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Hounsri K, Zhang J, Kalampakorn S, Boonyamalik P, Jirapongsuwan A, Wu VX, Klainin-Yobas P. Effectiveness of technology-based psychosocial interventions for improving health-related outcomes of family caregivers of stroke survivors: A systematic review and meta-analysis. J Clin Nurs 2024. [PMID: 39020515 DOI: 10.1111/jocn.17370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 02/17/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024]
Abstract
AIM To synthesize evidence regarding the effectiveness of technology-based psychosocial interventions in improving health-related outcomes among family caregivers of stroke survivors. DESIGN A systematic review and meta-analysis was reported by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS Randomized controlled trials that investigated the effects of psychosocial interventions delivered through information and communication technologies on self-efficacy, caregiving competence, caregiver burden, perceived social support, anxiety, depression, health-related quality of life and cost-effectiveness were included. Two researchers independently selected studies, extracted data, and appraised the quality of the included studies. Subgroup analysis, sensitivity analysis, and narrative synthesis were conducted. DATA SOURCES Ten electronic databases (PubMed, CENTRAL, Web of Science, Scopus, CINHAL, Embase, Institution of Electrical Engineers Xplore, Ovid Medline, PsycINFO, ProQuest Dissertations and Thesis) were searched up to February 2023. RESULTS Nineteen studies involving 1717 participants fulfilled the eligibility criteria. Technology-based psychosocial interventions significantly improved self-efficacy (SMD = .62), caregiving competence (SMD = .55), depression (SMD = -.25) and anxiety (SMD = -.35). However, perceived social support, caregiver burden, and health-related quality of life did not show significant improvements. Subgroup analyses revealed that the interventions, lasting from 4 to 6 weeks and encompassing comprehensive contents, exhibited larger effect sizes. None of the studies measured cost-effectiveness. CONCLUSION The technology-based psychosocial interventions are effective in enhancing self-efficacy and caregiving competence, as well as alleviating anxiety, and depression among family caregivers of stroke survivors. Future research should investigate interventions delivered through various digital platforms using well-designed RCTs with in-depth qualitative data collection and measurement of health and cost-effectiveness outcomes. IMPACT Through psychosocial interventions, healthcare providers in clinical and community settings, particularly nurses, could incorporate technologies into current stroke care practices. PATIENT OR PUBLIC CONTRIBUTION It is not applicable as this is a systematic review. REGISTRATION The protocol was registered on PROSPERO (CRD42023402871).
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Affiliation(s)
- Kanokwan Hounsri
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jinghua Zhang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Surintorn Kalampakorn
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Plernpit Boonyamalik
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Ann Jirapongsuwan
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore, Singapore
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Zhou Y, Bai Z, Wan K, Qin T, He R, Xie C. Technology-based interventions on burden of older adults' informal caregivers: a systematic review and meta-analysis of randomized controlled trials. BMC Geriatr 2024; 24:398. [PMID: 38704539 PMCID: PMC11070124 DOI: 10.1186/s12877-024-05018-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 04/26/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND An increasing number of technologies are provided to reduce the burden of older adults' informal caregivers. However, less is known about the effects and the mechanism of technology to work on burden. This review is to evaluate the effectiveness of technology-based interventions (TBI) in alleviating the burden of older adults' informal caregivers and to distinguish its effective mechanism via group disparities. METHODS A systematic review and meta-analysis of randomized controlled trials studies (RCTs) has been conducted. Web of Science, PubMed, EMBASE, Scopus, CINAHL, PsycINFO, WANFANG, CNKI, CQVIP databases, Cochrane Library Trials, and ClinicalTrials.gov were searched for trial studies and registry in both English and Chinese published from January 1990 to October 2022. Reviewers independently screened the articles and trials, conducted quality assessments, and extracted the data. All processes were guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias of the studies was evaluated by the Cochrane Systematic Review Handbook. The meta-analysis was conducted by RevMan 5.13. Subgroup analyses, sensitivity analyses, publication bias were also conducted. RESULTS A total of 11,095 RCTs were initially screened, and 14 trials representing 1010 informal caregivers were included finally. This review proved TBI effective in reducing caregiving burden older adults. Subgroup analysis showed effects of TBI differed by interventions on control group and medical conditions of care recipients. CONCLUSION TBI is an effective way to alleviate the burden on informal caregivers of aging people. Interventions for control groups and medical conditions of care-recipients are significant factors in effective interventions. Future researches could include more trials with high-quality or to explore more targeted aging groups, modalities of TBI, or caregiver outcomes. TRIAL REGISTRATION The review protocol was registered on PROSPERO [CRD42021277865].
