossrefPubMedGoogle Scholar
  • 74 Glass T A, Dym B, Greenberg S. et al . Psychosocial intervention in stroke: families in recovery from stroke trial (FIRST).  Am J Orthopsych. 2000;  70, 2 169-181
    PubMedGoogle Scholar
  • 75 Anderson C S, Rubenach S, Mhurchu C N. et al . Home or hospital for stroke rehabilitation? Results of a randomized controlled trail. I. health outcomes at 6 months.  Stroke. 2000;  31 1024-1031
    PubMedGoogle Scholar
  • 76 Holmqvist L W, Koch L von, Pedro-Cuesta J de. Use of healthcare, impact on family caregivers and patient satisfaction of rehabilitation at home after stroke in southwest Stockholm.  Scand J Rehabil Med. 2000;  32 173-179
    CrossrefPubMedGoogle Scholar
  • 77 Jones A L, Charlesworth J F, Hendra T J. Patient mood and carer strain during stroke rehabilitation in the community following early hospital discharge.  Disabil Rehabil. 2000;  22 490-494
    CrossrefPubMedGoogle Scholar
  • 78 Mant J, Carter J, Wade D T, Winner S. Family support for stroke: a randomised controlled trial.  Lancet. 2000;  356 808-813
    CrossrefPubMedGoogle Scholar
  • 79 McKinney M, Blake H, Treece K A. et al . Evaluation of cognitive assessment in stroke rehabilitation.  Clin Rehabil. 2002;  16 129-136
    CrossrefPubMedGoogle Scholar
  • 80 Grant J S, Elliott T R, Weaver M. et al . Telephone intervention with family caregivers of stroke survivors after rehabilitation.  Stroke. 2002;  33 2060-2065
    CrossrefPubMedGoogle Scholar
  • 81 Heier H H, Lämmler G, Steinhagen-Thiessen E. Evaluation eines psychoedukativen Kurses für Angehörige von Schlaganfallpatienten.  Zeitschr Neuropsychol. 2002;  13 201-209
    PubMedGoogle Scholar
  • 82 Sulch D, Melbourn A, Perez I, Kalra L. Integrated care pathways and quality of life on stroke rehabilitation unit.  Stroke. 2002;  33 1600-1604
    CrossrefPubMedGoogle Scholar
  • 83 Clark M S, Rubenach S, Winsor A. A randomized controlled trial of an education and counselling intervention for families after stroke.  Clin Rehabil. 2003;  17 703-712
    CrossrefPubMedGoogle Scholar
  • 84 Hartke R J, King R B. Telephone group intervention for older stroke caregivers.  Topics in Stroke Rehabil. 2003;  9 65-81
    PubMedGoogle Scholar
  • 85 Teng J, Mayo N E, Latimer E. et al . Costs and caregiver consequences of early supported discharge for stroke patients.  Stroke. 2003;  34 528-536
    CrossrefPubMedGoogle Scholar
  • 86 Lincoln N B, Francis C M, Lilley S A. et al . Evaluation of a stroke family support organizer: a randomized controlled trial.  Stroke. 2003;  34 116-121
    CrossrefPubMedGoogle Scholar
  • 87 Smith J, Forster A, Young J. A randomized trial to evaluate an education programme for patients and carers after stroke.  Clin Rehabil. 2004;  18 726-736
    CrossrefPubMedGoogle Scholar
  • 88 Kalra L, Evans A, Perez I. et al . Training carers of stroke patients: a randomized controlled trial.  Brit Med J. 2004;  328 1099-1104
    CrossrefPubMedGoogle Scholar
  • 89 Glass T A, Berkman L F, Hiltunen E F. et al . The families in recovery from stroke trial (FIRST): primary study results.  Psychsom Med. 2004;  66, 6 889-897
    PubMedGoogle Scholar
  • 90 Larson J, Franzen-Dahlin A, Billing E. et al . The impact of a nurseled support and education programme for spouses of stroke patients: a randomized controlled trial.  J Clin Nurs. 2005;  14, 8 995-1003
    CrossrefPubMedGoogle Scholar
  • 91 Mant J, Winner S, Roche J, Wade D T. Family support for stroke: one year follow up of a randomised controlled trial.  J Neurol Neurosurg Psychiatry. 2005;  76, 7 1006-1008
    CrossrefPubMedGoogle Scholar
  • 92 Forster A, Smith J, Young J. et al .Information provision for stroke patients and their caregivers. The Cochrane Database of Systematic Reviews 2001 Issue 3 Art. No.: CD001919. DOI: DOI: 10.1002/14651858.CD001919
    Google Scholar
  • 93 Gatz M, Bengtson V L, Blum M J. Caregiving families. In: Birren JE, Schaie KW (eds) Handbook of the Psychology of Aging. 3rd ed. New York; Academic Press 1990: 405-426
    Google Scholar
  • 94 Meichenbaum D. Cognitive behaviour modification: an integrative approach. New York; Plenum Press 1977
    Google Scholar
  • 95 Bakas T, Austin J K, Okonkwo K F. et al . Needs, concerns, strategies, and advice of stroke survivors the first 6 months after discharge.  J Neurosci Nurs. 2002;  34 242-251
    PubMedGoogle Scholar
  • 96 Schulz R, O'Brien A, Czaja S. et al . Dementia caregiver intervention research: in search of clinical significance.  Gerontol. 2002;  42 589-602
    PubMedGoogle Scholar
  • 97 Brodaty H, Green A B, Koschera A. Metaanalysis of psychosocial interventions for caregivers of people with dementia.  J Am Geriatr Soc. 2003;  51 657-664
    CrossrefPubMedGoogle Scholar

Prof. Dr. Gabriele Wilz

Technische Universität Berlin, Fachbereich für Klinische und Gesundheitspsychologie

Franklinstraße 28/29

10587 Berlin

Email: gabriele.wilz@gp.tu-berlin.de