TRACS (RCT) Training Caregivers After Stroke (randomised controlled trial)

Description

Background 

Stroke is a family illness generating considerable personal, financial and societal burdens. After a recommended initial hospital admission, up to 80% of patients are discharged home and many will be dependent on informal caregivers, to provide assistance with activities of daily living, including bathing, dressing, and toileting. For some, this avoids or delays admission to institutional care and the economic value of the informal care provided is considerable. This burden of care, however, has an important effect on caregivers’ physical and psycho-social well-being with up to 48% of caregivers reporting health problems, two-thirds a decline in social life and high self-reported levels of strain.

Effective training of caregivers should not only improve their own health but also the recovery and adjustment of the stroke patient. Caregivers’ central role is often given low priority in the management of stroke and there are missed opportunities for structured skills training.

Aim & Objectives

The aim of the TRACS trial is to evaluate the clinical and cost-effectiveness of a structured competency based caregiver-training programme for caregivers of stroke patients returning home with stroke-related disabilities.

The primary patient objective of the trial will be to determine whether the training programme improves physical outcomes for patients after disabling stroke. The primary caregiver objective of the trial will be to determine whether the training programme reduces the burden for caregivers of patients after disabling stroke.

Methods

TRACS has been designed as a pragmatic, multicentre, cluster randomised controlled trial with blinded follow-up. The unit of randomisation will be the participating stroke rehabilitation units. 18 stroke units were randomised to deliver the intervention which includes a number of carer training sessions, competency assessment and one follow-up visit; and 18 stroke units were randomised to continue to deliver usual care as per the National Guidelines for Stroke.

Recruitment completed at the end of January 2010 with a total of 930 patients and carers recruited.

Partners & Collaborators

  • Anne Forster (Chief Investigator), Academic Unit of Elderly Care and Rehabilitation, University of Leeds
  • Clinical Trials Unit, University of Leeds
  • King's College London

Funding

Funding agency: Medical Research Council 

Grant value: £2,029,049

Further information

For further information contact Anne Forster

Publications and outputs

Forster A, Dickerson J, Young J, Patel A, Kalra L, Nixon J, Smithard D, Knapp M, Holloway I, Anwar S, Farrin A. A cluster randomised controlled trial and cost-effectiveness analysis of a structured training programme for caregivers of in-patients after stroke (TRACS). Health Technology Assessment 2013; 17(46).

Forster A, Dickerson J, Young J, Patel A, Kalra L, Nixon J, Smithard D, Knapp M, Holloway I, Anwar S, Farrin A. A structured training programme for caregivers of inpatients after stroke (TRACS): a cluster randomised controlled trial and cost-effectiveness analysis. The Lancet 2013.

Forster A, Young J, Nixon J, Kalra L, Smithard D, Patel A, Knapp M, Monaghan J, Breen R, Anwar S. Farrin A. A cluster randomized controlled trial of a structured training programme for caregivers of inpatients after stroke (TRACS). International Journal of Stroke 2012,7:94-99.