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Agreements and disagreements with other studies or reviews Brereton 2007 is a systematic review of published and unpublished research evidence of the effects of interventions for adult family caregivers of people who have had a stroke based on a search of 17 electronic databases and the grey literature sources. The purpose of the review was to assess the effects of interventions targeted towards adult family caregivers of stroke survivors on caregivers’ primary outcomes and to determine the conceptual basis for the intervention. Studies were limited to RCTs. The authors did assess the quality of each study using the Critical Appraisal Skills Programme (CASP) tool for RCTs, with two reviewers performing double data extraction on all included studies. The review found eight trials assessing the effects of caregiver training interventions such as education and counselling, social problem-solving partnerships, psycho-educational telephone support groups, a nurse-led education and support programme, as well as a support programme delivered in hospital or at home. The review found that all interventions tested in the RCTs provided some benefit. However, the authors were unable to draw conclusions because of methodological limitations. The main differences between Brereton 2007 and this systematic review are that the Brereton review is narrative; it focuses on a family member as the informal caregiver and has no a priori stated primary and secondary outcomes. In addition, there are several areas of disagreement between the Brereton review and this review around assessment of methodological quality (primarily randomisation and blinding) of the included studies that are common to both reviews (Grant 2002; Hartke 2003; Kalra 2004; Larson 2005). Further, Kalra 2004 does not meet the Brereton study inclusion criteria as eligibility is not limited to family caregivers in either study. In addition, Van den Heuvel 2000 does not meet the criteria for a RCT as participants were not randomly assigned to intervention and comparator groups. Evans 1988 is excluded from this review because it does not collect any of the outcomes of interest. However, while we disagree with certain aspects of the review methods and results, we agree with their conclusion that there are insufficient data of adequate quality to draw firm conclusions. Eldred 2008 conducted a systematic review of published and unpublished research evidence of the effects of psychosocial interventions for caregivers of stroke survivors, based on psychological principles and theoretical frameworks, based on a search of eight electronic databases, handsearching, scanning reference lists and contacting experts in the field. Studies were limited to RCTs. The authors assessed the quality of each study using a quality assess- Non-pharmacological interventions for caregivers of stroke survivors (Review) Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. ment tool designed especially for the systematic review. Two reviewers independently assessed the quality of each study. No detail is provided on how data were extracted. The authors identified seven studies for inclusion. The interventions assessed included education with family counselling, education with individual counselling, individual telephone support, group telephone support, individual home visit support and group meeting support. A U T H O R S ’ C O N C L U S I O N S Implications for practice There is a general acceptance that good clinical care will include providing information, advice and informal support to caregivers (as well as to patients). The conclusions of this review do not provide any clear evidence on how best to perform these roles. Implications for research Eleven studies are ongoing so a future review update is merited and may lead to firmer conclusions. A C K N O W L E D G E M E N T S Chief Scientist Office, Scottish Government, for funding Lynn Legg’s research training fellowship. We are very grateful to Brenda Thomas (Cochrane Stroke Group Trials Search Co-ordinator) for designing the search history. In addition, we are very grateful to the following people for data or additional information on study details or methods: Professor Tamilyn Bakas (USA); Dr Åsa Franzén Dahlin (Sweden); Professor Brian Draper (Australia); Professor Anne Forster (UK); Professor Joan Grant (USA); Dr Tammy Hoffman (USA); Professor Lalit Kalra (UK); Dr Jenny Larson (Sweden); Michael Leathley (UK); Dr Lidwien Schure (The Netherlands); Professor Jonathan Mant (UK); Joanna McAdam (UK); Professor Linda Pierce (USA); Dr Patricia Rivera (USA); Professor Helen Rodgers (UK); Professor Olli-Pekka Ryynänen (Poland); Professor Yea-Ing Lotus Shyu (Taiwan); Professor Cynthia Teel (USA); Claire Thomson (Australia); Professor Caroline Leigh Watkins (UK). We are grateful to the following people for assistance with translations or extractions of data from publications published in a language other than English: Dr Sungeun Joy Lee (Korean translations and data extraction); Lou-qin Quinn (Chinese translations). 12
