Dyad interventions for health-related quality of life, activity, and participation after stroke: a systematic review

Purpose: To characterize the effects of dyad interventions on stroke survivor and caregiver health-related quality of life (HRQOL), participation, and activity outcomes. Methods: Five databases were searched using: stroke AND social support/dyad relationships AND intervention. No date or language restrictions were applied. Title/abstract/full-text review and data extraction were conducted by two independent raters. Studies that tested between-group or within-group effects of an intervention that engaged both dyad members together in at least one intervention session and measured at least one outcome of interest (HRQOL, participation, or activity) in both dyad members were included. Results: Among 64,988 records, 401 full-text articles were reviewed, and 17 studies were included. Three dyad intervention types were identified: stroke education and caregiver training, joint psychosocial interventions, and caregiver-mediated exercise. Effects on HRQOL were mixed. Among five studies that favored the intervention group on HRQOL, effects ranged from moderate to large among stroke survivors (Cohen’s d = 0.51 to 7.03) and caregivers (Cohen’s d = 0.66 to 7.90). Measures of caregiver activity and participation were rarely included. Conclusions: There is emerging evidence for certain types of dyad intervention after stroke. Future research should examine the effectiveness and mechanisms of these dyad interventions and include measures of caregiver activity and participation.