4.3.1 Patient’s functional status. Functional status of the stroke patients reflected to the ability to perform activities of daily living. The Modified Barthel Index (MBI) with 10 sections was an instrument using for assessing activities of daily living, which shows the degree of independence of a patient from any assistance, specified on stroke patients. Possible score of patient’s functional status is 0 to 100, and higher score indicated that the stroke patient functions well. In the current study, the functional status of patient’s actual score ranged from 20 to 73, with a mean of 49.32 and a standard deviation of 11.76. The meaning overall of patient’s functional status was severe dependence level. All most of the stroke patients required moderate and high help for daily activities with 24 (19%) and 101 (80.2%) respectively. There were not stroke patients with slight dependence and fully independence level of daily
activities in this study. The results of patient’s functional status variable were shown in table 4.5a.
Table 4.5a Frequency, percentage, range, mean, and standard deviation of activities of daily living of stroke patients (n = 126)
Level of activities of daily living
Frequency (%)
Possible range
Actual range
Mean SD
Total dependence 1 (0.8) 0 – 20 20 20 -
Severe dependence 101 (80.2) 21-60 24-60 45.76 9.28 Moderate dependence 24 (19.0) 61-90 61-73 65.50 3.28
Overall 126 (100) 0-100 20-73 49.32 11.76
Table 4.5b Mean and standard deviation of activities of daily living of stoke patients (n = 126)
Activities of daily living Mean SD Interpretation Chair/ bed transfers 7.48 2.35 Moderate dependence
Ambulation 6.59 2.44 Moderate dependence
Bladder control 6.02 1.53 Severe dependence
Bowel control 5.95 1.50 Severe dependence
Toilet 5.02 1.72 Severe dependence
Feeding 4.69 1.73 Severe dependence
Dressing 4.90 1.78 Severe dependence
Stair Climbing 3.39 1.79 Severe dependence
Bathing self 2.73 0.92 Severe dependence
Personal hygiene 2.54 1.09 Severe dependence
Table 4.5b shown detail of the mean, standard deviation, and level of dependence of stroke patients on activities of daily living. There were only chair/bet transfers (mean = 7.48, SD = 2.35) and ambulation (mean = 6.59, SD = 2.44) at moderate dependence. Most of activities as bladder control (mean = 6.02, SD = 1.53), bowel control (mean = 5.95, SD = 1.50), toilet (mean = 5.02, SD = 1.72), feeding (mean
= 4.69, SD = 1.73), dressing (mean = 4.90, SD = 1.78), stair climbing (mean = 3.39, SD
= 1.79), bathing self (mean = 2.73, SD = 0.92), personal hygiene (mean = 2.54, SD = 1.09) were at severe dependence level.
4.3.2 Caregiver burden. Caregiver burden reflected a stroke caregiver’s subjective perception of overload in one or more of the four perspectives of physical, psychological, social, and financial spheres. The Zarit Burden Interview (ZBI) with 22 items was used to measure the burden of caregiver perceive about responsibilities during take care for stroke patients. Possible range score of caregiver burden is 0 to 88, and higher score indicated a higher degree of burden. In the current study, actual range score of caregiver burden was between 24 to 66 with a mean score of 44.25 and a standard deviation of 9.25. The meaning overall of caregiver burden was at high burden level. Most of the subjects shown at high burden level 78 (61.90%). The results of caregiver burden variable were shown in table 4.6a.
Table 4.6a Frequency, percentage, range, mean, and standard deviation of caregiver burden (n = 126)
Caregiver Burden Frequency (%)
Possible range
Actual range
Mean SD
Low burden 48 (38.10) 21-40 24 – 40 34.75 4.47
High burden 78 (61.90) 41-88 41 – 60 50.10 5.99
Overall 126 (100) 0-88 24-66 44.25 9.25
In addition, the result shown that mean score of caregiver burden on four domains including: burden in social and family life (mean = 2.38, SD = 0.74); burden in finances (mean = 2.37, SD = 0.63); burden in emotional well-being (mean = 2.32, SD = 0.60); and burden in loss of control over one’s life (mean = 2.19, SD = 0.67) were at high burden level. Only one domain: burden in the relationship (mean = 1.21, SD = 0.87) was at low burden level (Table 4.6b).
