Effectiveness of technology-based interventions on the mental health of stroke survivors’ caregivers: A systematic review and meta-analysis

Abstract

Background: Stroke is a leading cause of disability. Current healthcare paradigms require shared responsibility between healthcare professionals and informal caregivers (IC) to care for stroke survivors (SS). These additional roles and responsibilities may negatively influence the IC, resulting in severe psychological morbidities. Current evidence suggests that technology-based interventions could reduce IC psychological morbidities. However, few studies have directly compared the effects. Objectives: To evaluate the effectiveness of technology-based interventions to reduce psychological morbidities and improve quality of life (QoL) and self-efficacy in SS IC. Data source: Seven databases were searched, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and PsycInfo. Grey literature and dissertations were searched in Google Scholar, ProQuest & Scholarbank@NUS. Clinicaltrials.gov and CENTRAL were searched for registered trials. Eligibility criteria: Published English-language randomised controlled trials from Year 2000 evaluating technology-delivered interventions (telephone, computer, internet, and mobile application) on psychological morbidities in SS IC. Methods: A total of 3636 articles were identified, with 15 included in this review. Two independent reviewers screened through title, abstracts, eligibility criteria, extracted data and assessed for risk of bias. Meta-analyses were conducted using RevMan 5.4 and narrative synthesis was performed for studies not pooled. Results: Subgroup analyses revealed 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=0.02). Technology-based interventions with regime <3-months revealed significant effects (d=-0.31, 95% CI [-0.49 to -0.13], p=0.0009). Notably, there was no statistically significant difference for anxiety, burden, QoL, and self-efficacy. Conclusion: Technology-based interventions are potentially effective in reducing IC depressive symptoms. It may serve as an alternative for IC with time-constrain. Future research should focus on sustainability and recommend optimal format and dosage of intervention.