Effectiveness of dyadic psychoeducational intervention for stroke survivors and family caregivers on functional and psychosocial health: A systematic review and meta-analysis

Understanding Care Partner Experiences in the First Month After Durable Left Ventricular Assist Device Implantation

Introduction: Durable left ventricular assist devices serve as a critical bridge to heart transplantation for patients with advanced heart failure. Yet the demands placed on care partners (CPs) are often underestimated, and their well-being in supporting postimplant recovery is frequently overlooked. Methods/Approach: This qualitative single-site study explored the struggles and support needs of 13 CPs who participated in audio-recorded interviews following device placement. Findings: Data analysis, using inductive content analysis, revealed 6 major themes: feeling unprepared, being hypervigilant, feeling overwhelmed, the vanishing CP, lacking self-care, and needing connection with other CPs. Findings revealed that CPs often felt overlooked by healthcare teams, contributing to emotional distress and isolation, while inadequate education on perioperative complications and minimal peer support reinforced their sense of being unprepared. Conclusion: These results underscored the integral role that CP well-being played in sustaining successful device management and ensuring patients remained eligible for heart transplantation. Psychosocial services, peer support, and structured educational programs may help mitigate the strain experienced by CPs and improve transplantation outcomes. Embedding CP needs into the transplant pathway, beginning at implantation, was essential to preventing burnout, maintaining candidacy, and improving overall posttransplant success. Refinements in CP-centered interventions may help reduce hospital readmissions, enhance device adherence, and support emotional resilience. By prioritizing CP support within advanced heart failure management, transplant programs can optimize both patient and CP well-being and foster positive outcomes. Such focus ensures bridging to transplantation and hope for families.

Effects of psychoeducation interventions on psychological outcomes among spousal caregivers of community-dwelling older adults: A systematic review and meta-analysis

BACKGROUND

Spouses often assume the role of primary informal caregivers for ageing partners. Spousal caregivers are more likely than other family members to experience negative psychological outcomes due to their unique identities. However, little is known as to whether psychoeducation interventions can support them in the caregiving process.

OBJECTIVES

To systematically identify and synthesise evidence regarding the effects of psychoeducation interventions on psychological outcomes among spousal caregivers of community-dwelling older adults.

DESIGN

A systematic review and meta-analysis.

METHODS

Eight electronic databases, including Cochrane Library, PubMed, CINAHL, MEDLINE, Embase, PsycINFO, Chinese Journal Net and Wanfang were searched from inception to August 2024. Randomised controlled trials of psychoeducation interventions on psychological outcomes in spousal caregivers of older adults were included. The quality of the evidence was evaluated using The Cochrane Risk of Bias Tool v2. The certainty of the evidence was assessed by the GRADE approach. Data synthesis methods, including meta-analysis and narrative synthesis, were conducted based on data availability. Meta-analysis was performed using a random-effects model given the substantial heterogeneity in the intervention design and outcomes. Sensitivity analyses were used to assess the robustness of the findings.

RESULTS

Among the 18 reviewed studies, the overall risk of bias indicated that four had low risk, eight had some concerns, and six had high risk. The pooled analysis suggested that psychoeducation interventions had significant effects on improving marital satisfaction (SMD = 0.28, 95 % CI: 0.09 to 0.47; low certainty) and positive aspects of caregiving (SMD = 1.30, 95 % CI: 0.44 to 2.16; very low certainty). However, the effects on depressive symptoms, caregiving burden, anxiety, mental health, coping and self-efficacy were negligible. Narrative synthesis of evidence suggested potential beneficial effects on posttraumatic growth, family functioning, family relationship and life satisfaction.

CONCLUSIONS

Psychoeducation interventions have potential to improve marital satisfaction and positive aspects of caregiving among spousal caregivers of older adults. However, the evidence has a low level of certainty with considerable variability in intervention design and outcome measures, indicating the need for further rigorous investigation. The non-significant effects on enhancing caregiving competence or alleviating negative psychological outcomes highlight the importance of exploring the specific needs and expectations of spousal caregivers.

REGISTRATION

PROSPERO (CRD42024498599).

Explaining the multifaceted experiences of family caregivers of stroke survivors: a qualitative study in Iran

OBJECTIVES

As the family caregivers of stroke survivors are typically subjected to care burden, spirituality has been advocated to protect them from its negative effects. The purpose of this study was to describe the caregiving experiences of family caregivers of stroke survivors.

DESIGN

This qualitative study was conducted from December 2023 to June 2024 in Iran. Data were analysed using the conventional content analysis method.

SETTING

The study was conducted in the neurology wards of two referral hospitals affiliated with Shahid Beheshti University of Medical Sciences in Tehran, Iran.

PARTICIPANTS

After meeting the inclusion criteria, a total of 17 family caregivers of stroke survivors were recruited using the purposive sampling technique with maximum variation. Data were then collected through 17 in-depth semistructured interviews, each lasting 30-60 min.

RESULTS

Four themes emerged from the study participants' statements: (1) 'challenges and struggles', (2) 'religious coping strategies', (3) 'psychological coping strategies' and (4) 'social and relational dynamics'. The core concept of 'balancing hope and hardship' was then introduced.

CONCLUSION

The study findings highlight the need to develop comprehensive support programmes for family caregivers of stroke survivors to minimise their caregiving burden. Healthcare planners and providers are encouraged to use these findings to improve the health outcomes of these families and reduce the burden of caregiving.

Effectiveness of non-pharmacological interventions for post-stroke depression in stroke survivors: A systematic review with meta-analysis

ObjectivesTo evaluate the effectiveness of non-pharmacological interventions for managing post-stroke depression and identify the characteristics of optimal interventions.Data SourcesEight English databases and two Chinese databases were searched from inception to February 2025, alongside grey literature.MethodsTwo reviewers independently screened studies and extracted data from randomised controlled trials (RCTs) or pilot/feasibility RCTs. Study quality was evaluated with the Cochrane Risk of Bias 2 tool. Meta-analyses used Review Manager 5.3 when feasible; otherwise, narrative syntheses were conducted. Certainty of evidence was assessed via the Grading of Recommendations Assessment, Development, and Evaluation system.ResultsSeventeen studies (1297 stroke survivors) were included. Two had a low risk of bias, two had a high risk, and 13 had some concerns. Meta-analyses showed cognitive-behavioural intervention had significant short-term effects (< one month) on depressive symptoms versus control (standardised mean difference SMD: -0.63, 95% CI: -1.00 to -0.26, p < 0.001, I2 = 81%; 7 studies; 693 participants). Cognitive-behavioural interventions without cognitive restructuring showed significant short-term (effect size ES = 0.52-1.08) and medium-term (1-6 months) effects (ES = 0.73-1.71). Preliminary evidence suggested that exercise with music, acceptance and commitment therapy, mindfulness meditation, and aromatherapy also improve depressive symptoms versus control.ConclusionNon-pharmacological interventions, including cognitive-behavioural intervention, exercise, acceptance and commitment therapy, mindfulness meditation, and aromatherapy, could improve post-stroke depressive symptoms. However, with very low evidence certainty, further rigorous RCTs are needed.

The impact of dyadic interventions on psycho-social outcomes for stroke patients and their caregivers: a systematic review and meta-analysis

Aims

To describe the details of dyadic interventions and summarize the current evidence on supporting dyadic interventions for psycho-social outcomes of stroke patients and their caregivers.

Design

A systematic review and meta-analysis based on PRISMA guidelines.

Data sources

Five English databases (PubMed, Web of Science, CINAHL, Embase and Cochrane Library) were searched to identify eligible studies published from the inception to October 15, 2024.

Methods

Two reviewers independently screened the literature in accordance with the selection criteria. The risk of bias of the included studies was assessed using Cochrane RoB 2.0. Relevant information was extracted, narrative synthesis was conducted and the meta-analysis was carried out using Review Manager 5.4 soft.

Results

A total of 28 literature were identified and included in this review. These interventions focused mainly on the provision of stroke related knowledge, promotion of family relationships and relief of negative emotions by a face-to-face mode. The outcome indicators can be grouped into three dimensions based on the developmental contextual coping model: dyadic appraisal, dyadic coping and dyadic adjustments. The results of meta-analysis showed that dyadic interventions significantly improved quality of life and coping capacity of patients, promoted family function of caregivers and alleviated caregiver-related burden.

