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Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Comparison 1 Telephone intervention versus Usual care, Outcome 1 Quality of Life.
Figuras y tablas -
Analysis 1.1

Comparison 1 Telephone intervention versus Usual care, Outcome 1 Quality of Life.

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Comparison 1 Telephone intervention versus Usual care, Outcome 2 Quality of life (Short‐term follow‐up).
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Analysis 1.2

Comparison 1 Telephone intervention versus Usual care, Outcome 2 Quality of life (Short‐term follow‐up).

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Comparison 1 Telephone intervention versus Usual care, Outcome 3 Burden.
Figuras y tablas -
Analysis 1.3

Comparison 1 Telephone intervention versus Usual care, Outcome 3 Burden.

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Comparison 1 Telephone intervention versus Usual care, Outcome 4 Burden (Short‐term follow‐up).
Figuras y tablas -
Analysis 1.4

Comparison 1 Telephone intervention versus Usual care, Outcome 4 Burden (Short‐term follow‐up).

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Comparison 1 Telephone intervention versus Usual care, Outcome 5 Skill acquisition: Problem‐Solving.
Figuras y tablas -
Analysis 1.5

Comparison 1 Telephone intervention versus Usual care, Outcome 5 Skill acquisition: Problem‐Solving.

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Comparison 1 Telephone intervention versus Usual care, Outcome 6 Skill acquisition: Preparedness to Care.
Figuras y tablas -
Analysis 1.6

Comparison 1 Telephone intervention versus Usual care, Outcome 6 Skill acquisition: Preparedness to Care.

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Comparison 1 Telephone intervention versus Usual care, Outcome 7 Skill acquisition: Preparedness to Care (medium‐term follow‐up).
Figuras y tablas -
Analysis 1.7

Comparison 1 Telephone intervention versus Usual care, Outcome 7 Skill acquisition: Preparedness to Care (medium‐term follow‐up).

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Comparison 1 Telephone intervention versus Usual care, Outcome 8 Skill acquisition:Competence.
Figuras y tablas -
Analysis 1.8

Comparison 1 Telephone intervention versus Usual care, Outcome 8 Skill acquisition:Competence.

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Comparison 1 Telephone intervention versus Usual care, Outcome 9 Psychological health: Depression.
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Analysis 1.9

Comparison 1 Telephone intervention versus Usual care, Outcome 9 Psychological health: Depression.

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Comparison 1 Telephone intervention versus Usual care, Outcome 10 Psychological health: Anxiety.
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Analysis 1.10

Comparison 1 Telephone intervention versus Usual care, Outcome 10 Psychological health: Anxiety.

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Comparison 1 Telephone intervention versus Usual care, Outcome 11 Psychological health: Coping.
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Analysis 1.11

Comparison 1 Telephone intervention versus Usual care, Outcome 11 Psychological health: Coping.

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Comparison 1 Telephone intervention versus Usual care, Outcome 12 Psychological health: Stress.
Figuras y tablas -
Analysis 1.12

Comparison 1 Telephone intervention versus Usual care, Outcome 12 Psychological health: Stress.

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Comparison 1 Telephone intervention versus Usual care, Outcome 13 Knowledge and understanding: Knowledge.
Figuras y tablas -
Analysis 1.13

Comparison 1 Telephone intervention versus Usual care, Outcome 13 Knowledge and understanding: Knowledge.

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Comparison 1 Telephone intervention versus Usual care, Outcome 14 Health status and well‐being: Physical health.
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Analysis 1.14

Comparison 1 Telephone intervention versus Usual care, Outcome 14 Health status and well‐being: Physical health.

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Comparison 1 Telephone intervention versus Usual care, Outcome 15 Health status and well‐being: Self‐efficacy.
Figuras y tablas -
Analysis 1.15

Comparison 1 Telephone intervention versus Usual care, Outcome 15 Health status and well‐being: Self‐efficacy.

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Comparison 1 Telephone intervention versus Usual care, Outcome 16 Health status and well‐being: Self‐efficacy (Medium‐term follow‐up).
Figuras y tablas -
Analysis 1.16

Comparison 1 Telephone intervention versus Usual care, Outcome 16 Health status and well‐being: Self‐efficacy (Medium‐term follow‐up).