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Affiliation(s)
- Yang Zhou
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, No. 200, Xiaolingwei District, Nanjing, 210094, Jiangsu Province, China.
- The Evidence-Based Research Center of Social Science & Health, Nanjing University of Science and Technology, No. 200, Xiaolingwei District, Nanjing, 210094, Jiangsu Province, China.
| | - Zhenggang Bai
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, No. 200, Xiaolingwei District, Nanjing, 210094, Jiangsu Province, China
- The Evidence-Based Research Center of Social Science & Health, Nanjing University of Science and Technology, No. 200, Xiaolingwei District, Nanjing, 210094, Jiangsu Province, China
| | - Keyan Wan
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, No. 200, Xiaolingwei District, Nanjing, 210094, Jiangsu Province, China
| | - Tianyi Qin
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, No. 200, Xiaolingwei District, Nanjing, 210094, Jiangsu Province, China
| | - Rui He
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, No. 200, Xiaolingwei District, Nanjing, 210094, Jiangsu Province, China
| | - Chengdan Xie
- Department of Sociology, School of Public Affairs, Nanjing University of Science and Technology, No. 200, Xiaolingwei District, Nanjing, 210094, Jiangsu Province, China
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Kringle EA, Kersey J, Lewis MA, Gibbs BB, Skidmore ER. Similarities and differences in factors associated with high and low sedentary behavior after stroke: a mixed methods study. Disabil Rehabil 2024:1-9. [PMID: 38632899 DOI: 10.1080/09638288.2024.2341867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To identify similarities and differences in factors affecting activity engagement between adults with stroke who are more and less sedentary. MATERIALS AND METHODS Data were pooled from two studies of adults with stroke (N = 36). Sedentary time was measured activPAL micro3. Participants completed activPAL interviews, which were analyzed using framework analysis. Participants were stratified into more and less sedentary groups based on activPAL data. Between-group similarities and differences were identified. RESULTS Adults with stroke (mean [SD] age = 65.8 [13.6] years, stroke chronicity = 40.5 [SD = 38.3] months, 36.1% female) were more sedentary (785.5 [64.7] sedentary minutes/day) and less sedentary (583.6 [87.4] sedentary minutes/day). Those who were more sedentary: engaged in basic activities of daily living, avoided activities, received assistance from other people, and did not use strategies to overcome barriers. Those who were less sedentary: engaged in instrumental and community activities, embraced new strategies, did activities with other people, and used strategies to overcome environmental barriers. CONCLUSIONS Factors affecting activity engagement differed between people who are more and less sedentary. Interventions that aim to reduce post-stroke sedentary behavior should consider the: (1) types of activities, (2) role of other people, and (2) application of strategies to overcome activity and environment-related barriers.
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Affiliation(s)
- Emily A Kringle
- School of Kinesiology, University of MN, Minneapolis, MN, USA
| | - Jessica Kersey
- Program in Occupational Therapy, School of Medicine, WA University, St. Louis, MO, USA
| | | | - Bethany Barone Gibbs
- Department of Epidemiology and Biostatistics, West VA University, Morgantown, WV, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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Delvallée M, Marchal M, Termoz A, Habchi O, Derex L, Schott AM, Haesebaert J. Development of a patient-centered transition program for stroke survivors and their informal caregivers, combining case-management and access to an online information platform: A user-centered design approach. Digit Health 2024; 10:20552076241272628. [PMID: 39114116 PMCID: PMC11304490 DOI: 10.1177/20552076241272628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 07/17/2024] [Indexed: 08/10/2024] Open
Abstract
Background During the hospital-to-home transition, stroke survivors and their caregivers face a significant lack of support and information which impacts their psychosocial recovery. We aimed to co-design a program combining individual support by a trained case-manager (dedicated professional providing individual support) and an online information platform to address needs of stroke survivors and caregivers. Methods A two-step methodology was used. The first step followed a "user-centered design" approach during four workshops with stroke survivors, caregivers, and healthcare professionals to develop the platform and define the case-manager profile. The second step was a usability test of the platform following a Think Aloud method with patients and caregivers. The workshops and interviews were analyzed following a qualitative thematic analysis. The analysis of Think Aloud interviews was based on User Experience Honeycomb framework by Morville. Results Eight participants attended the workshops: two patients, two caregivers, three nurses, and a general practitioner. Activities, training, and skills of the case-manager were defined according to stroke survivors and caregivers needs. Name, graphics, navigation, and content of the platform were developed with the participants, a developer and a graphic designer. The usability of the platform was tested with 5 patients and 5 caregivers. The Think Aloud confirmed satisfaction with graphics and content but a need for improvement regarding the navigability. An update of the platform was conducted in order to answer the needs expressed by participants. Conclusion We developed, with a participatory approach, a patient-centered transition program, which will be evaluated in a randomized controlled trial.