Conclusion

These findings highlighted the positive outcomes of dyadic interventions that focused on patients and their caregivers coping with stroke. However, the effectiveness of interventions is not absolute, the evaluation system of intervention effect needs to be improved and demand-driven interventions need to be developed urgently. Therefore, further large-scale randomized controlled trials with a high-quality design are warranted.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, CRD42024621297.

Effects of Dyadic Psychosocial Education on People Living with Cognitive Impairment and Their Informal Caregivers: A Systematic Review and Meta-Analysis

OBJECTIVES

Cognitive impairment places a substantial burden on both patients and caregivers. Dyadic psychosocial education may be a potential solution, but its effects have not been systematically evaluated. This study aimed to evaluate the effects of dyadic psychosocial education on outcomes and dyadic relationships among cognitively impaired adults and their informal caregivers.

DESIGN

Systematic review and meta-analysis.

SETTINGS AND PARTICIPANTS

People living with cognitive impairment and their informal caregivers.

METHODS

Six electronic databases were systematically searched from January 1, 2004, to October 13, 2024. Two researchers independently screened the literature by title, abstract, and full text. The revised Cochrane risk-of-bias tool for randomized trials was used to assess the risk of bias for included studies. A meta-analysis was performed using a random effects model, followed by subgroup and sensitivity analyses.

RESULTS

Sixteen studies representing 2446 dyads were identified. No effects were found on overall neuropsychiatric symptoms, agitation, apathy, or depression, nor caregiver quality of life and depression. Pooled results showed dyadic psychosocial education significantly reduced dyadic conflict (SMD = -0.42, 95% CI: -0.66 to -0.18, I2 = 0). No significant effects of dyadic psychosocial education were found on overall cognitive function (SMD = 0.12, 95% CI: -0.13 to 0.38, I2 = 69%) or caregiver burden (SMD = -0.20, 95% CI: -0.43 to 0.03, I2 = 56%). However, subgroup analyses indicated that interventions ≤6 months improved overall cognitive function (SMD = 0.30, 95% CI: 0.06-0.54, I2 = 19%) and reduced caregiver burden (SMD = -0.26, 95% CI: -0.51 to -0.01, I2 = 32%).

CONCLUSIONS AND IMPLICATIONS

These findings demonstrate that dyadic psychosocial education can reduce dyadic conflict. The intervention also benefited cognitive function and caregiver burden, but the intervention duration influenced the effectiveness. Given the instability of the results, the findings of this study need to be interpreted with caution.

Fear of disease progression and resilience parallelly mediated the effect of post-stroke fatigue on post-stroke depression: A cross-sectional study

AIMS

To explore the effect of post-stroke fatigue (PSF) on post-stroke depression (PSD) and examine the mediating effects of fear of disease progression (FOP) and resilience between PSF and PSD.

DESIGN

A cross-sectional study.

METHODS

A total of 315 stroke patients participated in the questionnaire survey between November 2022 and June 2023. Data were collected using the General Information Questionnaire, Fatigue Severity Scale, Fear of Disease Progression Questionnaire-Short Form, Connor-Davidson Resilience Scale-10 Item and Hospital Anxiety and Depression Scale-Depression Subscale. Data were analysed by descriptive analysis, Mann-Whitney U-test, Kruskal-Wallis H-test, Pearson or Spearman correlation, hierarchical regression analysis and mediation analysis.

RESULTS

PSF had a significant positive total effect on PSD (β = .354, 95% CI: .251, .454). Additionally, FOP and resilience played a partial parallel-mediating role in the relationship between PSF and PSD (β = .202, 95% CI: .140, .265), and the total indirect effect accounted for 57.06% of the total effect.

CONCLUSIONS

FOP and resilience parallelly mediated the effect of PSF on PSD, which may provide a novel perspective for healthcare professionals in preventing PSD. Targeted interventions aiming at reducing PSF, lowering FOP levels and enhancing resilience may be possible ways to alleviate PSD.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Interventions that tail to reducing PSF, lowering FOP levels and enhancing resilience may be considered as possible ways to alleviate PSD.

IMPACT

This study enriched the literature by exploring the effect of PSF on PSD and further examining the mediating effects of FOP and resilience between PSF and PSD. Findings emphasized the important effects of PSF, FOP and resilience on PSD.

REPORTING METHOD

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was used to guide reporting.

PATIENT OR PUBLIC CONTRIBUTION

One tertiary hospital assisted participants recruitment.

Motivational interviewing for improving functional and psychosocial outcomes among stroke survivors

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of motivational interviewing for functional and psychosocial outcomes in stroke survivors, compared to no intervention, waiting list, or attention controls.

A Bibliometric Analysis of Research Trends in Psychological Interventions for Stroke Survivors: Focusing on Resilience and Psychological Well-Being (2000-2024)

Purpose

This study aims to conduct a bibliometric analysis of research literature on psychological interventions for stroke survivors published from 2000 to 2024, focusing on psychological resilience and psychological well-being, utilizing VOSviewer and CiteSpace.

Patients and Methods

Literature data was sourced from the Web of Science Core Collection database (WoSCC). A total of 373 relevant articles published between January 1, 2000, and September 30, 2024, were included. CiteSpace and VOSviewer analyzed the literature from perspectives including authorship, country of origin, institutions, journals, references, and keywords.

Results

Annual publication output has steadily increased, reaching a peak in 2023 (55 articles). Vranceanu Ana-Maria emerged as the most productive author with eight publications. The United States led in research output (98 articles) and centrality (0.32), with Harvard University being the leading institution (24 articles). "Disability and Rehabilitation" was the most productive journal (12 articles), while "Stroke" was the most co-cited journal (241 times). Recent research trends emphasized meta-analysis (strength=3.6), assessment tool validation (strength=3.49), and acceptance-based interventions (strength=2.89), mainly focusing on psychological resilience cultivation and well-being promotion.

Conclusion

This bibliometric analysis reveals the increasing scholarly interest in psychological interventions for stroke survivors, particularly in resilience and psychological well-being research. The field has evolved from focusing on disease-related factors to systematic intervention research, with a growing emphasis on methodological standardization and individualized interventions. These findings provide significant theoretical and practical implications for improving psychological health services for stroke survivors. Future research should strengthen high-quality empirical studies, refine assessment tools, and innovate intervention strategies to better address the complex psychological needs of stroke survivors and enhance their resilience and psychological well-being, ultimately improving rehabilitation outcomes and quality of life for stroke survivors.

Effects of dyadic psychosocial education on people with mild cognitive impairment or dementia and their informal caregivers: protocol for a systematic review and meta-analysis

INTRODUCTION

Mild cognitive impairment (MCI) and dementia impose a significant burden on individuals and their caregivers. Dyadic psychosocial education, which treats care recipients and their caregivers as a pair of active participants, has the potential to improve health outcomes for people with cognitive impairment and their caregivers. However, the results of recent studies on this subject are contradictory. We aim to evaluate the effectiveness of dyadic psychosocial education for people with MCI or dementia and their informal caregivers.

METHODS AND ANALYSIS

Six databases will be searched. We will include all randomised controlled trials that compare dyadic psychosocial education to usual care. The risk of bias will be assessed using the Cochrane Risk-of-Bias Assessment Tool (V.2). Meta-analyses, subgroup analyses and sensitivity analyses will be performed using Stata V.15.1. A narrative synthesis will be conducted if quantitative analysis is not feasible.

ETHICS AND DISSEMINATION

This study and subsequent systematic review will not collect individual-level data and, therefore, do not require ethics committee approval. Peer-reviewed publications will disseminate the study results.

PROSPERO REGISTRATION NUMBER

CRD42024497554.

Effects of dyadic psychoeducational interventions for haemodialysis patients and their family caregivers: a randomised controlled trial

BACKGROUND

Haemodialysis may affect the changes in the patient's relationship with the family, and eventually cause some psychological distress to the patient and affect the health-related quality of life. This study examines the effectiveness of the dyadic psychoeducational intervention on patients' quality of life and psychosocial health, as well as caregiver burden and psychosocial outcomes among caregivers.