Table 4.6b Mean and standard deviation of caregiver burden (n = 126)
Caregiver burden Mean SD Interpretation
Burden in social and family life 2.38 0.74 High burden Do you feel uncomfortable having your friends
over because of your relative?
2.40 0.83 High burden Do you feel that your social life has suffered
because you are caring for your relative?
2.39 0.79 High burden Do you feel stressed between caring for your
relative and trying to meet other responsibilities for your family or work?
2.38 0.77 High burden
Do you feel that your relative currently affects your relationship with other family members?
2.36 0.84 High burden
Burden in finances 2.37 0.63 High burden
Do you feel that you don't have enough money to care for your relative, in addition to the rest of your expenses?
2.37 0.63 High burden
Burden in emotional well-being 2.32 0.60 High burden Overall, how burdened do you feel in caring for
your relative?
2.58 0.57 High burden Do you feel that you could do a better job in
caring for your relative?
2.37 0.65 High burden Do you feel that your health has suffered
because of your involvement with your relative?
2.35 0.71 High burden Do you feel that, because of the time you spend
with your relative, you don't have enough time for yourself?
2.26 0.75 High burden
Do you feel angry when you are around your relative?
2.25 0.75 High burden Do you feel embarrassed about your relative's
behavior?
2.25 0.80 High burden Do you feel strained when you are around your relative 2.23 0.72 High burden
Table 4.6b Mean and standard deviation of caregiver burden (n = 126) (Cont.)
Caregiver burden Mean SD Interpretation
Burden in loss of control over one’s life 2.19 0.67 High burden Are you afraid about what the future holds for
your relative?
2.23 0.71 High burden Do you feel that you have lost control of your
life since your relative's death?
2.21 0.76 High burden Do you feel uncertain about what to do about
your relative?
2.20 0.77 High burden Do you feel that you will be unable to take care
of your relative much longer?
2.14 0.84 High burden
Burden in the relationship 1.21 0.87 Low burden
Do you feel that you don't have as much privacy as you would like, because of your relative?
1.26 0.94 Low burden Do you feel that you should be doing more for
your relative?
1.24 0.95 Low burden Do you wish that you could just leave the care of
your relative to someone else?
1.24 0.93 Low burden Do you feel that your relative is dependent upon
you?
1.21 0.94 Low burden Do you feel that your relative seems to expect
you to take care of him or her, as if you were the only one he or she could depend on?
1.21 0.98 Low burden
Do you feel that your relative asks for more help than he or she needs?
1.13 1.05 Low burden
4.3.3 Social support. The Multidimensional Scale of Perceived Social Support (MSPSS) with 12 items was used to measure perceived social support of caregiver through the 3 factors relating to family, friends and significant others. Possible range score of social support is 12 to 84 with higher score indicating more perceived social support. In the current study, actual range score of social support was between 21 to 68 with a mean of 41.97 and a standard deviation of 10.77. The meaning overall of social support was moderate level. Most of the subjects required low and moderate
social support with 33 (26.2%) and 85 (67.5%) respectively. The results of social support variable were shown in table 4.7a.
Table 4.7a Frequency, percentage, range, mean, and standard deviation of social support (n = 126)
Social Support Frequency (%)
Possible range
Actual range
Mean SD
Low social support 33 (26.2) 12 – 35 21 – 35 28.48 4.36 Moderate social support 85 (67.5) 36 - 60 36 – 58 45.14 6.09 High social support 8 (6.3) 61 - 84 61 – 68 64.00 2.39
Overall 126 (100) 12 - 84 21 - 68 41.98 10.77
Table 47b showed detail of mean, standard deviation from high to low of each domain: family subscale (mean = 3.91, SD = 1.81); friends subscale (mean = 3.34, SD = 1.62); significant other subscale (mean = 3.24, SF = 1.60) and detail the mean and standard deviation of all items in each domain.
