Remote interventions for informal caregivers of patients with stroke: a systematic review and meta-analysis

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.