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Comparison 1 Telephone intervention versus Usual care, Outcome 17 Health status and well‐being: Social activity.
Figuras y tablas -
Analysis 1.17

Comparison 1 Telephone intervention versus Usual care, Outcome 17 Health status and well‐being: Social activity.

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Comparison 1 Telephone intervention versus Usual care, Outcome 18 Satisfaction: Satisfaction with supports.
Figuras y tablas -
Analysis 1.18

Comparison 1 Telephone intervention versus Usual care, Outcome 18 Satisfaction: Satisfaction with supports.

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Comparison 1 Telephone intervention versus Usual care, Outcome 19 Family functioning.
Figuras y tablas -
Analysis 1.19

Comparison 1 Telephone intervention versus Usual care, Outcome 19 Family functioning.

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Comparison 2 Telephone versus non‐telephone support intervention, Outcome 1 Burden.
Figuras y tablas -
Analysis 2.1

Comparison 2 Telephone versus non‐telephone support intervention, Outcome 1 Burden.

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Comparison 2 Telephone versus non‐telephone support intervention, Outcome 2 Depression.
Figuras y tablas -
Analysis 2.2

Comparison 2 Telephone versus non‐telephone support intervention, Outcome 2 Depression.

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Comparison 2 Telephone versus non‐telephone support intervention, Outcome 3 Stress.
Figuras y tablas -
Analysis 2.3

Comparison 2 Telephone versus non‐telephone support intervention, Outcome 3 Stress.

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Comparison 2 Telephone versus non‐telephone support intervention, Outcome 4 Physical Health.
Figuras y tablas -
Analysis 2.4

Comparison 2 Telephone versus non‐telephone support intervention, Outcome 4 Physical Health.

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Summary of findings for the main comparison. Telephone support intervention compared to Usual care for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses

Telephone intervention compared to Usual care for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses

Patient or population: Informal caregivers of adults with diagnosed illnesses
Setting: Community
Intervention: Education or psychosocial telephone support
Comparison: Usual care

Outcomes

Anticipated absolute effects* (95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with Telephone intervention

Quality of Life

End of intervention
Assessed with: WHOQoL Brief instrument (26‐item), SF‐36 (0‐100 scale), SF‐12, and Adapted BKOS (15‐item, 0‐7 scale)

For all scales, higher scores indicated higher QoL.

The mean score for QoL in the intervention group was 0.02 standard deviations lower (0.24 lower to 0.19 higher)

364
(4 RCTs)

⊕⊕⊕⊝
MODERATE 1,2

One further study reported that caregivers receiving a telephone intervention may have slightly higher QoL at end of intervention, compared with usual care.

Overall, at the end of intervention, telephone interventions probably have little or no effect on caregiver QoL

Burden

End of intervention

Assessed with: Revised Memory and Behaviour Problem Checklist (0‐24 range), 24‐ and 26‐item Caregiver Reaction Assessment, Family Appraisal of Caregiving Questionnaire (Caregiver Strain subscale – Palliative Care), Burden Interview (22‐ and 12‐item inventories; 0‐4 scale), Modified BKOS scale (22‐item, 5‐point scale)

For all scales, higher scores indicated higher burden.

The mean score for Burden in the telephone group was 0.11 standard deviations lower
(0.3 lower to 0.07 higher)

788
(9 RCTs)

⊕⊕⊝⊝
LOW 2,3

Two further studies reported caregiver burden. One reported that telephone interventions may decrease burden; the other reported no change in the intervention group, compared with usual care.

Overall, at the end of intervention, telephone interventions may have little or no effect on caregiver burden.

Psychological health: Depression

End of intervention

Assessed with: Center for Epidemiologic Studies Depression Scale 11‐item SF, 10‐item and, 20‐item measures (including German version) (0‐3 scales), Brief Symptom Inventory (18‐item, 5‐point scale), and the Geriatric Depression Scale (30‐item, score range 0‐30)

For all scales, higher scores were associated with increased depression/symptoms of depression.

The mean score for depression in the telephone group was 0.37 standard deviations lower (0.7 to 0.05 lower )

792
(9 RCTs)

⊕⊝⊝⊝
VERY LOW 2,4

Three further studies reported caregiver depression. One reported that telephone interventions may decrease depression; the other two reported no change in the intervention group, compared with usual care.

