Occupational therapy interventions for adult informal carers and implications for intervention design, delivery and evaluation: A systematic review.

Most included studies targeted carers of people with dementia or cognitive impairment (31 of 38 papers), so findings may not apply to carers of people with stroke, hip fracture, eating disorders, or cancer. Many included studies were pilots or feasibility studies with small samples, which the authors note are rarely sufficiently powered for definitive conclusions about intervention effects. The majority of carer participants were women, average age 55 or older, and mostly spouses or adult children, limiting generalisability to other carer demographics. Non-English papers and grey literature were excluded, which may have introduced publication bias. The search was limited to the last decade (2010-2021), so original RCTs of some interventions fell outside the timeframe and were not included as primary evidence. Outcome measures varied widely across studies, and the most commonly used measure (Zarit Burden Interview, 11 papers) is difficult to interpret when the underlying patient condition is deteriorating over time. Effects, when positive, were often not maintained at follow-up, and the review does not establish what duration or intensity of intervention is needed to sustain benefit.

No conflicts of interest declared. KM was supported by the Royal College of Occupational Therapists Research Foundation. MF was supported by the NIHR Applied Research Collaboration (ARC EoE) programme.

Do not read the positive qualitative feedback or the TAP and COPE results as evidence that OT interventions for carers work broadly. Several trials showed no significant difference, some showed increased carer burden, and effects were often not maintained at follow-up. Many of the included studies were small pilots or feasibility studies, not definitive RCTs, and the interventions varied widely in content, duration, and setting.