Systematic Review of the Evidence for Stroke Family Caregiver and Dyad Interventions

Abstract

Stroke family caregiver and dyad literature has expanded over the past few years. The purpose of this review was to build upon 2 prior systematic reviews to critique, analyze, and synthesize the evidence pertaining to the impact of family caregiver and dyad interventions on stroke survivor and family caregiver outcomes. CINAHL, PsychINFO, PubMed, and reference lists were searched from December 1, 2016 through March 31, 2021. Using PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), articles were identified that tested outcomes from stroke family caregiver or dyad interventions that targeted the health or well-being of family caregivers. Data from the articles were abstracted into tables for analysis, then compared with recommendations from the 2 prior systematic reviews. A total of 18 articles met inclusion criteria (10 caregiver interventions; 8 dyad interventions) representing sample sizes ranging from 7 to 349 caregivers or dyads. Most were randomized controlled trials (n=13); 2 were cluster randomized trials; and 3 were single-group quasi-experimental designs. Of the 18 studies, 8 had <50 caregivers or dyads and 5 were small feasibility studies that reported data trends rather than testing for significance. Only 6 studies reported significant survivor outcomes. Eleven studies reported significant caregiver outcomes, the most common being burden. A number of survivor and caregiver outcomes were not significant, or only significant for certain subgroups. The limited number of studies, small sample sizes, and conflicting results, made it difficult to draw firm conclusions regarding the impact of these interventions on outcomes. Based on the available evidence from these 18 studies, recommendations from the 2 prior reviews were generally supported. Well-designed and well-powered randomized controlled clinical trials are still needed to confirm efficacy of stroke family caregiver and dyad interventions.

Effect of a telephone and web-based problem-solving intervention for stroke caregivers on stroke patient activities of daily living: A randomized controlled trial

“…Although additional research is warranted, our study contributes to advancing the science of stroke caregiving. Our study includes all the recommendations of three reviews 20,21,50 for designing and implementing stroke caregiver interventions. Our intervention combined active skill-building with psychoeducational strategies, was individualized to the needs of the stroke caregivers, consisted of the recommended five to nine sessions, and included post-discharge assessments and instructions.…”

Addressing Uncertainty in Informal Familial Caregivers of Stroke Survivors: A Systematic Meta-Ethnography

“…Educational and skills-based interventions have aimed at improving caregiver knowledge and perceived competence by providing information on stroke events, practical skills for caregiving, and general coping skills (e.g., emotion regulation) [ 37 ]. These interventions, which are often delivered by nurses, social workers, or psychologists, have demonstrated beneficial effects on stroke caregivers’ mental health [ 37 , 38 , 39 , 40 , 41 ]. While caregivers in the current review reported a desire to “know” (e.g., about the stroke event, caregiving skills, and survivor prognoses), they also identified concerns about the accessibility of information provided to them by hospital staff.…”

Spilling over at the boiling point: A commentary on the need for dyadic approaches to psychosocial care with older adults and their care-partners in postacute rehabilitation.

“…Dyadic interventions are typically delivered by a trained provider either in-person or via telehealth and commonly range from 6 to 16 sessions (Backhaus et al, 2019; Martire et al, 2010; Vranceanu et al, 2020). A growing body of literature supports the feasibility and clinical benefits of dyadic psychosocial interventions with rehabilitation populations, including TBI (Kreutzer et al, 2020) and stroke (Bakas et al, 2022 ), as well as in the context of serious and/or chronic illnesses, such as cancer (Traa et al, 2015), heart failure (Buck et al, 2018), and dementia (Moon & Adams, 2013). However, dyadic psychosocial interventions have yet to be studied among the heterogeneous group of older patient–care-partner dyads in postacute rehabilitation settings.…”