Stroke Rehabilitation Use and Caregiver Psychosocial Health Profiles in Singapore: A Latent Profile Transition Analysis |
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| Institution: | 1. School of Social Sciences, Nanyang Technological University, Singapore, Singapore, Singapore;2. GeroPsych Consultants Pte Ltd, Singapore, Singapore, Singapore;3. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, Singapore;4. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, Singapore;5. Office of Healthcare Transformation, Ministry of Health, Singapore, Singapore, Singapore;6. Physical Medicine and Rehabilitation Science, Durham Veterans Administration Medical Center, Durham, NC, USA;7. Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA;8. Department of Medicine (General Internal Medicine), Duke University Medical Center, Durham, NC, USA;9. Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore, Singapore;10. Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore, Singapore;11. Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore, Singapore;12. Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore, Singapore;13. InfoComm, Technology and Data Group, Ministry of Health, Singapore, Singapore, Singapore;14. CHOU Neuroscience Clinic, Farrer Park Hospital, Singapore, Singapore, Singapore;15. Chou Neurosurgery Pte Ltd, Gleneagles Hospital, Singapore, Singapore, Singapore;p. Medical Services, St Andrew''s Community Hospital, Singapore, Singapore, Singapore;q. Department of Neurology, National Neuroscience Institute, Singapore, Singapore, Singapore;r. Lee Kim En Neurology Pte Ltd, Singapore, Singapore, Singapore;s. St Luke''s Hospital, Singapore, Singapore, Singapore;t. Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore, Singapore;u. Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore, Singapore;v. Division of Neurosurgery, University Surgical Cluster, National University of Singapore, Singapore, Singapore, Singapore;w. Department of Medicine (Division of Geriatric Medicine), National University Hospital, Singapore, Singapore, Singapore;x. Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore, Singapore;y. Manpower Planning and Strategy, Ministry of Health, Singapore, Singapore, Singapore;1. Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA;2. Research Group Innovación y Cuidado, Faculty of Nursing, Universidad Antonio Nariño, Neiva, Colombia;3. Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, Milwaukee, WI, USA;4. Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA;5. Froedtert Health, Milwaukee, WI, USA;6. Division of Geriatrics and Palliative Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA;1. Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA;2. Fargo VA Healthcare System, Fargo, ND, USA;3. Department of Education, Health and Behavior Studies, University of North Dakota, Grand Forks, ND, USA;4. Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, Australia;5. Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA;6. Department of Biomedical Sciences, Ohio University, Athens, OH, USA;7. Department of Geriatric Medicine, Ohio University, Athens, OH, USA;8. California Pacific Medical Center Research Institute, San Francisco Coordinating Center, San Francisco, CA, USA;9. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA;10. Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milano, Italy;11. Department of Clinical Sciences and Community Health, Università di Milano, Milano, Italy;12. Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA;13. Department of Geriatrics, University of North Dakota, Grand Forks, ND, USA;1. Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, Istanbul, Turkey;2. Department of Internal Medicine, Division of Geriatrics, Sisli Hamidiye Etfal Teaching and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey;3. Department of Internal Medicine, Division of Geriatrics, Marmara University Medical School, Istanbul, Turkey;4. Division of Geriatrics, Balikesir Ataturk City Hospital, Balikesir, Turkey;5. Department of Family Medicine, Basaksehir Cam and Sakura City Hospital, University of Health Sciences Turkey, Istanbul, Turkey;6. Istanbul Kayisdagi Nursing Home, Kayisdagi, Istanbul, Turkey;7. Department of Public Health, Istanbul Medical School, Istanbul University, Capa, Istanbul, Turkey;8. Department of Geriatrics, FHU CARTAGE, Centre hospitalier régional et universitaire de Nancy, and INSERM 1116, Université de Lorraine, Nancy, France;1. Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;2. Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA |
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| Abstract: | ObjectivesTo identify and describe caregiver profiles based on their psychosocial health characteristics over a 12-month period and transitions among these profiles, to determine if stroke rehabilitation use at 12 months post-stroke differed by caregiver profile transition patterns, and to investigate if caregiver profiles at 3 months post-stroke moderate the association of stroke rehabilitation use at 3 months and 12 months post-stroke after accounting for covariates.DesignLatent profile transition analysis of caregiver psychosocial health with stroke rehabilitation use at 12 month post-stroke as outcome.Setting and ParticipantsA total of 149 stroke patient-caregiver dyads from the Singapore Stroke Study.MethodsCross-sectional latent profile analyses were conducted on caregiver psychosocial health indicators of burden, depression, health status, quality of relationship with patient, and social support. Changes in latent profile classification over 3 time points (baseline, 3 months, and 12 months post-stroke) were analyzed using latent transition analysis. A transition model with stroke rehabilitation use at 12 months post-stroke as the outcome was tested after accounting for covariates.ResultsTwo distinct caregiver psychosocial health latent profiles were found across time: nondistressed and distressed. Most caregivers were classified as nondistressed and remained nondistressed over time. Distressed caregivers at baseline were 76% likely to become nondistressed at 12 month post-stroke. Regardless of profile transition patterns, nondistressed caregivers at 12 months post-stroke tended to have cared for stroke rehabilitation nonusers at 12 months post-stroke. Patient depression explained profile classification at 3 months and 12 months post-stroke. After accounting for covariates, rehabilitation users at 3 months post-stroke tended to continue using rehabilitation at 12 months post-stroke only when they had nondistressed caregivers at 3 months post-stroke.Conclusions and ImplicationsWhether caregiver adaptation explains the associations between the latent profile transition patterns and rehabilitation use at 12 months post-stroke should be examined. Early psychosocial health assessment and sustained support should be made available to stroke caregivers to enhance their well-being and subsequent patient rehabilitation participation. |
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| Keywords: | Stroke rehabilitation health services utilization informal caregiving psychosocial health latent profile analysis latent transition analysis |
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