Overall, we are uncertain of the effects of telephone interventions on caregiver depression at the end of intervention.

Satisfaction with the intervention

End of intervention

See comment

‐

‐

No study was found that assessed this outcome comparatively. Six studies measured satisfaction with the intervention in the intervention group only. All six reported high levels of satisfaction with the intervention (i.e. 'mostly', 'very much so', 'good' or 'excellent').

Adverse events including suicide and suicide ideation

See comment

‐

‐

No studies measured these outcomes.

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Although participant numbers were relatively few at n = 364, they were deemed sufficient for studies evaluating these types of intervention in a population of informal caregivers; we therefore did not downgrade on sample size (imprecision) for this reason.

2 Most information was from studies at low or unclear risk of bias on most items in the 'risk of bias' tool, although in some studies, one or two risk of bias criteria were assessed as having high risk of bias. We therefore downgraded by 1 level for plausible risk of bias that could seriously alter the results.

3 Some variation in the effect estimates and moderate heterogeneity; evidence downgraded by 1 level (serious inconsistency).

4 Variation in the effect estimates across studies and substantial heterogeneity; evidence downgraded by 2 levels (very serious inconsistency).

BKOS: Bakas Caregiver Outcomes Scale
QoL: Quality of life
SF: Short Form
SF‐12: Short Form ‐12 items
SF‐36: Short Form ‐ 36 items
WHOQoL: World Healthcare Organisation Quality of Life

Figuras y tablas -
Summary of findings for the main comparison. Telephone support intervention compared to Usual care for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses
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Summary of findings 2. Telephone support compared to non‐telephone support intervention for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses

Telephone compared to non‐telephone support intervention for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses

Patient or population: Informal caregivers of adults with diagnosed illnesses
Setting: Community
Intervention: Education or psychosocial telephone support
Comparison: Education or psychosocial non‐telephone support

Outcomes

Anticipated absolute effects* (95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with Telephone

Quality of Life

No studies measured this outcome

‐

‐

Burden

End of intervention
Assessed with: the subjective burden subscale of the Caregiver Appraisal Inventory

Higher scores indicated greater burden.

The mean score for burden in the telephone group was 0.2 lower
(0.74 lower to 0.34 higher)

11
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1,2

We are uncertain of the effects of telephone interventions on caregiver burden at the end of intervention.

Psychological health: Depression:

End of intervention

Assessed with: Center for Epidemiological Studies Survey‐Depression scale (20‐item, 0‐3 scale)

Higher scores indicated higher levels of depression.

The mean score for depression in the telephone group was 4.3 lower (9.57 lower to 0.97 higher)

11
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1,2

We are uncertain of the effects of telephone interventions on caregiver depression at the end of intervention

Satisfaction with the intervention

No studies measured this outcome

‐

‐

Adverse events including suicide and suicide ideation

No studies measured these outcomes

‐

‐

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 Most information from the 1 included study indicated low or unclear risk of bias on most items on the 'risk of bias' tool, although risk of bias was high for selective reporting. We therefore downgraded by 1 level for plausible risk of bias that could seriously alter the results.

2 Participant numbers were deemed insufficient at 11 and the upper and lower CI limits were > 0.5 from the effect size (downgraded by 2 levels for imprecision).

Figuras y tablas -
Summary of findings 2. Telephone support compared to non‐telephone support intervention for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses
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Table 1. Summary of quality ratings for interventions in included studies