METHODS

This is a parallel, two-arm, assessor-blind, randomised controlled trial with a repeated-measures design. A total of 80 haemodialysis dyads (patient and family caregivers) randomly assigned to the intervention group or control group with usual care (N = 40 dyads per group). The intervention included 4-week dyadic psychoeducational intervention. At before intervention (T0), immediately after intervention (T1), 1 month after intervention (T2) and 3 months after intervention (T3), patients' quality of life ana caregiver burden (primary outcomes), and other secondary outcomes (i.e., dyads' coping, depression and anxiety symptoms, and social support) were evaluated. Generalized Estimated Equation was used to test the intervention effect of the dyadic psychoeducation intervention, and intentional-to-treat analysis was used for all analyses.

RESULTS

Effects of dyadic psychoeducational intervention: The result of adjusting the GEE model shows that dyadic psychoeducational intervention can effectively improve patients' quality of life (T1: β = 8.51, p < 0.001; T2: β = 9.03, p < 0.001; T3: β = 8.82, p < 0.001), patients' anxiety (T1: β = -2.35, p = 0.022; T2: β = -2.84, p = 0.002; T3: β = -2.85, p = 0.001) and caregivers' anxiety (T2: β = -1.67, p = 0.012; T3: β = -2.57, p = 0.004), patients' depression (T2: β = -2.39, p = 0.017; T3: β = -2.71, p = 0.006), caregiver burden (T2: β = -6.95, p = 0.007; T3: β = -6.34, p = 0.008), caregiver depression (T2: β = -2.01, p = 0.015; T3: β = -1.85, p = 0.015).

CONCLUSIONS

The dyadic psychoeducational intervention can improve the psychosocial outcomes of haemodialysis dyads. This intervention provides effective ways and measures for the relevant psychological education intervention and provides new ideas and evidence for clinical nursing research.

TRIAL REGISTRATION

This study was retrospectively registered as a randomized controlled trial in the ClinicalTrials Registry. Registration Date: April 16, 2024.

REGISTRATION NUMBER

NCT06203730.

Stroke Rehabilitation: Synopsis of the 2024 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines

DESCRIPTION

In July 2024, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DOD) released a joint update of their 2019 clinical practice guideline (CPG) for the management of stroke rehabilitation. This synopsis is a condensed version of the 2024 CPG, highlighting the key aspects of the guideline development process and describing the major recommendations.

METHODS

The VA/DOD Evidence-Based Practice Work Group convened a joint VA/DOD guideline development work group (WG) that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy CPGs. The guideline WG conducted a patient focus group, developed key questions, and systematically searched and evaluated the literature (English-language publications from 1 July 2018 to 2 May 2023). The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to evaluate the evidence. The WG developed 47 recommendations along with algorithms for stroke rehabilitation in the inpatient and outpatient settings. Stakeholders outside the WG reviewed the CPG before approval by the VA/DOD Evidence-Based Practice Work Group.

RECOMMENDATIONS

This synopsis summarizes where evidence is strongest to support guidelines in crucial areas relevant to primary care physicians: transition to community (case management, psychosocial or behavioral interventions); motor therapy (task-specific practice, mirror therapy, rhythmic auditory stimulation, electrical stimulation, botulinum toxin for spasticity); dysphagia, aphasia, and cognition (chin tuck against resistance, respiratory muscle strength training); and mental health (selective serotonin reuptake inhibitor use, psychotherapy, mindfulness-based therapies for treatment but not prevention of depression).

Exploring Experiences and Perceptions of Stroke Survivors in Hospital-To-Home Transition Care: A Qualitative Systematic Review

AIM

To integrate experiences and perceptions about stroke survivors during the transition from hospital-to-home care.

DATA SOURCES

Seven databases, including PubMed, Embase, Cochrane Library, Ovid, Web of Science, EBSCO and MEDLINE, were searched comprehensively from inception to March 2024, including qualitative studies published in English.

DESIGN

A qualitative systematic review.

METHODS

The search followed the Preferred Reporting Items report for Systematic Reviews and Meta-analysis (PRISMA 2020). The included research quality was assessed according to the Critical Appraisal Skills Programme (CASP). Meta-aggregation was used to develop analytical themes. Confidence in the Evidence from the Reviews of Qualitative Research (GRADE-CERQual) framework was applied to the findings.

RESULTS

Fifteen qualitative studies were included, from which 54 findings were extracted. Similar findings were summarised into eight categories, resulting in four synthesised findings: Joy and sadness intertwined, Destruction of sense of self and life, External support and internal motivation, and Emotional longings and practical needs.

CONCLUSION

Stroke can lead to devastating changes in survivors' sense of self and physically. Through external support from family members and healthcare professionals, as well as internal motivation to cope positively, stroke survivors positively accept and adapt to life. Meanwhile they still have high expectations for personal independence and reintegration into society.

IMPACT

The review findings can guide health professionals, survivors and families in optimising care during the hospital-to-home transition.

PROTOCOL REGISTRATION

PROSPERO [CRD42024522555].

REPORTING

ENTREQ. No Patient or Public Contribution.

Effective Solutions for Caregivers of Older Adults: A Review of Systematic Reviews

This umbrella review aims to describe caregiver interventions tested across populations of informal caregivers of older adults and to examine the effect of caregiver interventions on depression, burden, and quality of life across intervention types and care-recipient populations. PubMed, Scopus, APA PsycInfo, ABIM, Sociological Abstracts, PAIS, and EconLit databases were systematically searched. Forty systematic reviews were identified as meeting inclusion criteria. Most commonly, interventions focused on improving outcomes for caregivers of older adults with dementia. Among the included reviews, caregiver depression was most likely to be reduced by caregiver interventions, and cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBI) were most effective. The use of information and communication technologies to deliver caregiver interventions is increasingly common. Standardization of intervention classifications and transparent reports of intervention delivery details will strengthen research in this field.

eHealth Interventions of Health Literacy for Stroke Survivors: Systematic Review and Meta-Analysis

BACKGROUND

eHealth literacy interventions have emerged as a new approach in management of stroke survivors. Its effect on knowledge and clinical outcomes presents an inconsistent result in literature.

OBJECTIVES

We aim to evaluate the impact of eHealth interventions on health literacy, clinical metrics, adherence to healthy behaviors, stroke recurrence, mortality, and health-related quality of life in stroke survivors.

METHODS

We systematically searched six databases (PubMed, Cochrane Library, CINAHL, EMBASE, Web of Science, ProQuest) up to February 21, 2024, selecting articles that meet these criteria: (i) patients with stroke; (ii) intervention with education content; (iii) eHealth interventions included telehealth, mobile phone, internet or computer; (iv) randomized controlled trials. The mean differences (MD) and standardized mean differences (SMD) between groups were measured. Risk of bias was evaluated using the Cochrane tool.

RESULTS

From 16 studies involving 9646 participants, we observed that eHealth interventions significantly improved systolic blood pressure (MD = -2.78 mmHg, 95% confidence interval (CI) [-4.67 to -0.88], p = 0.004), medication adherence (SMD = 0.28, 95% CI [0.04 to 0.52], p = 0.023), and health-related quality of life (SMD = 0.21, 95% CI [0.04 to 0.37], p = 0.013). Meta-regression found that age modified the effect size of systolic blood pressure (p = 0.027). There was insufficient evidence to conclude effects on other outcomes. The quality of evidence was moderate. Outcome variation may be due to the diversity in eHealth intervention approaches. The limited number of studies precluded the subgroup analysis. More interactive interventions with longer follow-ups were more effective.

CONCLUSIONS

eHealth interventions may benefit stroke survivors in terms of blood pressure, medication adherence, and health-related quality of life.

IMPLICATIONS FOR NURSING POLICY

eHealth literacy interventions could be implemented to improve the management of stroke survivors, especially in the context of resource limitations.

TRIAL REGISTRATION

PROSPERO registration number: CRD42024502470.

