Non-pharmacological interventions for caregivers ... - Update Software

Informal caregiver satisfaction
One study (Mant 2000) assessed satisfaction with services and understanding
of stroke using a caregiver satisfaction questionnaire
(Pound 1993). The study reported that caregivers in the intervention
group were more satisfied with their understanding of the
causes of stroke (84% versus 72%, P = 0.04) but no more satisfied
than the control group with their understanding of stroke (77%
versus 65%, P = 0.06) and how to prevent another stroke (82%
versus 71%, P = 0.06). No detail was provided on satisfaction with
stroke services in hospital, at discharge or after. One study (Grant
2002), assessing satisfaction with health care using the client satisfaction
questionnaire (Larsen 1979), reported that caregivers’ satisfaction
in the experimental and sham intervention groups remained
comparable while the level of satisfaction decreased over
time in the control group; no data were reported. Another study
(Hartke 2003) assessed caregiver satisfaction with the characteristics
of the intervention using a measure developed specifically for
that purpose; however, no assessment was made comparing satisfaction
in the intervention groups versus the control group.
Informal caregiver mortality
No study collected data on informal caregiver mortality.
D I S C U S S I O N
Summary of main results
There is currently insufficient data to support or refute the use of
’information and support’ interventions or ’psycho-educational’
interventions for informal caregivers of stroke survivors to reduce
or prevent caregiver-specific stress and strain, general stress or distress,
depression, anxiety or health-related quality of life compared
to no intervention or usual care. ’Teaching procedural knowledge’
type interventions delivered to caregivers of stroke survivors, prior
to the stroke patient’s discharge from hospital, appear to reduce
caregiver-specific stress and strain, general stress or distress, depression
and improve health-related quality of life compared to
usual care. However, this is based on data from one, small, singlecentre
study.
Overall completeness and applicability of
evidence
The goal of studies included in this review was either to evaluate
a potential ’cure’ for a health state (e.g. depression) or social state
(e.g. burden) or to identify measures to prevent the sequelae of
providing informal care such as stress, depression, anxiety or decline
in health-related quality of life.
Non-pharmacological interventions for caregivers of stroke survivors (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Unlike randomised controlled trials (RCTs) of patients (e.g. stroke
survivors), where participants must have the disease in question
to be admitted to the trial, the participants in the included studies
are free-living individuals and are not defined by the presence
of disease or ill health nor are they presenting for clinical care or
under active health care. A major limitation of all the included
studies is the lack of reporting of a detailed and precise definition
of the index condition for a current informal caregiver, making
it difficult to assess fully the merits and appropriateness of the
included studies. In addition, inadequate characterisation of the
informal caregiver study participants makes it difficult to know
who the results of the study apply to and to replicate the studies
in question. Moreover, an ambiguous eligibility criterion suggests
a study that is not properly designed to evaluate the effects of the
interventions; if a study population is chosen incorrectly, then the
ability to detect a benefit is likely to be reduced. Furthermore, the
substantial drop-outs witnessed across the included studies suggests
that, in some instances, the intervention may not have been
appropriate for the participants that were selected for enrolment
in the study.
Second, ’informal caregivers’ are perceived as individuals at high
risk of adverse health outcomes. However, the effect of an individual’s
informal caregiver classification/status on the same individual’s
risk of incident ’health outcomes’ (including depression, anxiety,
general stress and distress and health-related quality of life)
is not a well-defined causal quantity and therefore has no obvious
implications for interventions.
Quality of the evidence
The evidence in this review comes from eight studies from four
countries carried out over the previous 12 years. The total number
of participants was 1007. It is difficult to draw robust conclusions
about the effects of interventions targeted towards informal caregivers
of stroke survivors as there is a lack of a precise definition
of a current informal caregiver across all studies and in addition
there are limitations in the study design and conduct of individual
studies, which raise questions about the validity of their findings.
Potential biases in the review process
We believe that we have identified all the relevant RCTs. We have
successfully contacted all except one of the original authors. We
have sought any truly RCTs regardless of language of publication.
All papers in any language other than English have been either
translated or data have been extracted from the original paper by
an individual proficient in the language of the paper.
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