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Affiliation(s)
- Marion Delvallée
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Mathilde Marchal
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Anne Termoz
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Ouazna Habchi
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Laurent Derex
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Neuro-vasculaire, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Lyon, France
| | - Anne-Marie Schott
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
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Delvallée M, Garreau R, Termoz A, Ploteau PM, Derex L, Schott AM, Haesebaert J. What are the available online resources targeting psychosocial burden among stroke survivors and their informal caregivers: A scoping review. Digit Health 2024; 10:20552076241240895. [PMID: 38515613 PMCID: PMC10956153 DOI: 10.1177/20552076241240895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 03/23/2024] Open
Abstract
Background After discharge home, stroke survivors and their informal caregivers face a significant lack of support and information which accentuates their psychosocial burden. Online resources might provide this support and address psychosocial needs, but existing online stroke programmes mainly target functional rehabilitation. We aimed to map the existing literature on online resources that have been evaluated in stroke rehabilitation and aimed at reducing psychosocial impact in stroke survivors and informal caregivers. Methods MEDLINE was searched (2010-2024) to identify studies investigating online resources targeting psychosocial health. Studies were selected and extracted independently by two reviewers. We described the content, use, and psychosocial impact of these interventions using a narrative approach. Results Eleven studies were included in the review, reporting 10 online resources (two studies relating to the same resource). Online resources were heterogeneous: eight information/resources websites, one mobile app, and one forum. Five online resources were dedicated to stroke survivors, four to stroke survivors and their informal caregivers, and one to informal caregivers. Two randomized controlled trials reported a significant decrease in depressive symptoms associated with the use of online resources. Stroke survivors and informal caregivers find online resources useful and acceptable to address their psychosocial needs. Conclusions Few online stroke resources have been designed and evaluated to support post-stroke psychosocial rehabilitation. Further larger-scale research needs to study the impact of these interventions on psychosocial recovery over time.
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Affiliation(s)
- Marion Delvallée
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Romain Garreau
- Pharmacy Department, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Evolutive, UMR CNRS 5558, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne Termoz
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Pierre-Marie Ploteau
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Laurent Derex
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Neuro-vasculaire, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Lyon, France
| | - Anne-Marie Schott
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Pôle de Sante Publique, Lyon, France
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Yu T, Ren JW, Wang C, Liu SS, Cun W, Jiang Y. Remote interventions for informal caregivers of patients with stroke: a systematic review and meta-analysis. BMJ Open 2023; 13:e071461. [PMID: 37696638 PMCID: PMC10496682 DOI: 10.1136/bmjopen-2022-071461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/02/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVES It is unclear whether remote interventions are effective in improving outcomes of informal caregivers of patients who had a stroke. We synthesised evidence for the impact of remote interventions on informal caregivers of patients who had a stroke. Moreover, we also analysed its potential effects on patients who had a stroke. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Excerpta Medica Database, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Database and China Science and Technology Journal Database were searched from inception up to 1 February 2022. ELIGIBILITY CRITERIA We included randomised controlled trials (RCTs) that assessed the effect of remote interventions on informal caregivers who provide unpaid care for patients who had a stroke living at home compared with traditional interventions, including with respect to caregivers' mood, care burden, life satisfaction and perceived competence. Moreover, we considered the potential impact of remote interventions on the depressive and anxiety symptoms, functional rehabilitation and re-admission of patients who had a stroke. Only studies published in Chinese or English were included. We excluded studies of interventions aimed at healthcare professionals