Mack Amanda, Hildebrand Mary
Amanda Mack, OTD, MS, OTR/L, CLC, is Assistant Professor and Director of Post-Professional Education, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO;
Mary Hildebrand, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, MA.
Am J Occup Ther. 2023 Jan 1;77(1). doi: 10.5014/ajot.2023.050012.
It is vital that occupational therapy practitioners address caregivers' needs to enable them to maintain participation in caregiving for people poststroke.
To explore the evidence for the effectiveness of interventions within the scope of occupational therapy practice for caregivers of people poststroke that facilitate maintaining participation in the caregiver role.
We conducted a narrative synthesis systematic review of the literature published in the MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases between January 1, 1999, and December 31, 2019. Article reference lists were also hand searched.
The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines were used, and articles were included if they were within the date range and scope of occupational therapy practice and included caregivers of someone poststroke. Two independent reviewers used Cochrane methodology to perform the systematic review.
Twenty-nine studies met the inclusion criteria and were divided into five intervention themes: cognitive-behavioral therapy (CBT) techniques, caregiver education only, caregiver support only, caregiver education and support, and multimodal interventions. Both the CBT technique of problem-solving combined with stroke education and one-on-one caregiver education and support interventions had strong strength of evidence. Multimodal interventions had moderate strength of evidence, and caregiver education only and caregiver support only had low strength of evidence.
Addressing caregiver needs with problem-solving and caregiver support in addition to typical education and training is essential. More research is needed that uses consistent doses, interventions, treatment settings, and outcomes. What This Article Adds: Although more research is needed, occupational therapy practitioners should provide combinations of interventions such as problem-solving techniques, customized support for each caregiver, and individualized education in the care of the stroke survivor.
职业治疗从业者满足照料者的需求，使他们能够继续参与中风患者的护理工作至关重要。
探讨职业治疗实践范围内的干预措施对中风患者照料者维持照料角色参与度有效性的证据。
我们对1999年1月1日至2019年12月31日期间发表在MEDLINE、PsycINFO、CINAHL、OTseeker和Cochrane数据库中的文献进行了叙述性综合系统评价。还手动检索了文章的参考文献列表。
采用系统评价和荟萃分析方案的首选报告项目（PRISMA）指南，纳入在职业治疗实践日期范围内且涉及中风患者照料者的文章。两名独立评审员使用Cochrane方法进行系统评价。
29项研究符合纳入标准，分为五个干预主题：认知行为疗法（CBT）技术、仅照料者教育、仅照料者支持、照料者教育与支持以及多模式干预。解决问题的CBT技术与中风教育相结合以及一对一的照料者教育与支持干预措施有强有力的证据支持。多模式干预有中等强度的证据，仅照料者教育和仅照料者支持有低强度的证据。
除了典型的教育和培训外，通过解决问题和提供照料者支持来满足照料者需求至关重要。需要更多使用一致剂量、干预措施、治疗环境和结果的研究。本文补充内容：尽管需要更多研究，但职业治疗从业者应提供多种干预措施的组合，如解决问题的技术、针对每个照料者的定制支持以及中风幸存者护理方面的个性化教育。
