Effectiveness of interventions for caregiver burden and quality of life of informal caregivers of stroke survivors: a systematic review and meta-analysis.

BACKGROUND

Informal caregivers, who play a pivotal role in post-stroke care, frequently report substantial caregiver burden and reduced quality of life (QoL), which may adversely affect caregiving capacity and stroke rehabilitation outcomes. However, evidence regarding effective interventions to lessen caregiver burden and improve the QoL of informal caregivers remains fragmented.

AIMS: This study aimed to synthesize evidence on the effectiveness of interventions for reducing the caregiver burden and improving the QoL of informal caregivers of stroke survivors.

METHODS

A systematic search of eight databases (PubMed, MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, CINAHL, and PsycINFO) was conducted until June 18, 2026. Randomized controlled trials (RCTs) published in English were included if they investigated the caregiver burden or QoL of informal caregivers of stroke survivors. The revised Cochrane risk-of-bias tool (RoB 2.0) was used to assess the risk of bias in the eligible studies. Random-effects meta-analyses using the DerSimonian-Laird method were conducted to pool data on caregiver burden and QoL. Subgroup analyses were performed based on the defined intervention characteristics.

RESULTS

Overall, 39 RCTs involving 3,096 informal caregivers of stroke survivors were included in this analysis. Meta-analyses showed that standalone (psycho)education yielded the largest effect size in reducing the caregiver burden (k = 12; Hedges' g = 0.87; 95% confidence interval [CI]: 0.52 to 1.23; I2  = 86.31%), followed by the medium effect size of (psycho)education plus skill building (k = 12; Hedges' g = 0.62; 95% CI: 0.28 to 0.97; I2  = 84.86%) and the small effect size of multicomponent interventions (the combination of (psycho)education, skill building, and support interventions; k = 3; Hedges' g = 0.27; 95% CI: 0.03 to 0.52; I2  = 0.00%). However, the combination of (psycho)education and support interventions was not significantly associated with caregiver burden (k = 4; Hedges' g = 0.23; 95% CI: -0.04 to 0.49; I2  = 0.00%). Standalone (psycho)education was the only intervention associated with significant improvements in the QoL of informal caregivers of stroke survivors (k = 7; Hedges' g = 1.11; 95% CI: 0.39 to 1.83; I2  = 94.09%). Subgroup analyses indicated that larger effect sizes for both caregiver burden and QoL tended to be observed when interventions exclusively targeted informal caregivers, were researcher-led, spanned both hospital and home settings, used hybrid delivery modalities (face-to-face and remote), and comprised 5-9 sessions.

CONCLUSION

Standalone (psycho)education demonstrated the largest pooled effect estimate for reducing caregiver burden and improving the QoL of informal caregivers of stroke survivors. These findings hold important clinical and practical implications for healthcare professionals by informing the design and implementation of caregiver-support interventions. Further high-quality studies are warranted to confirm these findings and identify the optimal intervention package.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/register/TemplatePreview, identifier: CRD420251152425.