Table 4.7b Mean and standard deviation of social support (n = 126)
Social support Mean SD
Family subscale 3.91 1.81
My family is willing to help me make decisions 4.03 1.82
My family really tries to help me 3.94 1.90
I get the emotional help and support I need from my family 3.85 1.88 I can talk about my problems with my family 3.82 1.94
Friends subscale 3.34 1.62
I have friends with whom I can share my joys and sorrows 3.39 1.66 I can talk about my problems with my friends 3.38 1.67
My friends really try to help me 3.33 1.68
I can count on my friends when things go wrong 3.27 1.69
Table 4.7b Mean and standard deviation of social support (n = 126) (Cont.)
Social support Mean SD
Significant other subscale 3.24 1.60
There is a special person who is around when I am in need 3.35 1.67 I have a special person who is a real source of comfort to me 3.32 1.71 There is a special person with whom I can share my joys and
sorrows
3.23 1.62 There is a special person in my life who cares about my
feelings
3.06 1.71
4.3.4 Family conflict. Family conflict referred to a disagreement within the family system about various issues (physical or emotional) arising during stroke recovery.
Family Caregiver Conflict Scale (FCCS) with 15 items was developed to measure family conflict. Possible range score of family conflict is 15 to 105, and higher score represented higher levels of conflict within a family. In this study, actual range score of family conflict was between 24 to 79 with a mean of 52.46 and a standard deviation of 12.36. The meaning overall of family conflict was at high conflict level. Most of the stroke caregivers reported high family conflict (70.6%). The results of family conflict variable were shown in table 4.8a.
Table 4.8a Frequency, percentage, range, mean, and standard deviation of family conflict (n = 126)
Family conflict Frequency (%)
Possible range
Actual range
Mean SD
Low family conflict 37 (29.4) 15 - 45 24- 45 37.32 6.28 High family conflict 89 (70.6) 46 - 105 46 - 79 58.75 8.03
Overall 126 (100) 15-105 24-79 52.46 12.36
Table 4.8b showed detail of mean, standard deviation from low to high of each domain: general family functioning (mean = 3.19, SD = 0.81); problem solving (mean = 3.31, SD = 0.83); communication (mean = 3.51, SF = 1.01) and also detail the mean and standard deviation of all items in each domain.
Table 4.8b Mean and standard deviation of family conflict (n = 126)
Family conflict Mean SD
General family functioning 3.19 0.81
We have disagreements about family members not helping enough with our relative
3.72 1.22 Family members often complain when I ask help to help
with all the things I have to do while caring for our relative
3.61 1.30 I avoid asking family members for help with our relative
because it results in disagreements
3.59 1.28 Family members often complain when I ask them to help
with our relative
3.58 1.26 We avoid discussing things about our relative because it
results in disagreements
3.58 1.31 I avoid some family members since our relative had a stroke
because of the disagreements we have
3.54 1.16 We have disagreements about some family members not
doing their part to help care for our relative
3.51 1.28 We have disagreements when I ask family members to help
me take care of our relative
3.48 1.32 We have disagreements about the way some family members
treat our relative
3.39 1.40
Table 4.8b Mean and standard deviation of family conflict (n = 126) (Cont.)
Family conflict Mean SD
Problem solving 3.31 0.83
We have disagreements about health care decisions for out relative.
3.01 0.32 We have disagreements about how well our relative is
recovering from the stroke.
3.40 1.37 We have disagreements about the amount of physical
activities our relative needs to be doing.
3.52 1.36
Communication 3.51 1.01
We have disagreements that I am doing too much to take care of our relative.
3.46 1.34 We have disagreements that I am doing too little to take
care of our relative
3.60 1.29 We have disagreements about how much our relative has
changed since the stroke.