Perspectives of Clients and Health Care Professionals on the Opportunities for Digital Health Interventions in Cerebrovascular Disease Care: Qualitative Descriptive Study

BACKGROUND

Cerebrovascular diseases (CVDs) are a major and potentially increasing burden to public health. Digital health interventions (DHIs) could support access to and provision of high-quality health care (eg, outcomes, safety, and satisfaction), but the design and development of digital solutions and technologies lack the assessment of user needs. Research is needed to identify opportunities to address health system challenges and improve CVD care with primary users of services as the key informants of everyday requirements.

OBJECTIVE

This study aims to identify opportunities for DHIs from clients' and health care professionals' perspectives to address health system challenges and improve CVD care.

METHODS

This study used a qualitative, descriptive approach. Semistructured, in-person interviews were conducted with 22 clients and 26 health care professionals in a single tertiary-level hospital in Finland between August 2021 and March 2022. The data were analyzed using a deductive and inductive content analysis.

RESULTS

Identified opportunities for DHIs in CVD care were organized according to clients, health care professionals, and data services and classified into 14 main categories and 27 generic categories, with 126 subcategories of requirements. DHIs for clients could support the long-term management of health and life changes brought on by CVD. They could provide access to personal health data and offer health information, support, and communication possibilities for clients and their caregivers. Health care professionals would benefit from access to relevant patient data, along with systems and tools that support competence and decision-making. Intersectoral and professional collaboration could be promoted with digital platforms and care pathways. DHIs for data services could enhance care planning and coordination with novel predictive data and interoperable systems for data exchange.

CONCLUSIONS

The combined study of client and health care professional perspectives identified several opportunities and requirements for DHIs that related to the information, availability, quality, acceptability, utilization, efficiency, and accountability challenges of health systems. These findings provide valuable social insights into digital transformation and the emerging design, development, and use of user-centered technologies and applications to address challenges and improve CVD care and health care.

A modified Delphi survey to build expert consensus on the structure and content of an enhanced care pathway for cognitive changes after stroke in the UK

BACKGROUND

Enhancing long-term support for post-stroke cognitive impairment is a top research priority. Addressing current gaps in UK post-stroke cognitive care provision requires a pragmatic and scalable intervention that can be integrated within the existing stroke care pathway. This study aimed to develop consensus on an initial set of core features for a UK-based monitoring and psychoeducational intervention for cognitive changes after stroke.

METHODS

An expert panel of UK healthcare professionals and researchers participated in an online modified Delphi survey. Candidate intervention features were identified from clinical guidelines, existing literature, research team/collaborator expertise, and PPI group lived experience. Survey participants indicated whether they agreed/disagreed/had no opinion about including each candidate feature in the intervention and free-text responses were invited. We analysed responses for consensus (≥ 75% agreement) using descriptive statistics, with items not reaching consensus carried into subsequent rounds. Template analysis was used to identify similarities/differences in viewpoints for items that did not reach consensus.

RESULTS

Three survey rounds were completed by 36, 29 and 26 participants, respectively. Participants agreed reviews should include a stroke-specific cognitive screen (97% agree) and assessment of other psychological changes (low mood, anxiety, fatigue: 94%, 90%, 89% agree, respectively). They agreed stroke survivors should be offered at least one review, regardless of their cognitive profile in hospital. They agreed on the importance of various cognition-focused psychoeducation topics, and formal (100% agree) and informal (79% agree) training for those conducting reviews. Consensus was not reached on the review mode (in person/remote options: 67% agree), offering reviews one-year post-discharge to patients without acute cognitive impairments (68% disagree), or including a dementia screen (63% disagree) and/or neuropsychological assessment battery (58% disagree). However, there were similarities in participant viewpoints. For example, participants emphasised the importance of onwards referral where clinically indicated.   CONCLUSIONS: The UK-based post-stroke monitoring and psychoeducation intervention was originally conceptualised as a cognitive care pathway, but expert participants agreed on the importance of simultaneously addressing related psychological changes (e.g. low mood, anxiety). There was clear consensus on a minimum set of intervention features. Recommendations outlined here may usefully inform local service improvements.

The experience of mutual support during hospitalization of co-morbid couples with recurrent older stroke survivors - A descriptive phenomenological study

The phenomenon of the experiences of mutual support of co-morbid couples of recurrent older stroke survivors during hospitalization is receiving increased interest from nursing scholars. However, little is known about how they support each other. The aim of this study was to explore the experiences of co-morbid couples of older stroke survivors with recurrent stroke who support each other during hospitalization. A descriptive phenomenology study was employed. 21 co-morbid couples with recurrent older stroke survivors were recruited. The interviews were analyzed with Colaizzi's descriptive analysis framework. Three themes emerged from the data analysis: (1) maintaining the couple's relationship through mutual support, (2) mutual support so as not to drag the children down, and (3) providing support while struggling between ideals and reality. It is crucial to provide them with individualized, tailored support and interventions that can help these couples achieve a more optimal balance in their mutual support.

Effectiveness of family centred interventions for family caregivers: A systematic review and meta-analysis of randomized controlled trials

AIMS AND OBJECTIVES

To examine the effectiveness of family-centred interventions among family caregivers.

BACKGROUND

Family-centred interventions are an emerging form of intervention that can be effective at improving physical and mental health outcomes for patients and family caregivers. To date, no reviews have examined the effectiveness of family-centred interventions for family caregivers.

DESIGN

A systematic review, including a meta-analysis, was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) checklist.

METHODS

Seven English and two Chinese electronic databases were compressively searched from the outset to March 2023. Two researchers independently reviewed the abstracts and full texts, extracted the data and assessed the risk of bias independently by using the Cochrane 'Risk of bias assessment tool'.

RESULTS

This systematic review and meta-analysis included 20 articles. The results of the meta-analysis showed that family-centred interventions could significantly improve caregiver burden (p=0.003), quality of life (p = 0.007), depression (p = 0.0002), and stress (p < 0.0001) but not anxiety or family functioning. According to our subgroup analysis, the family-centred empowerment model (p = 0.009) was superior to the other family intervention (p=0.004) in reducing caregiver burden. Family-centred interventions are more effective at reducing the burden of caregiving on family caregivers of adolescent patients (SMD=-0.79, 95% CI[-1.22,-0.36], p = 0.0003) than on adult patients (SMD=-0.37, 95% CI [-0.61,-0.12], p = 0.004).

CONCLUSIONS

Family-centred interventions could enhance family caregivers' burden, quality of life, stress and depression but had no significant impact on anxiety or family functioning.

RELEVANCE TO CLINICAL PRACTICE

Family-centred interventions have the potential to improve the health status and caregiving burden of family caregivers. Rigorous and high-quality evidence is needed to confirm the long-term effects of these interventions on family caregivers.

TRIAL REGISTRATION DETAILS

The protocol has been registered in the PROSPERO international prospective register of systematic reviews (Protocol registration ID: CRD42023453607).

The caregiver contribution to self-care of stroke inventory (CC-SCSI): evaluation of psychometric characteristics

BACKGROUND

The caregiver contribution to self-care plays an important role in improving the health outcomes of chronic patients, which needs urgent attention. However, it has been hindered by the lack of a tailored instrument that assesses the caregiver contribution to self-care of stroke.

OBJECTIVES

To test the psychometric characteristics of the caregiver contribution to self-care of stroke Inventory (CC-SCSI) in health care practice.

METHODS

Participants were recruited in Henan Province from March 2021 to October 2022, utilizing a multicenter stratified sampling approach. A 23-item self-report CC-SCSI with 3 separate scales measuring caregiver contribution to self-care maintenance of stroke, caregiver contribution to self-care monitoring of stroke and caregiver contribution to self-care management of stroke was tested for validity through discriminant validity, confirmatory factor analysis, concurrent validity and convergent validity. The reliability was tested by Cronbach's α coefficient and test-retest reliability. Qualitative data were analysed using thematic analysis. A STROBE checklist was used.

