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The effect of respite care was measured by using a time-averaged proxy variable of formal care use.
The adverse effect of respite service users' Activity of Daily Living (ADL) functional performance and sleep rhythms were observed in past studies [ 35- 37].
It may be necessary to focus more on the content of respite service to investigate the effect of respite service on changes in the care needs level.
Drawn up from the literature, the effect of respite care on well-being of parents of chronically ill children is however not easily evaluated [ 33- 36].
The effect of respite care could mainly be attributed to the latter [ 24, 26, 59- 61], and not to the former [ 24, 62].
Though our study cannot indicate the effect, the reported effect of respite service use in previous studies itself is also still controversial.
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This is supported by the fact that numerous publications evaluate the effects of respite care focusing on outcomes for caregivers not care recipients [ 41].
For many carers such dynamic and often distressing situations might have a considerable negative impact on their well-being thus confounding positive effects of respite.
Besides the cost-effectiveness effects there are positive effects of usage of day care on caregivers' health: Although in reviews [ 28] and in meta-analytical studies [ 29] the moderately positive effects of respite on subjective burden and depression of family caregivers have now been proven, little is known about what an effective intervention should be like.
Both the effectiveness and cost-effectiveness of respite remain poorly understood [ 21].
Also, these effects depended on the kind of intervention carried out, with psychoeducational and psychotherapeutic interventions showing the most consistent effects, above those of respite care, support groups, knowledge and multicomponent.
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