• Adan Sardar Department of Medicine, Combined Military Hospital Peshawar
  • Khurram Shahzad Department of Medicine, Combined Military Hospital, Peshawar
  • Abdul Rehman Arshad Department of Nephrology/ Medicine, Combined Military Hospital, Peshawar
  • Khawar Shabbir Department of Gastroenterology/Medicine, Combined Military Hospital, Peshawar
  • Syed Hassan Raza Department of Medicine, Combined Military Hospital, Peshawar



Keywords: Stroke, Caregivers, Disability


Background: Stroke results in serious long-term disability in fifty percent of the survivors, making them dependent on others for activities of daily living. Our study aims to study the effect of this dependence on care-givers. Cross sectional study. Methods: It was a cross sectional study conducted at Combined Military Hospital Peshawar from September 2020 to November 2020. Self-administered questionnaires were used to interview 96 patients with stroke and their caregivers selected through convenience sampling technique. Barthel Index was used to measure disability among patients, whereas Modified Caregivers Strain Index (M-CSI) was used for the caregivers. An association between the two scores was analyzed through Pearson’s coefficient of correlation (r) and linear regression. Results: Mean ages of the patients and their caregivers were 66.13±11.32 and 36.32±13.71 years respectively. Median score of Barthel index was 1.00 (interquartile range 0.00- 9.75). Mean M-CSI score was 17.31±5.04. There was significant negative correlation between Barthel Index and M-CSI (R=0.542, p<0.001). No significant association was found between duration of stroke and history of recurrent stroke with Barthel Index (p=0.399 and p=0.527 respectively). Conclusion: Greater the dependence of patients for activities of daily living on their caregivers, higher is the level of strain among the latter. There is dire requirement of social support and rehabilitation centers to address the physical and mental needs of both the patients and their care providers.


Caprio F, Sorond F. Cerebrovascular Disease: Primary and Secondary Stroke Prevention. Med Clin North Am 2019;103(2):295–308.

Musuka T, Wilton S, Traboulsi M, Hill M. Diagnosis and management of acute ischemic stroke: speed is critical. CMAJ 2015;187(12):887–93.

Béjot Y, Daubail B, Giroud M. Epidemiology of stroke and transient ischemic attacks: Current knowledge and perspectives. Rev Neurol (Paris) 2016;172(1):59–68.

Guzik A, Bushnell C. Stroke Epidemiology and Risk Factor Management. Continuum (Minneap Minn) 2017;23(1):15–39.

Donkor E. Stroke in the21stCentury: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat 2018;2018:3238165.

O’Shea R, Goode D. Effects of stroke on informal carers. Nurs Stand 2013;28(15):43–7.

Brasier C, Ski C, Thompson D, Cameron J, O’Brien C, Lautenschlager N, et al. The Stroke and Carer Optimal Health Program (SCOHP) to enhance psychosocial health: study protocol for a randomized controlled trial. Trials 2016;17(1):446.

Duffy L, Gajree S, Langhorne P, Stott D, Quinn T. Reliability (Inter-rater Agreement) of the Barthel Index for Assessment of Stroke Survivors: Systematic review and meta-analysis. Stroke 2013;44(2):462–8.

S.Ramasamy M, Ibrahim R, Madon Z, Arshat Z. A Validity Study of Malay-translated Version of the Modified Caregivers Strain Index Questionnaire (M-CSI-M). J Bus Soc Rev Emerg Econ 2017;3(2):217–26.

Josh Senyak M. Correlation sample size | Sample Size Calculators [Internet]. 2021 [cited 2021 April 19]. Available from:

Em S, Bozkurt M, Caglayan M, Ceylan Cevik F, Kaya C, Oktayoglu P, et al. Psychological health of caregivers and association with functional status of stroke patients. Top Stroke Rehabil 2017;24(5):323–9.

Barthel Index. (2021). [Internet]. Retrieved 13 September 2020, [cited 2021 April 19]. Available from:

Feigin VL, Norrving B, Mensah GA. Global Burden of Stroke. Circ Res 2017;120(3):439–48.

Campbell BCV, De Silva DA, Macleod MR, Coutts SB, Schwamm LH, Davis SM, et al. Ischaemic stroke. Nat Rev Dis Primers 2019;5(1):70.

Ogunlana M, Dada O, Oyewo O, Odole A, Ogunsan M. Quality of life and burden of informal caregivers of stroke survivors. Hong Kong Physiother J 2014;32(1):6–12.

Musa KI, Keegan TJ. The change of Barthel Index scores from the time of discharge until 3-month post-discharge among acute stroke patients in Malaysia: A random intercept model. PLoS One 2018;13(12):e0208594.

Cucchiara B, George D, Kasner S, Knutsson M, Denison H, Ladenvall P. et al. Disability after minor stroke and TIA: A secondary analysis of the SOCRATES trial. Neurology 2019;93(7):e708–16.

Belagaje SR. Stroke Rehabilitation. Continuum (Minneap Minn) 2017;23(1):238–53.

Nave A, Rackoll T, Grittner U, Bläsing H, Gorsler A, Nabavi D, et al. Physical Fitness Training in Patients with Subacute Stroke (PHYS-STROKE): multicentre, randomised controlled, endpoint blinded trial. BMJ 2019;366:l5101.

Choi-Kwon S, Kim HS, Kwon SU, Kim JS. Factors Affecting the Burden on Caregivers of Stroke Survivors in South Korea. Arch Phys Med Rehabil 2005;86(5):1043–8.

Mandowara B, Patel AN, Amin AA, Phatak A, Desai S. Burden faced by caregivers of stroke patients who attend Rural-based medical teaching hospital in Western India. Ann Indian Acad Neurol 2020;23(1):38–43.

Jeong YG, Myong JP, Koo JW. The modifying role of caregiver burden on predictors of quality of life of caregivers of hospitalized chronic stroke patients. Disabil Health J 2015;8(4):619–25.

Denno MS, Gillard PJ, Graham GD, DiBonaventura MD, Goren A, Varon SF, et al. Anxiety and Depression Associated With Caregiver Burden in Caregivers of Stroke Survivors With Spasticity. Arch Phys Med Rehabil 2013;94(9):1731–6.

Katan M, Luft A. Global burden of stroke. Semin Neurol 2018;38(2):208–11.



Most read articles by the same author(s)