RESULTS

The three scales of the CC-SCSI exhibited good discriminant validity. Confirmatory factor analysis supported the three-factor structure of the Caregiver Contribution to Stroke Self-Care Maintenance and Management scales and the one-factor structure of the Caregiver Contribution to Stroke Self-Care Monitoring scale. The moderate correlation between the CC-SCSI and the Self-Care of Stroke Inventory indicated acceptable concurrent validity. The moderate correlation between the CC-SCSI and the Caregiver Contribution to Self-Care of Chronic Illness Inventory indicated acceptable convergent validity. Cronbach's αs for the Caregiver Contribution to Self-Care Maintenance, Self-Care Monitoring, and Self-Care Management scales ranged from 0.876 to 0.974. Test-retest reliability showed average ICC values ranging from 0.828 to 0.903 (P < 0.001).

CONCLUSIONS

The 23-item CC-SCSI presents good psychometric properties and could be used to explore the caregiver contribution to stroke self-care in health care practice and research.

Backbone of Care: Lived Experiences of Family Caregivers of Stroke Survivors in Guadalupe, Cebu City

This study explored the lived experiences of five family caregivers of stroke survivors in a village in Cebu City, Philippines. Data was gathered through individual in-depth interviews and underwent interpretative phenomenological analysis. Three themes emerged: (1) Altruism of caregiving: Of self and family, (2) Victories in caregiving, and (3) Burdens of caregiving. Themes illustrated the duality of roles, overcoming difficulties of caregiving, and sources of motivation in caregiving. Findings indicate that a need for collaborative efforts and active involvement between the communities and occupational therapy with the healthcare system to provide programs and support to family caregivers.

Psychosocial interventions for people with amyotrophic lateral sclerosis and motor neuron disease and their caregivers: a scoping review

BACKGROUND

As amyotrophic lateral sclerosis/motor neuron disease (ALS/MND) is a fatal progressive neurodegenerative disorder, patients experience severe impairments, with patients and family caregivers facing emotional distress and exhaustion. Several psychosocial interventions are aimed at providing tailored support for ALS/MND patients and caregivers. The aim of this study was to conduct a scoping review and present a comprehensive overview of psychosocial interventions designed for individuals and families affected by ALS/MND, while also pinpointing research gaps.

METHODS

This scoping review utilized Arksey and O'Malley's methodological framework to investigate psychosocial interventions designed for individuals with ALS/MND and their families. The study adhered to the PRISMA-ScR checklist for reporting.

RESULTS

A total of 27 articles describing 25 interventions met the inclusion criteria. The predominant interventions observed in the research encompassed education-related strategies, closely followed by behavior therapy, counseling, social support interventions, and psychotherapy interventions. Across the majority of the studies, findings indicated promising feasibility and acceptability of these interventions. Notably, a significant proportion of quantitative investigations yielded one or more statistically significant effects, while qualitative studies consistently reported favorable outcomes, including enhancements in well-being and heightened awareness of individual circumstances.

CONCLUSIONS

Given the progressive and debilitating nature of this condition, coupled with the absence of a cure, the adoption of a psychosocial approach can prove beneficial for both ALS/MND patients and their families. However, high-quality RCTs with a large sample size are recommended to examine and confirm the effectiveness.

Interventions for improving self-efficacy in patients after stroke based on self-efficacy-related principles of Bandura's cognition theory: a systematic review and meta-analysis

BACKGROUND

Interventional approaches based on Bandura's cognition theory are effective in improving self-efficacy poststroke. However, a systematical investigation for identifying effectives therapeutic components of the intervention has not yet been conducted.

OBJECTIVE

This meta-analysis was conducted to systematically investigated the effects of interventions with different principles on improving self-efficacy after stroke.

METHODS

Searches were conducted in PubMed, EMBASE, CINAHL, PsycINFO, MEDLINE, Cochrane Library, and two randomized controlled trials registration websites for randomized controlled trials from inception to 18th January 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The meta-analysis was performed using Review Manager and Stata software.

RESULTS

In total, 36 RCTs were included. Interventions using any one of the self-efficacy principles - principle 1 (Mastery), principle 2 (Modeling), principle 3 (Social persuasion), and principle 4 (Understanding), were more effective in improving self-efficacy in patients with stroke at post-training and follow-up, compared with the control group. Psycho-educational interventions might significantly improve self-efficacy in both post-intervention and follow-up stages, compared with control group. Meta-regression revealed time since stroke onset was significantly associated with effect sizes.

CONCLUSION

Interventions developed based on Bandura's cognition theory are beneficial to the improvement of self-efficacy. This review highlights principles of Bandura's cognition theory are worth considering to be integrated to interventions targeted at improving self-efficacy. The application of self-efficacy principles with Bandura's cognitive theory could be encouraged in clinical practice in the future.

PROTOCOL REGISTRATION NUMBER

PROSPERO CRD42020154984.

Effectiveness of Dyadic Psychoeducational Intervention on Cancer Patients and Their Caregivers: A Systematic Review and Meta-analysis

BACKGROUND

Dyadic psychoeducational intervention targets the dyads of cancer patients and caregivers as active participants in partnership, which can potentially address the needs and challenges faced by patients with cancer and their caregivers. However, there is insufficient evidence on the effectiveness of the intervention on psychological health and illness-related outcomes among the dyads.

OBJECTIVE

To systematically examine the dyadic psychoeducational intervention of cancer patients and their caregivers on psychological health and illness-related outcomes.

METHODS

Cochrane Library, EMBASE, CINAHL, PsycINFO, PubMed, Web of Science, and 4 Chinese databases were searched from inception to May 29, 2022. Two investigators independently extracted data and evaluated methodological quality. RevMan 5.4 was used for meta-analysis; heterogeneity was evaluated using Higgins' I2 (%). Standardized mean difference (SMD) with a 95% confidence interval (CI) was used to assess the effects.

RESULTS

Eight randomized controlled trials that involved 1234 dyads were collected. Meta-analysis showed that the intervention was effective in reducing the dyadic depression (patients' SMD, -0.41 [95% CI, -0.78 to -0.04; P = .03]; caregivers' SMD, -0.70 [95% CI, -1.31 to -0.09; P = .03]). It also improved caregivers' quality of life (SMD, -0.29 [95% CI, -0.56 to -0.03; P = .03]), whereas no significant effect was found on patients' quality of life. Dyadic results including anxiety, self-efficacy, disease communication, and appraisals of illness/caregiving were observed.

CONCLUSION

Dyadic psychoeducational intervention reduced the dyadic depression. It also improved caregivers' quality of life.

IMPLICATIONS FOR PRACTICE

Nurses can apply dyadic psychoeducational intervention in clinical practice. More studies are needed to draw higher-quality conclusions and investigate the effects on psychological health and illness-related outcomes in cancer patients and caregivers.

A psychometrics evaluation of the Thai version of Caregiver Contribution to Self-Care of Chronic Illness Inventory Version 2 in stroke caregivers

Objectives

To evaluate the psychometric characteristics of the Thai version of Caregiver Contribution to Self-Care (CC-SC) of Chronic Illness Inventory version 2 (CC-SC-CII-v2) in stroke caregivers.

Methods

We conducted a multicenter, cross-sectional study following the COSMIN guidelines, evaluating validity and reliability of three separate scales, CC-SC Maintenance, CC-SC Monitoring, and CC-SC Management, as well as overall CC-SC-CII-v2. From September to December 2022, we enrolled 422 stroke caregivers from primary care centers in southern Thailand. Structural validity was assessed through confirmatory factor analysis (CFA), while concurrent validity was evaluated using Pearson's correlation r coefficients between CC-SC-CII-v2 and the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale (CSE-CSC). Internal coherence reliability was assessed using Cronbach's α coefficient, the composite reliability index, and the McDonald's ω coefficient. Additionally, test-retest reliability was assessed with intraclass correlation coefficients (ICCs).

Results

The study included mostly middle-aged women who cared for their parent. CFA supported the two-factor structure of the CC-SC Maintenance and Management scales and the one-factor structure of the CC-SC Monitoring scale. A simultaneous CFA on the combined set of items supported the more general model. The concurrent validity of CC-SC-CII-v2 with CSE-CSC was established (r ranging 0.47-0.65, all P < 0.001). Reliability estimates supported adequate Cronbach's α coefficient (ranging 0.83-0.89), composite reliability (ranging 0.84-0.85), McDonald's ω coefficients (ranging 0.83-0.85), and ICCs (ranging 0.86-0.90) across the three scales.

