Caregiver-mediated exercises may be a promising form of therapy to add to usual care.
Stroke is a major cause of acquired adult disability. Research has shown that more time spent on exercise therapy in the first weeks to months after stroke leads to better functioning and allowing early supported discharge. Due to lack of personnel and resources, in practice it is difficult to spend more time on exercise therapy in this period. One method to increase this exercise time is to involve caregivers in performing exercise training together with stroke patients. During this exercise training, a therapist coaches patient and caregiver and an evaluation is planned on a regular basis.
A team of Cochrane authors based in the Netherlands worked with Cochrane Stroke to determine if caregiver-mediated exercises improved ability and health-related quality of life in people with stroke, and to determine the effect on caregiver burden. This meta-analysis included nine trials with a total of 333 patient-caregiver teams. The quality of included randomized controlled trials was low, resulting in low to moderate evidence.
The Cochrane Review found evidence that caregiver-mediated exercises could have a positive effect on patients' standing balance, quality of life directly after the intervention, and on basic activities of daily living. In the long term, they found evidence for a positive effect on walking distance. No significant side effects or beneficial effects on caregiver strain were identified.
“Having caregivers help stroke patients with exercising is a low-cost and simple intervention. Our Cochrane Review shows that caregiver-mediated exercises may be a promising form of therapy to add to the usual care,” said Judith DM Vloothuis from the Amsterdam Rehabilitation Research Centre, and lead author of the Cochrane Review. “Overall the quality of included trials was low to moderate, which requires replication. Our findings suggest that higher quality studies are needed, including analysis of the costs of this promising intervention. Currently, our research group is studying the cost-effectiveness of a caregiver-mediated exercises program combined with e-health facilities, initiated within the first weeks post stroke.”