Telerehabilitation for Family Caregivers of Stroke Survivors: A Systematic Review and Meta-Analysis

Abstract

Aim. This systematic review aimed at evaluating the effectiveness of telerehabilitation on family caregivers of stroke survivors. Background. After discharge from the hospital, family caregivers of stroke survivors faced physical and psychological stress. Telerehabilitation seems crucial for family caregivers. However, the impact of telerehabilitation on family caregivers' health outcomes remains to be studied. Evaluation. Six databases (PubMed, Embase, Cochrane Library, Web of Science, CINAHL, and PsycINFO) were searched up to June 16th, 2022, without language restrictions. The Revised Cochrane Risk-of-bias Tool for Randomized Trials was used to assess the quality of included studies. The GRADEpro (Grading of Recommendations Assessment, Development, and Evaluation Profile) tools were applied to assess the synthesized evidence quality. The subgroup analysis was performed according to the intervention formats. Statistical analysis was conducted using Review Manager 5.3, and the publication bias was calculated by Stata 14.0. Key Issue(s). A total of 16 studies containing 992 caregivers were pooled in this systematic review. Telerehabilitation significantly improved the caregiver burden (SMD = -0.18, 95% CI = -0.35∼-0.02, P=0.03, moderate-quality evidence), knowledge (SMD = 0.75, 95% CI = 0.03∼1.47, P=0.04, very low-quality evidence), and competence (SMD = 1.35, 95% CI = 0.82∼1.88, P<0.001, very low-quality evidence) but not depression (SMD = -0.04, 95% CI = -0.3∼0.21, P=0.74, moderate-quality evidence), anxiety (MD = 0.68, 95% CI = -0.68∼2.04, P=0.32, low-quality evidence), and self-efficacy (SMD = -0.30, 95% CI = -1.22∼0.61, P=0.52, very low-quality evidence) in family caregivers of stroke survivors. The subgroup analysis demonstrated that multi-form telerehabilitation (SMD = 1.86, 95% CI = 1.32∼2.40, P<0.001) was significantly effective in improving caregiving competence. Conclusion. Telerehabilitation can effectively reduce the caregiver burden as well as improve the knowledge and competence of stroke caregivers. Implications for Nursing Management. The emergence of telerehabilitation can help relieve caregivers' stress and provide a new form for nursing managers to make discharge plans for stroke.