Conclusions

The Thai CC-SC-CII-v2 demonstrated strong psychometric properties among stroke caregivers. It can be a valuable instrument to investigate the role of caregivers in contributing to stroke patients' self-care in diverse cultural contexts like Thailand.

Dyadic psycho-social interventions for stroke survivors and family caregivers: A systematic review and meta-analysis of randomized controlled trials

AIMS AND OBJECTIVES

To describe dyadic psycho-social intervention measures and to evaluate their influence on stroke survivors and caregiver's functional independence, quality of life, depression, anxiety, self-efficacy and coping ability.

BACKGROUND

Because of the importance of dyadic intervention and the seriousness of the psycho-social problems of stroke survivors and caregivers, understanding the influence of dyadic psycho-social interventions is vital.

DESIGN

A systematic review and meta-analysis based on PRISMA guidelines.

DATA SOURCES

Nine databases were systematically searched for randomized controlled trials submitted from 1910 to 4 July 2022.

METHODS

The included papers were evaluated for quality, and quantitative data were standardly extracted and analysed by meta-analysis, followed by synthesis. The meta-analysis was carried out using Review Manager 5.4 software.

RESULTS

Fifteen randomized controlled trials were included (n = 2190 for patients, and n = 1933 for caregivers). Study results showed that dyadic psycho-social interventions significantly alleviated the depressive symptoms of patients, obviously improved the ability to function independently of patients and more quickly alleviated the care burden of caregivers.

CONCLUSIONS

This study provided moderate support for the benefits of dyadic psycho-social intervention in improving survivor and caregiver's functional independence, quality of life, depression, anxiety, self-efficacy and care burden. Nevertheless, due to limitations of the study, it was deemed necessary that this topic is studied further.

RELEVANCE TO CLINICAL PRACTICE

This review suggests that dyadic psycho-social interventions should be considered as effective strategies for decreasing psycho-social problems of stroke survivors and caregivers, and provides evidence for the formulation of targeted intervention programs. The personalized implementation of such interventions should be the focus of clinical practice.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

Measuring poststroke fatigue: The psychometric properties of the Chinese version of multidimensional fatigue inventory

OBJECTIVE

Poststroke fatigue (PSF) is a common and debilitating problem among stroke patients. Multidimensional fatigue inventory (MFI) has been recommended to assess fatigue related to acquired brain injury. This study aimed to examine the psychometric properties of the Chinese version of MFI among stroke patients.

METHODS

The study recruited 252 stroke patients in China. The internal consistency of the Chinese-version MFI was evaluated using Cronbach's α coefficients. The test-retest reliability was measured over a 5-day interval with intraclass correlation coefficient. Exploratory factor analysis was conducted to analyze the construct validity. The concurrent validity of MFI was examined by calculating the Pearson's correlation coefficient between the scores of MFI and the fatigue assessment scale (FAS).

RESULTS

The exploratory factor analysis of the Chinese-version of MFI showed that it captured three dimensions of PSF, namely, physical fatigue, mental fatigue, and level of activity. The Chinese-version MFI demonstrated satisfactory internal consistency with Cronbach's α ranging from 0.83 (mental fatigue) to 0.91 (total scale). The Chinese-version MFI showed adequate test-retest reliability with intraclass correlation coefficients of 0.70 for the total scale, 0.69 for physical fatigue, 0.66 for mental fatigue, and 0.62 for level of activity. The concurrent validity of the Chinese-version MFI was demonstrated by a significant positive correlation (r=0.49, p <0.001) with FAS.

CONCLUSION

This study findings showed that Chinese-version MFI has adequate internal consistency and test-retest reliability, and demonstrated its concurrent validity with FAS. The findings provide preliminary evidence of the three-factor structure of Chinese-version MFI by exploratory factor analysis.

Improving palliative care outcomes in remote and rural areas of LMICs through family caregivers: lessons from Kazakhstan

Approximately 60 million people require palliative care worldwide, and nearly 80% of them live in low- and middle-income countries (LMICs). Providing palliative care in remote and rural areas of LMICs requires special consideration to ensure equitable access to healthcare. This perspective aims to deliver pragmatic, context-oriented policy recommendations designed to improve palliative care outcomes in Kazakhstan by capitalizing on existing resources and considering its unique geopolitical and sociocultural context. With approximately half of the population in Kazakhstan residing in remote and rural regions, the provision of healthcare services - specifically palliative care - mandates particular attention to ensure equal access to high-quality care. To understand challenges of implementing palliative care in remote and rural regions of Kazakhstan and to propose tailored solutions, 29 key stakeholders, including family caregivers, health professionals, and palliative care administrators, were identified in five regions of Kazakhstan. The main challenges encountered by family caregivers include lack of palliative care skills, the need for home-based care from mobile services, and high out-of-pocket expenditures. The challenges highlighted by healthcare providers and administrators were the lack of formal education in palliative care, shortage of opioids, and limited societal awareness and state support. Based on challenges elaborated from stakeholders and existing literature in palliative care and family caregiving, this perspective advocates against replicating the strategies implemented in high-income countries. Family caregivers play a critical role in implementing affordable and efficient palliative care in resource-limited settings. Enhancing their competencies through digital training and increasing access to palliative care services through mobile teams are tailored and localized solutions that address specific challenges in Kazakhstan. It is postulated that these recommendations may find utility in other LMICs, potentially benefiting nearly 48 million individuals who require these services.

Interventions targeting psychosocial adaptation in people with stroke: A scoping review

OBJECTIVE

This scoping review aimed to describe and map interventions targeting psychosocial adaptation in people with stroke.

METHODS

A scoping review was conducted using the Joanna Briggs Institute methodology and reported according to Systematic Review and Meta-Analyses Extension for Scoping Reviews guidelines. We included original studies with interventions targeting psychosocial adaptation (concept) on people with stroke (population) in any setting (context). We searched five online electronic databases (PubMed, Embase, CINAHL, PsycINFO, and Cochrane Central Registry of Controlled Trials). We described interventions in terms of design characteristics, theoretical basis, details of interventions, and quantitative outcomes indicated in psychosocial adaptation.

RESULTS

Forty-three studies were identified. Five intervention categories were identified to describe the interventions targeting psychosocial adaptation. Quantitative outcomes indicated psychosocial adaptation in our review were grouped into four domains: global adaptation, psychological adaptation, social adaptation, and others.

CONCLUSIONS

The mapping and description brought to light the large heterogeneity of interventions targeting psychosocial adaptation in people with stroke.

PRACTICE IMPLICATIONS

Deepening understanding of psychosocial adaptation can help health professionals further develop effective interventions aiming at promoting psychosocial adaptation and reducing negative health sequelae, such as risk of reduced psychosomatic recovery post stroke.

Validity and reliability of the Korean caregiver contribution to self-care chronic illness inventory

The contribution of caregivers to self-care for chronically ill patients is important for improving patient outcomes. The Caregiver Contribution to Self-Care Chronic Illness Inventory (CC-SC-CII) has been used to assess caregivers' contributions to three distinct aspects of self-care (maintenance, monitoring, and management) globally. This study aimed to examine the psychometrics of the Korean version of the CC-SC-CII with 230 family caregivers (mean age = 49.8 years, 70% women) of patients with chronic illness. We demonstrated that the CC-SC-CII-Korean has good reliability with acceptable internal consistency and construct validity for all three factors using confirmatory factor analysis. The CC-SC-CII-Korean is a reliable and valid instrument to measure the contributions of Korean caregivers to the self-care of patients with chronic illnesses.

The effects of a family-focused dyadic psychoeducational intervention for stroke survivors and their family caregivers: A randomised controlled trial

BACKGROUND

Stroke can cause a variety of physical and psychosocial disturbances for both survivors and their family caregivers (i.e., stroke dyads). Dyadic psychoeducation appears to be a promising approach for providing knowledge of stroke and self-care or caregiving skills to improve stroke dyads' health outcomes. Therefore, a family-focused psychoeducation intervention was designed and tested to improve the health outcomes of stroke dyads.

OBJECTIVE

To examine the effects of a family-focused dyadic psychoeducational intervention on the functional and psychosocial outcomes of stroke survivors and family caregivers.

DESIGN

A single-blinded, parallel-group randomised controlled trial with repeated-measures design.

