Interventions for caregivers of stroke survivors: An update of the evidence

Abstract

Objective: The purpose of this systematic review was to summarize the latest evidence on the effectiveness of interventions for family caregivers of stroke survivors. Methods: Using multiple databases, the search strategy included randomized controlled trials, published in English, between 2002 and 2013. Two independent reviewers extracted information and evaluated study quality. Results: From an initial search of 120 studies, 18 were included. Most interventions were multi-faceted, including elements of information/education, support, and skill building. Skill building was defined as an intervention that equipped the caregiver with skills to provide care to the stroke survivor or skills to cope with the caregiving role. A variety of outcomes, most commonly psychological distress, caregiver burden, and quality of life, were measured with effectiveness of the intervention shown on at least one outcome in over 50\% of studies. About half of the studies explicitly provided a theory that guided the intervention and outcomes. Interventions that included elements of skill building were more likely to show a significant effect. The majority of studies had insufficient power to detect significant differences and there was an under-representation of minority caregivers, limiting the generalizability of the review. Conclusions: Interventions that deliver specific skills relative to performing the physical care needed by the stroke survivors and/or to manage the stroke survivor’s emotional responses to the stroke as well as the caregiver’s responses to the role seemed to be most effective in decreasing psychological distress and burden. Studies are beginning to examine technology as a mechanism for intervening with caregivers.