References to studies included in this review Draper 2007 {published data only} Draper B, Bowring G, Thompson C, Van Heyst J, Conroy P, Thompson J. Stress in caregivers of aphasic stroke patients: a randomized controlled trial. Clinical Rehabilitation 2007; 21:122–30. Grant 2002 {published data only} Grant JS, Elliot TR, Weaver M, Bartolucci AA, Newman Giger J. Telephone intervention with family caregivers of stroke survivors after rehabilitation. Stroke 2002;33: 2060–5. Hartke 2003 {published data only} Hartke RJ, King RB. Telephone group intervention for older stroke caregivers. Topics in Stroke Rehabilitation 2003; 9(4):65–81. Kalra 2004 {published data only} Kalra L. Evaluation of the impact of carer information and support on patients, carers and service utilisation following hospital discharge. UK Clinical Trials Gateway: ISRCTN25954820 2004. ∗ Kalra L, Evans A, Perez I, Melbourn A, Patel A, Knapp M, et al.Training carers of stroke patients: randomised controlled trial. BMJ 2004;328(1099):1–5. Patel A, Knapp M, Evans A, Perez I, Kalra L. Training care givers of stroke patients: economic evaluation. BMJ 2004; 328(7448):1102. Patel A, Knapp M, Perez I, Evans A, Kalra L. Alternative strategies for stroke care cost effectiveness and cost utility analyses from a prospective randomized controlled trial. Stroke 2004;35:196–204. Larson 2005 {published data only} Larson J, Franzen-Dahlin A, Billing E, Von Arbin M, Murray V, Wredling R. The impact of a nurse-led support and education programme for spouses of stroke patients: randomized controlled trial. Journal of Clinical Nursing 2005;14:995–1003. Mant 2000 {published data only} ∗ Mant J, Carter J, Wade DT, Winner S. Family support for stroke: a randomised controlled trial. Lancet 2000;356 (9232):808–13. Mant J, Winner S, Roche J, Wade DT. Family support for stroke: one year follow-up of randomised controlled trial. Journal of Neurology, Neurosurgery and Psychiatry 2005;76: 1006–8. Pierce 2004 {published data only} Pierce LL, Steiner V, Govoni AL, Hicks B, Thompson TLC, Friedemann ML. Internet-based support for rural caregivers of persons with stroke shows promise. Rehabilitation Nursing 2004;29(3):95. Pierce LL, Steiner V, Khuder S. Web-based support for stroke caregivers. Stroke 2007;38(2):570. ∗ Pierce LL, Steiner VL, Khuder SA, Govoni AL, Horn LJ. The effect of a Web-based stroke intervention on R E F E R E N C E S Non-pharmacological interventions for caregivers of stroke survivors (Review) Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. carer’s well-being and survivors’ use of health care services. Disability and Rehabilitation 2009;31(20):1676–84. Yoo 2007 {published data only} Yoo EK, Jeon S, Yang JE. The effects of a support group intervention on the burden of primary family caregivers of stroke patients. Taehan Kanho Hakhoe Chi 2007;37(5): 693–702. References to studies excluded from this review Albert 2002 {published data only} Albert S, Im AMS, Brenner LCSW, Smith M, Waxman R. Effect of a social work liaison program on family caregivers to people with brain injury. Journal of Head Trauma Rehabilitation 2002;17(2):175–89. Bakas 2005 {published data only} Bakas T. Telephone Assessment and Skill-building Kit (TASK): a new program for family caregivers of stroke survivors. ClinicalTrials.gov NCT00264745 (accessed 18 March 2010). Bhakta 2000 {published data only} Bhakta BB, Cozens AJ, Chamberlain MA, Bamford JM. Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trial. Neurology, Neurosurgery & Psychiatry 2000;69(2):217–21. Bhogal 2003 {published data only} Bhogal SK, Teasell RW, Foley NC, Speechley MR. Community reintegration after stroke. Topics in Stroke Rehabilitation 2003;10(2):107–29. Bjorkdhal 2007 {published data only} Bjorkdhal A, Nilsson AL, Sunnerhagen KS. Can rehabilitation in the home setting reduce the burden of care for the next-of-kin of stroke victims?. Journal of Rehabilitation Medicine 2007;39:27–32. Boter 2004 {published data only} Boter H. Multicenter randomized controlled trial of an outreach nursing support program for recently discharged stroke patients. American Heart Association 2004;35(12): 2867–72. Burton 2005 {published data only} Burton C, Gibbon B. Expanding the role of the stroke nurse: pragmatic clinical trial. Journal of Advanced Nursing 2005;52(6):640–50. Carnavale 2006 {published data only} Carnavale GJ, Anselmi V, Johnston MV, Busichio K. A natural setting behaviour management program for persons with acquired brain injury: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2006;87: 1289–97. Chang 2000 {published data only} Chang T, Li I. The effect of social support intervention on home-bound stroke patients’ physical and mental health in 13
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