SETTINGS

Two general hospitals and one rehabilitation facility in Jinan, China.

PARTICIPANTS

Stroke survivors and family caregivers (N = 162 dyads).

METHODS

The dyads were randomly allocated to either psychoeducation or control group with usual care only (N = 81 dyads per group). The intervention included three structured face-to-face education sessions (one hour per session) in hospital pre-discharge and four weekly telephone counselling calls post-discharge. Study outcomes included survivor functioning and caregiver burden (primary outcomes), and other secondary outcomes (i.e., caregiving competence, dyads' coping, depressive and anxiety symptoms, family functioning, and dyadic relationship, as well as survivor healthcare utilisation and caregiving-related injury). Data were collected at baseline (T₀) and immediately (T₁) and 3 months post-intervention (T₂). The intervention effects were estimated using generalised estimating equation models.

RESULTS

Participants in the psychoeducation group revealed significantly greater reductions on caregiver burden than the control group at T₁ (β = -6.01, p = 0.026) and T₂ (β = -6.73, p = 0.039), but non-significant effects on survivor functioning, except in emotion domain at T₁ (β = 7.22, p = 0.015). In addition, the intervention demonstrated significantly greater improvements on caregiving competence (β = 0.98, p = 0.013; β = 1.58, p < 0.001), survivors' depressive symptoms (β = -1.56, p = 0.007; β = -2.06, p = 0.005), and dyadic relationship (β = 0.26, p = 0.012; β = 0.27, p = 0.022) at T₁ and T₂, as well as on survivor coping at T₂ (β = 6.73, p = 0.008).

CONCLUSIONS

Our study added values on the benefits of family-focused dyadic psychoeducation to routine stroke rehabilitation and family care. Future research can evaluate its long-term effects for families of stroke survivors with diverse socio-demographic and stroke-related characteristics.

REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2100042684). Recruitment: March to June 2021.

Physio-psycho-social interaction mechanism in dyadic health of young and middle-aged stroke survivors and their spousal caregivers: a longitudinal observational study protocol

INTRODUCTION

In recent years, stroke has become more common among young people. Stroke not only has a profound impact on patients' health but also incurs stress and health threats to their caregivers, especially spousal caregivers. Moreover, the health of stroke survivors and their caregivers is interdependent. To our knowledge, no study has explored dyadic health of young and middle-aged stroke survivors and their spousal caregivers from physiological, psychological and social perspectives. Therefore, this proposed study aims to explore the mechanism of how physiological, psychological and social factors affect dyadic health of young and middle-aged stroke survivors and their spousal caregivers. The findings of this study will provide implications for developing interventions to improve dyadic health of this growing population.

METHODS AND ANALYSES

We will collect data from 57 dyads of young and middle-aged stroke survivors and their spousal caregivers during hospitalisation and at 1, 3, 6, 9 and 12 months after discharge. Questionnaires will be used to collect participants' demographic information, stress, depression, anxiety, benefit finding, social support, mutuality and quality of life. The following physiological reactions will be collected at baseline, including interleukin 6, tumour necrosis factor-alpha and salivary cortisol.

ETHICS AND DISSEMINATION

The study was approved by the ethics review committee of life sciences of Zhengzhou University (No. ZZUIRB2020-53). Prior to being enrolled in the study, participants will be given full and detailed information about the possible risks involved, the informed consent process, confidentiality, the study procedure and secure data storage. Participants will be guaranteed that they can withdraw from the study at any time without providing a reason or leading to any consequences. Both oral and written informed consent will be obtained from all participants. The findings of this proposed study will be disseminated through peer-reviewed journals and academic conferences.

A Bibliometric Analysis of Stroke Caregiver Research from 1989 to 2022

Many stroke survivors suffer with varying degrees of disability and require assistance. Family members commonly act as informal caregivers, caring for these stroke survivors and ensuring care adherence. However, many caregivers reported a poor quality of life and physical and psychological distress. Due to these issues, multiple studies have been conducted to understand the experience of caregivers, the outcomes of caregiving, and interventional studies among caregivers. This study aims to explore the intellectual landscape of studies on stroke caregivers using bibliometric analysis. Studies with "stroke" and "caregiver" terms in the title were extracted from the Web of Sciences (WOS) database. The resulting publications were analysed using the 'bibliometrix' package in R. There were 678 publications analysed, dating from 1989 to 2022. The USA has the highest number of publications (28.6%), followed by China (12.1%) and Canada (6.1%). The most productive institution, journal and author were The University of Toronto (9.5%), 'Topics in Stroke Rehabilitation' journal (5.8%) and Tamilyn Bakas (3.1%), respectively. Co-occurrences keywords analysis revealed mainstream research on stroke survivors, burden, quality of life, depression, care, and rehabilitation, reflecting the timeless hotspot in the field. This bibliometric analysis helps us understand the current state of stroke caregiver research and its recent developments. This study can be used to evaluate research policies and promote international cooperation.

Contributing Factors to the Burden on Primary Family Caregivers of Stroke Survivors in South Korea

The purpose of this study is to identify the factors associated with the burden on primary family caregivers of stroke patients at home without care services. For this study, the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) data were used. Of the total 8010 caregivers, 1133 family caregiver burden was assessed with the shortened Caregiver Burden Inventory (CBI) 3 months after stroke. Patient and caregiver-related factors affecting the heavier burden of caregivers were identified by comparing the heavier caregiver burden group and the lighter caregiver burden group, which divided according to the CBI scores. The 719 (63.5%) family caregiver cared for patients at home without care services. Logistic regression analysis showed that four or more comorbidities (p = 0.002), neurological impairment at early onset (p < 0.001), dependence on daily life (p < 0.001), aphasia (p = 0.024), and depression(p < 0.001) were associated with a heavier burden of care. According to the shortened CBI, caregivers tended to be concerned more about psychological stress than physical strain. The findings suggest the importance of proactively guiding the emotional support services to caregivers who are at high risk of the heavier burden of patient care.

Mediating effect of post-stroke depression between activities of daily living and health-related quality of life: meta-analytic structural equation modeling

BACKGROUND

Stroke survivors face various problems that affect their health-related quality of life (HRQoL). Reduced activities of daily living (ADL) may contribute to post-stroke depression (PSD) and low HRQoL, and depression might be associated with low HRQoL. However, these relationships are not well known. This study aimed to analyze correlations among ADL, PSD, and HRQoL in stroke survivors and further explore the mediating role of PSD between ADL and HRQoL.

METHODS

This study utilized meta-analytic structural equation modeling (MASEM) on systematically searched articles from six electronic databases, namely PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (China), Wanfang database (China), and SinoMed (China), from inception up to July 31, 2021. Two researchers independently assessed study eligibility, and data from the eligible studies were encoded and assessed for quality. MASEM was utilized to examine correlations among ADL, PSD, and HRQoL, with an estimation of a pooled correlation matrix under a random-effects model. The matrix was directly fitted to a structural equation model using webMASEM.

RESULTS

In total, 8580 articles were screened, and data from 27 studies involving 33 effect sizes were used in the MASEM analysis. Correlations among the three variables were significant (both P < 0.01). Furthermore, PSD partially mediated the correlation between ADL and HRQoL (β = 0.24, 95% confidence interval 0.15-0.30).

CONCLUSIONS

The findings suggest that both decreased ADL and PSD may reduce HRQoL, while a decrease in ADL tends to cause depression after stroke. Therefore, ADL and PSD reductions should be improved to achieve better HRQoL of stroke survivors. Future studies should continue to discuss other factors affecting HRQoL to achieve optimal recovery in stroke survivors.

Effects of a family-focused dyadic psychoeducational intervention for stroke survivors and their family caregivers: a pilot study

BACKGROUND

Stroke is one of the leading causes of disability in China and worldwide, affecting the health and well-being of both stroke survivors and their family caregivers (i.e. stroke dyads). Dyadic interventions targeting both as active participants can be beneficial for the dyads' health and well-being. Psychoeducation is a potentially acceptable approach to developing participants' knowledge about their disease management to promote their recovery. This study aims to explore the feasibility, acceptability, and preliminary effects of a family-focused dyadic psychoeducational intervention for stroke dyads.