3.49 1.31
4.4 Relationship between Caregiver’s age, Caregiver’s income, Patient’s functional status, Caregiver burden, Social support and Family conflict and Health Status of Stroke Caregivers
This part answered the questions about the relationship between caregiver’s age, caregiver’s income, patient’s functional status, caregiver burden, social support, family conflict and health status of stroke caregivers in Thai Nguyen, Vietnam.
4.4.1 Relationship between caregiver’s age, caregiver’s income and health status of stroke caregivers
The relationship between caregiver’s age, caregiver’s income and health status of stroke caregivers was tested by Spearman’s Rho because using product-
moment correlation, firstly, test of normality must be done, however, it did not meet the assumption (see Appendix K). The results were shown in table 4.9.
Table 4.9 Relationship between caregiver’s age, caregiver’s income and health status of stroke caregivers (n = 126)
Variables Health status of stroke caregivers
r p - value
Caregiver’s age -.303** .001
Caregiver’s income -.078 .388
The results from table 4.9 revealed that caregiver’s age was significantly moderate negative correlated with health status of stroke caregivers (r = -.303, p <
.001). However, caregiver’s income was not significantly associated with health status of stroke caregivers (r = -.078, p = .388).
4.4.2 The relationship between patient’s functional status, caregiver burden, social support, family conflict and health status of stroke caregivers.
Pearson’s product-moment correlation coefficient was employed to analyze the relationships between patient’s functional status, caregiver burden, social support and family conflict and caregiver health status which were showed in table 4.10. The assumptions of Pearson analysis were tested including normality of variables of patient’s functional status, caregiver burden, social support and family conflict; homoscedasticity and linearity. The results showed that all these four independent variables had normal distribution because p values of those variables from Kolmogorow-Smimov output was greater than .05 (see Appendix K). Next scatter plots were considered. It was found that scatter plots took the shape of a rectangular and was parallel, meaning there were homoscedasticity. Besides that, linearity was presented by considering scatter plot between regression and residual. It showed the means of residual were on the same straight line (see Appendix K).
Table 4.10 Relationship between patient’s functional status, caregiver burden, social support, family conflict and health status of stroke caregivers (n = 126)
Variables Health status of stroke caregivers
r p - value
Patient’s functional status .717** <.01
Caregiver burden -.839** <.01
Social support .598** <.01
Family conflict -.407** <.01
As shown in table 4.10, the results of the Pearson product-moment correlation coefficient demonstrated that there were strong positive correlations between patient’s functional status, social support and health status of stroke caregivers (r = .717, p < .01, r = .598, p < .01, respectively). Whereas, there were strong negative and moderate negative correlations between caregiver burden and family conflict and health status of stroke caregivers (r = -.839, p < .01, r = -.407, p < .01, respectively).
Table 4.11 Correlation matrix and correlation between predictors and health status of stroke caregivers (n = 126)
Variables 1 2 3 4 5 6 7
1. Caregiver’s age 1.00
2. Caregiver’s income -.046 1.00
3. Patient’s functional status -.174 -.173 1.00
4. Caregiver burden .193* -.200* -.643** 1.00
5. Social support -.165 -.139 -.494** -.524** 1.00
6. Family conflict -.040 -.264** -.288** .419** -.290** 1.00 7. Health status of stroke
caregivers
-.303** -.078 .717** -.839** .598** -.407** 1.00
*p < .05. **p < .01
Table 4.11 showed that, there were positive and negative associations between independent variables and dependent variable as described above in table 4.9 and table 4.10. In addition, there was also a mutual correlation between the independent variables. Caregiver’s age was positively associated with caregiver burden (r = .193, p < .05). Caregiver’s income was negatively associated with caregiver burden (r = -.200, p < .05) and family conflict (r = -.264, p < .01). Patient’s functional status was negative associated with caregiver burden, social support and family conflict (r = -.643, p < .01, r = -.494, p < .01, r = -.288, p < .01, respectively).
Caregiver burden was negatively associated with social support (r = -.524, p < .01) but positively associated with family conflict (r = .419, p < .01). Social support was negatively associated with family conflict (r = -.290, p < .01).