or patients who had a stroke and those that could not provide complete data. DATA EXTRACTION AND SYNTHESIS Data analyses were performed using RevMan V.5.3. The Cochrane Collaboration risk of bias tool for RCTs was used to evaluate the quality of the included studies, and the review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. For continuous outcomes, we calculated the mean difference or standardised mean difference (SMD) and 95% CIs. The Grading of Recommendations, Assessment, Development, and Evaluations method was used to assess the certainty of the evidence. RESULTS Eight RCTs with a total of 733 participants were included. Compared with traditional interventions, for informal caregivers, we found that remote interventions did not produce significant effects on depressive symptoms (SMD -0.04, 95% CI -0.24 to 0.15), anxiety symptoms (SMD -0.26, 95% CI -0.94 to 0.43), care burden (SMD -0.06, 95% CI -0.56 to 0.45), life satisfaction (SMD -0.16, 95% CI -0.43 to 0.11), or perceived competence (SMD 0.37, 95% CI -0.23 to 0.96). Similarly, for patients who had a stroke, remote interventions had no significant effect on depression (SMD 0.16, 95% CI -0.61 to 0.93) or anxiety symptoms (SMD -0.34, 95% CI -0.72 to 0.04). The effects of remote interventions on functional rehabilitation and re-admission in patients who had a stroke were evaluated by three studies and two studies, respectively, but the studies were too varied to combine their data in meta-analysis. CONCLUSIONS Current evidence suggests that remote interventions for informal caregivers of patients who had a stroke have no significant superiority over traditional interventions. However, the quality of the included studies was low and more high-quality evidence is required to determine the possible impacts of remote interventions. PROSPERO REGISTRATION NUMBER CRD42022313544.
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Affiliation(s)
- Ting Yu
- Evidence-based Nursing Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Jing-Wen Ren
- Clinical Medical College of Guizhou Medical University, Guiyang, China
| | - Cong Wang
- Evidence-based Nursing Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Shan-Shan Liu
- Evidence-based Nursing Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Wei Cun
- Evidence-based Nursing Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yan Jiang
- Department of Nursing, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
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Fernández-González M, Lozano-Lozano M, Martín-Martín L, Ortiz-Piña M, Martín-Matillas M, Ariza-Vega P. Is a telerehabilitation programme for older adults with hip fracture associated with burden of family caregivers who provide support? Digit Health 2023; 9:20552076231213574. [PMID: 38025098 PMCID: PMC10656811 DOI: 10.1177/20552076231213574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Objective @ctivehip is a home-based multidisciplinary telerehabilitation programme for older adults with hip fracture, conducted with the assistance of their family caregivers. This programme was useful in improving their functional recovery. Nevertheless, we were concerned about how the programme might have affected caregivers, whose assistance was essential for supporting older adults in using new technologies and ensuring their safety during the exercises and activities at home. The aim of the present study was to compare the burden, psychological factors and physical fitness of the family caregivers of older adults who opted the @ctivehip telerehabilitation programme versus those family caregivers of older adults who received the face-to-face rehabilitation provided by the Andalusian Public Healthcare System (in Spain). Methods In this single-blinded, non-randomized clinical trial, participants were older adults with hip fracture and their family caregivers. The telerehabilitation group (n = 30) underwent a 12-week multidisciplinary telerehabilitation programme, and the comparative group (n = 32) received face-to-face rehabilitation. Caregivers outcomes measured were (i) the burden using the Zarit Burden Interview, (ii) the anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), and (iii) the Physical Fitness with the International Fitness Scale (IFIS). Results There were not statistically significant differences on caregiver burden between family caregivers in the @ctivehip and the comparative group, although there was a trend towards lower values [[Mean (95%CI); 14.73 (9.09 to 20.37) vs 16.03 (10.63 to 21.43); p = 0.771] as well as for anxiety and depression [5.66 (3.21 to 8.78) vs 11.19 (8.52 to 13.86); p = 0.022]. Likewise achieved better, though not statistically significant, scores in physical fitness [19.37 (17.94 to 20.81) vs 17.15 (15.77 to 18.53); p = 0.055]. Conclusion Caregiver burden is not associated with telerehabilitation. In addition, telerehabilitation is associated with lower anxiety and depression levels among family caregivers who opt for this programme. Physical fitness is not related with telerehabilitation.
