Chapter 6. System Validation and Trade-off Research
6.3 Subpixel Target Detection Model Validation
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The Relationship between Demographic Variables and
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explaining the study. Subjects were assured of confi dentiality. Ethical clearance for the study was obtained from Institute Ethics (Human) commi� ee, JIPMER.
Barthel index was used to assess the activities of daily living of stroke patients who were aff ected with stroke for more than six months. It consisted of ten variables describing activities of daily living such as feeding, bathing, grooming, dressing, bowels, bladder, toilet use, transfer (from bed to chair and vice versa), mobility (on level surfaces) and stairs. The score ranges from 0-100 and a higher score indicate independence in activities of daily living.
The Modifi ed Rankin Scale (MRS) was also used to assess the degree of disability in stroke patients.
The MRS describes varying levels of disability ranging from no symptoms at all, no signifi cant disability despite symptoms, slight disability, moderate disability, moderately severe disability and severe disability, to dead or maximum disability. The lowest score is zero indicating no symptom at all, and the highest score is six indicating dead.
For assessing the burden of the caregivers, Caregiver burden scale (Elmstahl, 1996)6 was used. This scale consists of twenty one questions with fi ve diff erent domains such as general strain, isolation, disappointment, emotional involvement and environment. A score of 0-20 indicates li� le or no burden, 21-40 indicates mild to moderate burden, 41- 60 indicates moderate to severe burden and 61-84 indicates severe burden.
RESULTS
The statistical analysis was carried out using both descriptive and inferential statistics. Frequency and percentage were used to analyze the distribution of patients and caregivers’ socio-demographic variables.
Kruskal Wallis test and Mann Whitney U test was used to assess the association between the caregiver burden score and socio-demographic variables based on the number of groups involved. All statistical analysis was carried out at 5% level of signifi cance and P value <0.05 was considered as statistically signifi cant.
The results of the study suggested that the mean age of the patients with stroke was 54 years and the
mean age of stroke onset was found to be 52 years. The mean stroke duration was two years. Barthel index mean score was found to be 60.18 which indicates severe dependency and the mean score of modifi ed rankin scale was found to be 2.71 which indicates moderate disability. Regarding the caregivers, the mean age was 40 years and ranged from 20 to 65 years. There was a signifi cant relationship between caregiver burden score and caregiver gender, employment status, marital status and relationship with the patient. Female gender, unemployment, caregivers who are married and spouses of the caregivers were found to be having increased burden of care.
Distribution of patients based on demographic variables is presented in table 1.The results showed that majority (70.2%) of the patients were males, 98.8%
of them were married and 93% of the patients had no family history of stroke. Further, the caregivers’
demographic variables are presented in table 2.
58.3% of caregivers were females, 82% of them were married, 58.2% were spouses and 63% of caregivers belonged to the nuclear family.
Further, the relationship between caregiver burden and socio demographic variables of caregivers is presented in table 3. The caregiver burden score was found to be higher in females (50.93) when compared to the males (30.7) and it was statistically signifi cant at p<0.01 level. Similar fi ndings were reported by Bha� acharjee et al4. and Choi- Kwon et al5. The subjects who were unemployed experienced more burden as revealed by the mean burden score of 50.48 and it was also found to be statistically signifi cant at p<0.01 level. Further, the results of the study indicated the married caregivers as well as spouses as caregivers reported more burden and it was statistically signifi cant at p<0.05 level. No signifant association was found with other variables such as educational level and the presence of medical illness in the caregivers. Even though, the burden score was found to be higher (43.4) in the caregivers who belonged to the nuclear family, it was not statistically signifi cant when compared to the joint (42.6) and extended family (38.2).
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Table 1: Distribution of patients based on demographic variables (n=84)
Variables Category Frequency Percentage (%)
Gender Male 59 70.2
Female 25 29.8
Illiterate 23 27.4
Education Primary level (1-5) 24 28.6
Secondary (6-10) 30 35.7
Others (11 and above) 7 8.3
Previous Occupation Skilled job 29 34.5
Unskilled job 36 42.9
Unemployed 19 22.6
Marital status Married 83 98.8
Never married 1 1.2
Stroke site of brain Right Side 39 46.4
Left Side 37 44.0
Both side 8 9.5
Family history of stroke Yes 6 7.1
No 78 92.9
Table 2: Caregiver characteristics of patients with stroke (n=84)
Variable Category Frequency Percentage (%)
Gender Male 35 41.7
Female 49 58.3
Illiterate 16 19.0
Education Primary level(1-5) 21 25.0
Secondary 6-10 28 33.3
others(11 and above) 19 22.6
Employment status Skilled 19 22.6
Unskilled 34 40.5
Unemployed 31 36.9
Marital status Married 69 82.1
Never married 14 16.7
Single (widow) 1 1.2
Relation with the patient Spouse 43 51.2
Children 28 33.3
Parent 2 2.4
Other 11 13.1
Family type Nuclear family 53 63.1
Joint family 19 22.6
Extended family 12 14.3
Medical illness in caregiver Yes 18 21.4
No 66 78.6
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Table 3: Relationship between burden score and demographic variables of caregivers.
Variables Category n Mean® Test value Degree of
freedom Ρ
Gender Male 35 30.7
z= - 3.75 <0.001**
Female 49 50.93
Education
Illiterate 16 48.03
= 7.00
3
0.07 (N.S)
Primary 21 51.05
Secondary 28 39.77
Others 19 32.42
Employment status
Skilled 19 27.58
= 10.5 2 0.005**
Unskilled 34 43.56
Unemployed 31 50.48
Marital status
Married 69 45.92
=7.62 2
0.022*
Never married 14 26.96
Single 1 24
Relationship with Patient
Spouse 43 50.90
=10.51 3
0.015**
Children 28 34.27
Parent 2 30.25
Others 11 32.86
Family type
Nuclear 53 43.43
=0.45 2
0.79 (N.S)
Joint 19 42.61
Extensive 12 38.21
Medical illness Yes 18 44.44
z= -0.382 0.7
(N.S)
No 66 41.97
z= Mann Whitney U test = Kruskal Wallis test
* Signifi cant at p <0.05 level ** signifi cant at p <0.01 level N.S. Not signifi cant
CONCLUSION
The study suggested that moderate to severe burden was experienced by caregivers who were females by gender, unemployed, married person and spouses of the patient. The increased prevalence of stroke as well as the increasing pressures on families to provide care, more research is needed to identify the caregivers who are at risk of developing burnout.
Research is also needed to identify services that are eff ective in strain alleviation.
Acknowledgement: We would like to thank Dr.
Sunil K Narayan, Professor and Head, Department of Neurology, JIPMER for his valuable support and all
the care givers who participated in the study.
Sources of Funding: Nil Confl icts of Interest: Nil
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