Caregiver-mediated exercises for improving outcomes after stroke

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Gerontology

Background:

• Stroke is a leading cause of adult disability, with higher training intensity linked to better outcomes.
• Inpatient rehabilitation resources are often insufficient, driving the need for cost-effective, innovative methods.
• Caregiver involvement in exercise training (caregiver-mediated exercises or CME) offers a potential solution to augment training intensity.

Purpose of the Study:

• To evaluate the effectiveness of caregiver-mediated exercises (CME) in improving functional ability and health-related quality of life in stroke survivors.
• To assess the impact of CME on caregiver burden.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials comparing CME to usual care or other non-caregiver-mediated interventions.
• Searched multiple databases up to October/December 2015, including Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, and SPORTDiscus.
• Data extraction, quality assessment, and risk of bias evaluation were performed independently by two reviewers; GRADE methodology was used to determine evidence quality.

Main Results:

• Six trials with 333 patient-caregiver couples were included. CME showed no significant effect on basic or extended activities of daily living (ADL).
• Caregiver burden did not significantly increase. However, CME significantly improved standing balance and quality of life.
• A sensitivity analysis of CME-core interventions indicated a significant effect on basic ADL. Limitations include small study sizes and intervention heterogeneity.

Conclusions:

• Caregiver-mediated exercises (CME) represent a potentially valuable addition to stroke rehabilitation options.
• The current evidence is of very low to moderate quality, with included studies being small, heterogeneous, and carrying a risk of bias.
• Future high-quality research is essential to confirm the (cost-)effectiveness of CME interventions in stroke recovery.