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Affiliation(s)
- María Fernández-González
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Mario Lozano-Lozano
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- “Cuídate” Support Unit for Oncology Patients, Sport and Health University Research Institute (iMUDS), Granada, Spain
| | - Lydia Martín-Martín
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- “Cuídate” Support Unit for Oncology Patients, Sport and Health University Research Institute (iMUDS), Granada, Spain
| | - Mariana Ortiz-Piña
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Patrocinio Ariza-Vega
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical Education and Sports, Faculty of Sport Science, University of Granada, Granada, Spain
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Mårtensson E, Coumoundouros C, Sörensdotter R, von Essen L, Woodford J. Psychological interventions for symptoms of depression among informal caregivers of older adult populations: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord 2023; 320:474-498. [PMID: 36174787 DOI: 10.1016/j.jad.2022.09.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/31/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Symptoms of depression are commonly experienced by informal caregivers of older adults, however there is uncertainty concerning effectiveness of psychological interventions targeting symptoms of depression in this population. Further, there is uncertainty concerning important clinical moderators, including intervention type and care recipient health condition. This review examined the effectiveness of psychological interventions targeting symptoms of depression in informal caregivers of older adults. METHODS PubMed, CINAHL, Embase, PsycINFO, Cochrane Library and Web of Science were searched. Risk of bias was assessed using the Cochrane Risk of Bias tool version 2. RESULTS Fifteen studies were identified and twelve (1270 participants) provided data for the meta-analysis. Interventions included cognitive behavioral therapy (4 studies), problem-solving therapy (4 studies); non-directive supportive therapy (4 studies) and behavioral activation (3 studies). A small effect size favouring the intervention was found for symptoms of depression (g = -0.49, CI = -0.79, -0.19, I2 = 83.42 %) and interventions were effective in reducing incidence of major depression (OR = 0.177, CI = 0.08, 0.38), caregiver burden (g = -0.35, CI = -0.55, -0.15) and psychological distress (g = -0.49, CI = -0.70, -0.28). Given high heterogeneity, findings should be interpreted with caution. Overall risk of bias was high. LIMITATIONS Studies were limited to those in English or Swedish. CONCLUSION Psychological interventions may be effective in reducing symptoms of depression among informal caregivers of older adults. However, evidence is inconclusive due to heterogeneity, high risk of bias, and indirectness of evidence.
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Affiliation(s)
- Erika Mårtensson
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, 752 37 Uppsala, Sweden; Centre for Gender Research, Uppsala University, 752 36 Uppsala, Sweden.
| | - Chelsea Coumoundouros
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, 752 37 Uppsala, Sweden.
| | | | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, 752 37 Uppsala, Sweden.
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, 752 37 Uppsala, Sweden.
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Ameme DK, Akweongo P, Afari EA, Noora CL, Anthony R, Kenu E. Effectiveness of adjunct telephone-based postnatal care on maternal and infant illness in the Greater Accra Region, Ghana: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:800. [DOI: 10.1186/s12884-022-05138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Globally, postnatal care (PNC) is fraught with challenges. Despite high PNC coverages in Ghana’s Greater Accra Region (GAR), maternal and newborn health outcomes are of great concern. In 2017, neonatal and post-neonatal mortality rates in GAR were 19 and 13 per 1000 live births respectively despite PNC coverages of 93% for at least one PNC and 87.5% for PNC within 48 hours post-delivery. Telephone follow-up has been used to improve health outcomes in some settings, however, its usefulness in improving maternal and infant health during the postnatal period is not well known in Ghana. We assessed effectiveness of telephone-based PNC on infant and maternal illness in selected hospitals in GAR.
