Effectiveness of telehealth interventions for family caregivers of older adults with multiple diseases: A systematic review and meta-analysis

Introduction Telehealth may offer a valuable resource for family caregivers' physical and psychological well-being; however, understanding its effectiveness is crucial to determining its true potential. Thus, this systematic review and meta-analysis aims to examine the effectiveness of telehealth interventions focused on family caregivers' physical and psychological well-being, along with other factors during the care of older adults with various diseases (such as neurocognitive disorders, chronic conditions, and musculoskeletal diseases).Methods PubMed, Web of Science, Scopus, and Cochrane Library databases were searched. Studies that investigated the effects of telehealth on family caregivers of older adults with any disease and a comparison group receiving any type of intervention were selected. Two independent reviewers carried out the study selection and data extraction. We conducted a meta-analysis using standardized mean differences (SMDs) to pool the continuous outcomes included. Heterogeneity (I-2 and Tau(2)), publication bias (Egger's test and funnel plots), risk of bias (Joanna Briggs Institute tool), potential mediators (meta-regressions), and robustness (leave-one-out method) were also assessed.Results Twenty-six studies were selected (23 randomized controlled trial and 3 quasi-experimental studies), including a total of 2932 family caregivers. Telehealth was more effective than usual care in improving psychological well-being (SMD = 0.21; p = 0.006), caregiving competence (SMD, 0.73; p = 0.007), and reducing caregiver burden (SMD = -0.26; p = 0.01) in a follow-up shorter than 4 months. It was not effective in reducing anxiety or depression (SMD = -0.18 and -0.40; p = 0.08 and 0.20, respectively), nor in improving physical fitness (SMD = -0.16; p = 0.460). Considering a follow-up period of 4-12 months, the only outcome in favor of telehealth was the improvement in managing patients' problematic behaviors (SMD = -1.27; p < 0.0001). It was not effective for psychological well-being, anxiety, depression, or caregiver burden (SMD = 0.15, 0.22, 0.08, and -0.33; p = 0.290, 0.260, 0.550, and 0.550, respectively).Conclusion Telehealth may be a valuable option for supporting family caregivers of older adults in improving psychological well-being, caregiving competence, and reducing burden, but the benefits may not last long term.