METHODS

This study was a single-blinded, parallel-group randomised controlled trial. Totally, a convenience sample of 40 stroke dyads was recruited. The intervention included three in-hospital face-to-face education sessions and four weekly post-discharge follow-up telephone counselling sessions. Feasibility was assessed by the rates of recruitment, attritions, and adherence to the intervention. Acceptability was evaluated via semi-structured qualitative interviews. Preliminary intervention effects were evaluated on primary (survivors' functioning and caregivers' burden) and secondary (caregivers' competence and dyads' coping, depressive and anxiety symptoms, family functioning, and dyadic relationship) outcomes.

RESULTS

Intervention feasibility was established with satisfactory recruitment (76.9%), attrition (10%), and intervention completion (75%) rates. Qualitative interviews suggested that the intervention was acceptable and useful to stroke dyads. The intervention effects on survivors' functioning were significant in the memory and thinking (F = 8.39, p = 0.022, η = 0.18) and mobility (F = 5.37, p = 0.026, η = 0.12) domains, but not significant on their overall functioning (F = 2.39, p = 0.131). Caregiver burden in the intervention group was significantly greater reduced at post-test than the control group, with a large effect size (F = 7.55, p = 0.013, η = 0.28). For secondary outcomes, this intervention suggested a significant effect on caregivers' competence (F = 5.20, p = 0.034, η = 0.22), but non-significant effects on other outcomes.

CONCLUSIONS

The family-focused dyadic psychoeducation programme was feasible and acceptable for stroke dyads and showed preliminary effects for stroke dyads. These findings support a larger-scale controlled trial to further examine its intervention effects over a longer-term follow-up.

TRIAL REGISTRATION

This study was retrospectively registered as a randomised controlled trial in the ISRCTN Registry. Registration Date: October 10, 2022.

REGISTRATION NUMBER

ISRCTN18158500.

Addressing Uncertainty in Informal Familial Caregivers of Stroke Survivors: A Systematic Meta-Ethnography

Background: Informal familial caregivers of stroke survivors experience uncertainty that begins at the time of the stroke event and continues into home-based care. The uncertainty faced by caregivers contributes to poor mental and physical health outcomes. Objective: This review details the factors associated with, impacts of, and coping skills used to manage uncertainty across the caregiving trajectory. By defining uncertainty reduction and tolerance recommendations, this review also builds upon the Stroke Caregiver Readiness Model to improve preparedness following the stroke event. Methods: A meta-ethnographic review was systematically conducted on thirteen qualitative studies with 218 participants from four countries. The Critical Appraisal Skills Programme (CASP) was used to assess study quality. Results: Following the stroke event, caregivers reported a lack of knowing (e.g., about the cause of the stroke event and survivor prognoses) as contributing to post-stroke uncertainty. As a result of this uncertainty, caregivers expressed concerns about their abilities to navigate caregiving responsibilities and how to plan for the future. Longer-term concerns (e.g., managing finances) and feelings of hopelessness occurred after discharge. Still, caregivers identified strategies to manage uncertainty. Caregiver coping skills included present-focused thinking, gratitude, faith, humor, and social support. Conclusions: The uncertainty faced by informal familial caregivers of stroke survivors is pervasive and changes across time. Uncertainty reduction and tolerance interventions can be used to build upon caregiver strengths and promote preparedness across the caregiving trajectory.

Exploring the shared experiences of people with stroke and caregivers in preparedness to manage post-discharge care: A hermeneutic study

AIMS AND OBJECTIVES

To explore the shared experiences of people with stroke and caregivers in preparedness to manage post-discharge care.

BACKGROUND

People with stroke and caregivers show dyadic effects in dealing with post-discharge care challenges. However, few studies have explored their shared experiences and unique challenges for each dyadic member in preparedness to manage post-discharge care. This study addresses this research gap.

DESIGN

An interpretive approach underpinned by Gadamer's philosophical hermeneutics.

METHODS

Semi-structured interviews were conducted with people with stroke and caregivers in 5 days before hospital discharge (n = 26) or 2 weeks after discharge (n = 4) between July and December 2019. The study followed a five-step data analysis method aligning with Gadamerian hermeneutics. The study reporting followed the COREQ checklist.

RESULTS

Three themes and six subthemes were identified. First, both people with stroke and caregivers experienced psychological stress, although the sources differed. Second, stroke dyads demonstrated resilience built on positive thoughts, confidence, and support from family and health professionals. Third, stroke dyads exhibited different levels of certainty about post-discharge care. They desired to be equal partners in co-developing and co-implementing discharge plans.

CONCLUSIONS

Similarities and differences in perceived preparedness to manage post-discharge care existed between stroke dyadic members. A co-design approach to developing and implementing discharge plans would enhance planned post-discharge care.

IMPACT

Hospital-to-home transition is a challenging time for people with stroke and their caregivers. Understanding the shared experiences of stroke dyads in preparedness for post-discharge care enables nurses to take proactive actions to enhance managing post-discharge care. Early identification of those at risk of developing psychological stress will enable nurses to co-develop stress-coping strategies. These will have a positive influence on the dyad when facing setbacks due to stroke-related complications.

Intra- and interpersonal effects of coping style and self-efficacy on anxiety, depression and life satisfaction in patient-partner couples after stroke

Many stroke patients and partners suffer from anxiety, depression, and low life satisfaction. Psychological factors such as coping style and self-efficacy can be protective factors within individuals. The close relationship between stroke patients and partners suggests that there may be interdependence in psychological functioning. The aim of this study was to examine intra- and interpersonal effects of coping style and self-efficacy on anxiety, depression, and life satisfaction in patient-partners couples. In this prospective cohort study, pro-active coping (UPCC), general self-efficacy (GSES), anxiety (HADS-A), depression (HADS-D), and life satisfaction (1-6 scale) were assessed in 215 couples at 2 and 12 months post-stroke. Effects within couples were assessed using structural equation modelling. Several intra- and interpersonal effects of coping style and self-efficacy at 2 months post-stroke were related to emotional health at 12 months post-stroke. Most effects were intrapersonal effects. The interpersonal effects were small but showed that pro-active coping by the patient was associated with lower anxiety of the partner. Higher self-efficacy of the partner was associated with lower depression scores and higher life satisfaction of the patient. This study underscores the importance of a dyadic approach to post-stroke functioning. It supports a family-based approach for treating post-stroke emotional problems.

Effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors: a randomised controlled trial

OBJECTIVES

To evaluate the effectiveness of a tailored multidimensional intervention in reducing the care burden of family caregivers of stroke survivors. This intervention considered caregivers' perceived needs and incorporated three evidence-based dimensions (psychoeducation, skill-building and peer support).

DESIGN

A prospective randomised control trial.

SETTING

A community-based study conducted in Egypt.

PARTICIPANTS

A total of 110 caregivers aged ≥18 years who cared for a survivor within 6 months of stroke, with modified Rankin Scale scores of 3-5, and without other physical disabilities or terminal illnesses were recruited between December 2019 and May 2020. Participants were assigned to the intervention group (IG; n=55) and control group (CG; n=55) through open-label, parallel 1:1 randomisation.

INTERVENTION

The IG was provided with tailored multidimensional interventions for 6 months until November 2020, including three home visits, six home-based telephone calls and one peer-support session. The CG received simple educational instructions at a single visit.

OUTCOME

The participants completed the Zarit Burden Interview (primary outcome) and the WHO Quality of Life-BREF (secondary outcome) before the intervention (T0), at 3 months (T1) and at 6 months (T2).

RESULTS

No differences were observed between the characteristics of the groups at baseline (T0). The independent t-test showed no significant differences in the care burden and Quality of Life (QoL) at T1 and T2 between the groups. The intervention had no significant effect on the outcomes between or within groups over time, as shown by the repeated-measures analysis of variance. However, the group and time interaction had significant main effects on caregivers' QoL (psychological and social domains).

CONCLUSION

The main results showed that participants in the IG did not experience an improvement in the main outcomes. Nevertheless, the improvement in the psychological and social domains may have been attributed to our intervention.

TRIAL REGISTRATION NUMBER

NCT04211662.