Education and Training Interventions for Caregivers of People With Stroke (January 1,1999–December 31,2019)

Full Systematic Review Question

This systematic review addressed the question, “What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice that provide only education and training for caregivers of people who have had a stroke to facilitate maintaining participation in the caregiver role?”

Current Theme Reported

The main theme of the articles included in this Systematic Review Brief is caregiver interventions providing education and training only.

Clinical Scenario

Caregivers of people who have had a stroke often experience negative effects of caregiving in the areas of employment, finances, and physical and emotional health (Collinson & De La Torre, 2017; Loh et al., 2017; National Academies of Sciences, Engineering, and Medicine, 2016; National Alliance for Caregiving & AARP Public Policy Institute, 2015). When caregivers experience negative effects, care recipients with stroke may experience a greater incidence of institutionalization, more frequent and longer hospital stays, and poorer outcomes (Bakas et al., 2014). Caregivers of people with stroke have identified needs for information and for education and training about stroke and the resulting impairments at all stages poststroke (Hafsteinsdóttir et al., 2011). Examples of the education and training needs they prioritized were preventing falls, driving, and dealing with behavior, communication, and feeding problems (Hafsteinsdóttir et al., 2011). Occupational therapy practitioners routinely provide caregiver education and training in these areas, and stroke guidelines specifically recommend that caregivers receive education and training to mitigate the negative effects of caregiving (Lawson et al., 2015; Winstein et al., 2016). The systematic review theme presented here is education and training interventions for caregivers of people who have had a stroke to determine whether these interventions facilitate maintaining participation in the caregiver role by improving caregiver outcomes such as depression, anxiety, burden, knowledge, and self-efficacy.

Summary of Key Findings

Nine Level 1b randomized controlled trials (RCTs) described in 11 articles met the inclusion criteria. Risk of bias ranged from low to high. We used the Oxford Centre for Evidence-Based Medicine (2009) levels of evidence in this review. Subthemes are synthesized and reported in Table 1.

Bottom Line for Occupational Therapy Practice

When delivering occupational therapy interventions to caregivers of people with stroke, occupational therapy practitioners should use individualized interventions that provide some aspect of in-person education or training, preferably in the home. Home visits can improve caregiver outcomes; the home is the recommended setting for in-person education and training because it is the caregiver’s and care recipient’s natural environment or context. For the same reason, home visits may increase follow-through and participation for caregivers who find it difficult to attend in-person appointments outside the home. Practitioners should consider carefully the use of self-directed interventions for caregivers because the evidence regarding this approach is limited.

Studies examining caregiver education for stroke patients prior to discharge from a hospital only did not demonstrate statistically significant results. Therefore, occupational therapy practitioners should deliver caregiver education in a combination of pre- and postdischarge or postdischarge-only sessions. Most studies, both with and without statistically significant results, provided caregiver education and training sessions over the course of weeks to months. Occupational therapists should consider these findings in determining the duration of an intervention; longer durations may promote caregivers’ retention and incorporation of knowledge and provide them with opportunities to ask questions as they arise over time.

The studies included in this review did not reveal a consistent method of education that proved more successful than others. Education methods included informal discussion, web-based material, manual, hands-on training in skills, lecture, individualized mailed information, tip sheets, and others. Occupational therapy practitioners should consider using a variety of educational methods that match caregivers’ needs and learning styles.