The perceived burden of care for caregivers of post discharged CVA patients with functional impairments at a private rehabilitation unit in Bloemfontein
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Article 1: Recent surveys show an alarming increase in the number of individuals suffering from strokes annually, resulting in functional impairments. Comprehensive rehabilitation is crucial in order to enhance patients’ level of independence in daily activities and to facilitate community integration. Unfortunately, rehabilitation services in South Africa are hampered by several factors, leaving many patients without the opportunity for comprehensive rehabilitation. This place a higher burden of care on informal caregivers and family members, who are often forced to take up the unplanned occupation as caregivers. Not being adequately prepared for this new role results in occupational loss and unbalanced activity profiles. Caregiver education, home-based caregiving services, support groups, and therapeutic home visits should, therefore, take priority. Therapeutic intervention throughout all rehabilitation outcome levels is advised in order to assist with the transition between the rehabilitation and community reintegration phase of patients with strokes, in order to ensure that they will be as independent as possible in their daily occupations and decrease the burden on caregivers. This literature review aims to provide a background of the current rehabilitation services in South Africa for persons who suffered strokes, the occupation of caregiving, caregivers’ burden of care, as well as recommendations for clinical practice. Article 2: Introduction: The transition between inpatient rehabilitation and discharge of survivors of strokes from private rehabilitation services in South Africa is often challenging. After discharge, the caregiver role as an extension of rehabilitation, as well as the assistance of patients in daily occupations, becomes important. Although the occupation of caregiving could have positive attributes for the caregiver, it can be perceived as a burden. This study investigates the burden of care as experienced by patients’ caregivers post discharge, contributing factors to burden of care, and how occupations relate thereto. Method: A quantitative descriptive study was conducted with 63 patients and caregivers, using a consecutive, non- randomised sampling method. Patients’ Functional Independence Measure (FIM) scores upon discharge were obtained. Telephonic interviews were conducted two months after discharge, using the Modified Caregiver Strain Index (MCSI), as well as a non-standardised questionnaire. Results: Patients’ median FIM scores at discharge were 86, indicating that they needed minimal assistance. Caregivers experienced some burden of care, since the median MCSI score was nine, interpreted as minimal/moderate strain. Contributing factors include financial, physical, psychological, and social aspects. Caregivers also seem to have unbalanced occupational profiles. Conclusions: The problematic transition between private inpatient rehabilitation and discharge needs to be addressed.