Methods
An open-label, assessor-blinded, parallel-group, two-arm superiority randomized controlled trial with 1:1 allocation ratio was conducted from September 2020 to March 2021. Mother-baby pairs in intervention arm, in addition to usual PNC, received midwife-led telephone counselling within 48 hours post-discharge plus telephone access to midwife during postnatal period. In control arm, only usual PNC was provided. Descriptive and inferential data analyses were conducted to generate frequencies, relative frequencies, risk ratios and 95% confidence intervals. Primary analysis was by intention-to-treat (ITT), complemented by per-protocol (PP) analysis.
Results
Of 608 mother-baby pairs assessed for eligibility, 400 (65.8%) were enrolled. During 3 months follow-up, proportion of infants who fell ill was 62.5% in intervention arm and 77.5% in control arm (p = 0.001). Maternal illness occurred in 27.5% of intervention and 38.5% of control participants (p = 0.02). Risk of infant illness was 20% less in intervention than control arm in both ITT analysis [RR = 0.8 (95%CI = 0.71–0.92] and PP analysis [RR = 0.8 (95%CI = 0.67–0.89)]. Compared to controls, risk of maternal illness in intervention arm was 30% lower in both ITT [RR = 0.7 (95%CI = 0.54–95.00)] and PP analysis [RR = 0.7 (95%CI = 0.51–0.94)].
Conclusion
Telephone-based PNC significantly reduced risk of maternal and infant illness within first 3 months after delivery. This intervention merits consideration as a tool for adoption and scale up to improve infant and maternal health.
Trial registration
This trial was retrospectively registered with the International Standard Randomized Controlled Trial Number (ISRCTN) Registry with number ISRCTN46905855 on 09/04/2021.
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10
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Bakas T, McCarthy MJ, Miller EL. Systematic Review of the Evidence for Stroke Family Caregiver and Dyad Interventions. Stroke 2022; 53:2093-2102. [PMID: 35264010 PMCID: PMC9133104 DOI: 10.1161/strokeaha.121.034090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Tamilyn Bakas
- University of Cincinnati College of Nursing, Cincinnati, OH
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11
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LeLaurin JH, Sypniewski C, Wing K, Freytes IM, Findley K, Uphold CR. Development, Usability Testing, and Promotion of the English- and Spanish-language RESCUE Stroke Caregiver Websites. AMERICAN JOURNAL OF HEALTH EDUCATION 2022. [DOI: 10.1080/19325037.2022.2048747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Kristen Wing
- North Florida/South Georgia Veterans Health System
- VA Office of Rural Health
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12
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Chin WJ, Ho YLS, Ramazanu S, Itoh S, Klainin-Yobas P, Wu XV. Effectiveness of technology-based interventions on psychological morbidities, quality of life for informal caregivers of stroke survivors: A systematic review and meta-analysis. J Adv Nurs 2021; 78:947-967. [PMID: 34904746 DOI: 10.1111/jan.15130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/08/2021] [Accepted: 11/27/2021] [Indexed: 02/03/2023]
Abstract
AIMS To evaluate the effectiveness of technology-based interventions in reducing psychological morbidities such as depressive symptomology, anxiety, burden and improving quality of life and self-efficacy in informal caregivers of stroke survivors. DESIGN A systematic review and meta-analysis. DATA SOURCES An extensive search was systematically undertaken at CENTRAL, PubMed, Embase, Scopus, CINHAL, Web of Science and PsycInfo until January 2021. Grey literature and dissertations were searched in Google Scholar, ProQuest & Scholarbank@NUS. Studies involving registered trials were retrieved from Clinicaltrials.gov and CENTRAL, respectively. REVIEW METHODS Two reviewers independently screened the trials, conducted quality appraisal and extracted the data. Quality of the studies included in the review was assessed using Cochrane Risk of bias tool. Meta-analysis was conducted using RevMan 5.4. Narrative synthesis was performed for studies where results could not be pooled statistically. The results were reported abiding Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS This review included 15 trials with a total of 1276 informal caregivers of stroke survivors. Eleven trials were included in the meta-analysis. Subgroup analyses revealed that technology-based interventions with structured educational programs were statistically significant in reducing depressive symptoms (d = -0.27, 95% CI [-0.49 to -0.05], p = .02). Technology-based interventions with structured educational programs <3-month revealed significant effects (d = -0.31, 95% CI [-0.49 to -0.13], p = .0009). Results of narrative synthesis reported technology-based intervention with face-to-face training minimized depressive symptoms of informal caregivers. Notably, there were no statistically significant effects on anxiety, burden, quality of life and self-efficacy outcomes. CONCLUSION Technology-based interventions had beneficial effects in alleviating depressive symptoms among informal caregivers. IMPACT Technology-based interventions serve as a support mechanism for informal caregivers of stroke survivors who face time-constrains. Further high-quality randomized controlled trials are warranted to elucidate sustainability, optimal format and dosage of intervention.
