The effectiveness of caregiver psychosocial interventions on the psychosocial wellbeing, physical health and quality of life of stroke family caregivers and their stroke survivors: A systematic review.
BACKGROUND
Family caregivers play a significant role in the rehabilitation of stroke survivors. Various types of psychosocial interventions have been developed to improve the well-being of both stroke survivors and their caregivers. However, studies showed the results to be mixed and provided insufficient evidence about the optimal dose, approach and format of interventions.


OBJECTIVE
To identify the best available evidence related to the effectiveness of psychosocial interventions for family caregivers on the psychosocial and physical wellbeing of family caregivers and stroke survivors.


METHODS
Adult patients were community-dwelling stroke survivors with a clinical diagnosis of stroke. Family caregivers were adult family members of stroke survivors who were the primary caregivers.Trials of psychosocial interventions for family caregivers that aimed at improving the wellbeing of caregivers and stroke survivors.Randomised controlled trials, quasi-randomised, historical cohort and pre- and post-test studies.Primary outcomes were psychosocial wellbeing, physical health, and quality of life of both family caregivers and their stroke survivors. Secondary outcomes were family functioning, intervention satisfaction and use of social resources.


METHODS
Thirty-nine electronic bibliographic databases in English and Chinese were searched from their inception to March 2011 and yielded 5,327 citations.Methodological quality The JBI Critical Appraisal Checklists were used to critically appraise study quality.Data Collection Two reviewers extracted and summarised the details of included studies using the JBI-MAStARI data extraction form independently.Data synthesis Standardised mean difference and 95% confidence interval were calculated for the summary effect of continuous data measured by different scales, and mean difference and 95% confidence interval were calculated for each included study using the same scale. Narrative summary was used when statistical pooling was not possible.


RESULTS
A total 18 studies involving 1,723 family caregivers and 1,836 stroke survivors, were included. Three types of psychosocial interventions, including counselling, psychoeducation and social support group were identified. On the basis of two studies examining the outcomes of counselling intervention, there was a significant improvement in family functioning (SMD: -0.12; 95% CI: -0.23 to -0.01; p = 0.03) immediately post-intervention. Caregivers receiving psychosocial interventions also reported a higher level of satisfaction when compared to those receiving usual care. No statistically significant effects on physical health, psychosocial wellbeing and quality of life of caregivers, or on their stroke survivors were found.


CONCLUSIONS
The review demonstrated evidence of positive effect of psychosocial interventions on family functioning of caregivers. More well designed randomised controlled trials are needed to further examine the optimal dose and format of psychosocial interventions owing to the diversity of interventions.
1.The Nethersole School of Nursing, The Chinese University of Hong Kong The Hong Kong Centre for Evidence Based Nursing: a collaborating centre of the Joanna Briggs Institute.
Ho Yu
HY
Cheng
Sek Ying
SY
Chair
Janita Pc
JP
Chau