Optimising support for stroke caregiver burden: a systematic review and meta-analysis of randomised clinical trials...

Stroke caregivers often experience significant physical and psychological burden during long-term caregiving, leading to reduced quality of life. Traditional unidimensional support models inadequately address their complex needs. Occupational therapy interventions based on the International Classification of Functioning, Disability and Health (ICF), which integrate multidimensional support across body function, activity and participation, and environmental factors, may systematically alleviate caregiver burden. However, the efficacy and optimal intervention approaches lack comprehensive synthesis.

A systematic literature search was performed in the following seven databases from January 2010 until January 2025: PubMed, EMBASE, Cochrane Library, Web of Science, Science Direct, CNKI, and WANFANG. The search aimed to identify all relevant randomized controlled trials (RCTs) where the participants were informal stroke caregivers, the intervention was occupational therapy, and the comparator was usual care. Subgroup analyses were performed to explore heterogeneity by categorising interventions according to the International Classification of Functioning, ICF framework: body functions, activities and participation, environmental factors, and personal factors. Methodological quality was evaluated using the Cochrane Risk of Bias tool. Random-effects meta-analyses were employed to calculate mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI).

Twelve RCTs involving 1,636 participants were included in the analysis. The meta-analysis demonstrated that occupational therapy-related interventions significantly reduced caregiver burden (SMD = -0.32, 95% CI: -0.53 to -0.10; p = 0.004). For secondary outcomes, no significant effects were found for caregiver depression or survivor functional recovery. Subgroup analyses based on the ICF framework indicated that interventions combining activity participation, environmental factors, and personal factors resulted in a statistically significant reduction in caregiver burden (SMD = -0.50, 95% CI: -0.81 to -0.20; p = 0.001). Interventions targeting other dimensions did not show significant effects.

Occupational therapy-related interventions demonstrate a small but statistically significant beneficial impact on alleviating the caregiving burden for stroke caregivers. Prioritizing multifaceted ICF-based interventions that address activities, participation, and contextual factors is crucial. Future research should evaluate long-term outcomes to advance the shift from patient-centered to family-centered rehabilitation, thereby enhancing wellbeing for stroke caregivers.