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Affiliation(s)
- Wei Jien Chin
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yun Ling Selina Ho
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sheena Ramazanu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sakiko Itoh
- Department of Genome Informatics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,NUSMED Healthy Longevity Translational Research Programme, National University of Singapore, Singapore
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13
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LeLaurin JH, Lamba AH, Eliazar-Macke ND, Schmitzberger MK, Freytes IM, Dang S, Vogel WB, Levy CE, Klanchar SA, Beyth RJ, Shorr RI, Uphold CR. Postdischarge Intervention for Stroke Caregivers: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e21799. [PMID: 33174856 PMCID: PMC7688383 DOI: 10.2196/21799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The majority of stroke survivors return to their homes and need assistance from family caregivers to perform activities of daily living. These increased demands coupled with the lack of preparedness for their new roles lead to a high risk for caregivers developing depressive symptoms and other negative outcomes. Follow-up home support and problem-solving interventions with caregivers are crucial for maintaining stroke survivors in their homes. Problem-solving interventions are effective but are underused in practice because they require large amounts of staff time to implement and are difficult for caregivers logistically. OBJECTIVE The aim of this study is to test a problem-solving intervention for stroke caregivers that can be delivered over the telephone during the patient's transitional care period (time when the stroke survivor is discharged to home) followed by 8 asynchronous online sessions. METHODS The design is a two-arm parallel randomized clinical trial with repeated measures. We will enroll 240 caregivers from eight Veterans Affairs (VA) medical centers. Participants randomized into the intervention arm receive a modified problem-solving intervention that uses telephone and web-based support and training with interactive modules, fact sheets, and tools on the previously developed and nationally available Resources and Education for Stroke Caregivers' Understanding and Empowerment Caregiver website. In the usual care group, no changes are made in the information, discharge planning, or care the patients who have had a stroke normally receive, and caregivers have access to existing VA resources (eg, caregiver support line, self-help materials). The primary outcome is a change in caregiver depressive symptoms at 11 and 19 weeks after baseline data collection. Secondary outcomes include changes in stroke caregivers' burden, knowledge, positive aspects of caregiving, self-efficacy, perceived stress, health-related quality of life, and satisfaction with care and changes in stroke survivors' functional abilities and health care use. The team will also determine the budgetary impact, facilitators, barriers, and best practices for implementing the intervention. Throughout all phases of the study, we will collaborate with members of an advisory panel. RESULTS Study enrollment began in June 2015 and is ongoing. The first results are expected to be submitted for publication in 2021. CONCLUSIONS This is the first known study to test a transitional care and messaging center intervention combined with technology to decrease caregiver depressive symptoms and to improve the recovery of stroke survivors. If successful, findings will support an evidence-based model that can be transported into clinical practice to improve the quality of caregiving post stroke. TRIAL REGISTRATION ClinicalTrials.gov NCT01600131; https://www.clinicaltrials.gov/ct2/show/NCT01600131. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21799.
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Affiliation(s)
- Jennifer H LeLaurin
- North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Avi H Lamba
- Flint Hill School, Oakton, VA, United States
| | | | | | - I Magaly Freytes
- North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States
| | - Stuti Dang
- Geriatric Research Education and Clinical Center, Miami VA Healthcare System, Miami, FL, United States.,Miller School of Medicine, University of Miami, Miami, FL, United States
| | - W Bruce Vogel
- North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Charles E Levy
- Physical Medicine and Rehabilitation Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Department of Occupational Therapy and Center for Arts in Medicine, University of Florida, Gainesville, FL, United States
| | | | - Rebecca J Beyth
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Ronald I Shorr
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States
| | - Constance R Uphold
- North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.,Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States
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