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Interventions done with caregivers of stroke survivors improve some caregiver and patient outcomes

Bakas T, Clark PC, Kelly-Hayes M, et al. Evidence for stroke family caregiver and dyad interventions: a statement for healthcare professionals from the american heart association and american stroke association. Stroke. 2014;45:2836-52.

Review question

In caregivers of people who survived a stroke, do interventions improve outcomes in caregivers or stroke survivors?

Background

People who survive a stroke may have ongoing disabilities. They may need help with their care from family members and friends (caregivers). Interventions done with caregivers may help to relieve stress or improve coping in caregivers. They may also improve outcomes in stroke survivors.

How the review was done

The researchers did a systematic review, searching for studies that were published in English up to October 2012.

They found 26 randomized controlled trials and 6 nonrandomized studies. Studies included between 17 and 486 people.

The key features of the studies were:

• people were caring for a family member or friend who had survived a stroke;
• interventions were done with the caregiver alone or with the caregiver and stroke survivor; and
• interventions included 1 or more of the following strategies: skill building (e.g., problem-solving or goal setting, stress management, communication), providing psycho-educational information (e.g., how to manage emotions and health needs of caregivers and stroke survivors, coping with changes in lifestyle), and support (e.g., peer support groups, online discussion groups).

Control groups were not described.

What the researchers found

Most interventions provided psycho-educational information alone or with skill building. Most studies had follow-up of 6 to 12 months.

Compared with control groups:

• interventions done with caregivers improved outcomes in caregivers and sometimes in stroke survivors; and
• interventions done with both caregivers and stroke survivors improved outcomes in stroke survivors and sometimes in caregivers.

Conclusions

Interventions done with caregivers of survivors of stroke mainly improve caregiver outcomes. Interventions done with caregivers and stroke survivors mainly improve outcomes in stroke survivors.

Interventions for people (caregivers) who care for family members or friends who survived a stroke*

*Control interventions were not described.

†Outcomes included depression, anxiety, quality of life, social and family functioning, problem-solving, knowledge, and satisfaction.

‡Outcomes included depression, anxiety, quality of life, social functioning, daily living activities, healthcare service use, moving to an institution, knowledge, and satisfaction.

§1 intervention provided psycho-educational information alone, 7 combined it with skill building, 3 with support, and 3 with both skill building and support. 2 interventions provided skill building only, and 1 provided skill building with support.

||All interventions provided psycho-educational information; 5 combined it with skill building, 3 with support, and 1 with both skill building and support.