Y=YES, PY=Partly YES, N=NO

ITEM

1

2*

3

4

5*

6*

7

8*

9

10

11

12*

13

14

15

16

17

18

19*

20

21

22

Overall rating

Bishop 2014

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

N

N

PY

N

Y

PY

Y

Y

Y

N

N/A

High

Connell 2009

PY

PY

PY

Y

PY

PY

Y

PY

N

Y

N

N

N

N

N/A

Y

N

Y

Y

N

N

N/A

Medium

Corry 2015

Y

Y

Y

Y

Y

Y

Y

N/A

Y

Y

N

Y

PY

PY

N/A

Y

N

Y

Y

Y

Y

PY

Medium

Davis 2011

Y

Y

PY

Y

Y

PY

Y

N

N/A

N/A

Y

N

PY

N

Y

PY

N

Y

Y

Y

PY

N

Medium

Gallagher‐Thompson 2007

Y

PY

PY

N

PY

PY

N/A

N

N

N

N

N

N

N

N/A

N

N

N

Y

N

N

N/A

Low

Glueckauf 2012

Y

Y

Y

Y

Y

Y

PY

Y

PY

Y

N

N

N

PY

N/A

Y

Y

Y

Y

Y

N

N/A

High

Kwok 2013

Y

PY

Y

PY

PY

PY

N/A

N

N

N

N/A

N

N

Y

N

N

N

N

N

N/A

N

N/A

Low

Martindale‐Adams 2013

Y

PY

Y

PY

PY

PY

Y

N

N

Y

N

N

N

N

Y

N

N

Y

N

N/A

N

N/A

Medium

NCT00646217

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐

‐

No information

Shum 2014

PY

PY

Y

N

PY

PY

PY

PY

N

N

PY

N

N

N

PY

N

N

N

PY

N

N

N

Medium

Pfeiffer 2014

Y

Y

Y

Y

Y

PY

Y

PY

N/A

PY

Y

N

PY

N

N/A

PY

Y

PY

Y

N

N

N/A

Medium

Piamjariyakul 2015

Y

PY

Y

PY

PY

PY

Y

N

N/A

N/A

Y

N

N

N

Y

PY

Y

Y

PY

Y

PY

N

Medium

Powell 2014

Y

PY

Y

Y

Y

PY

Y

Y

N/A

N/A

Y

N

N

N

PY

Y

N

N

Y

N

N

N/A

Medium

Shaw 2016

Y

PY

Y

N

PY

PY

Y

PY

N/A

PY

Y

N

N

N

Y

PY

PY

PY

Y

N

PY

N

Medium

Smith and Toseland 2006

Y

PY

Y

PY

PY

Y

Y

PY

N/A

N/A

N/A

N

PY

N

Y

PY

N

Y

Y

PY

PY

N

Medium

Toye 2016

Y

PY

Y

PY

Y

PY

Y

Y

N/A

N/A

PY

N

N

N

Y

PY

PY

Y

Y

N

PY

PY

Medium

Tremont 2008a

Y

Y

Y

PY

Y

PY

PY

PY

N

Y

NA

N

N

N

Y

Y

Y

Y

Y

Y

N

N/A

Medium

Vazquez 2016

Y

Y

Y

PY

Y

PY

N/A

PY

Y

PY

PY

N

N

PY

Y

Y

Y

Y

Y

N

N

N/A

Medium

Wilz 2016a

Y

PY

Y

PY

Y

PY

PY

PY

Y

Y

N/A

N

N

PY

PY

Y

Y

Y

Y

Y

N

N/A

Medium

Winter 2006

Y

Y

Y

N

PY

Y

N/A

PY

N/A

N

N/A

N

N

N

N/A

N

N

N

N

N/A

N

N/A

Medium

Wray 2010

Y

Y

Y

N

Y

Y

PY

PY

PY

N

PY

N

N

N

N

PY

N

N

N

N/A

N

N/A

Medium

Items assessed (Inclusion of detail for all Items with a * was essential for a high rating)

1. Did the researchers/authors provide a clear definition of the intervention so it could be replicated?* (this should include type, overview of content but very in‐depth details such as the manual do not have to be included)

2. Were the aims/goal of the intervention clearly stated?* (the aim/goal of the intervention may be the same/similar to the goal of the study)

3. Did the researchers/authors provide clear rationale for the intervention?

4. Did the researchers/authors provide an overview of the theory underpinning the intervention/framework used to develop the intervention?

5. Was the content of the intervention consistent with the stated aim/goal of the intervention?*

6. Was a clear description provided of how (method) the intervention was delivered? (e.g. phoned using mobile phone, skype, landline)*

7. If appropriate, did the researchers/authors provide an overview of other materials used e.g. Guidebook, information sent by post, etc?

8. Did the researchers/authors justify the selection of interventionists?* (e.g. appropriateness in terms of professional background/education of the person delivering the intervention)

9. If relevant, did the researchers/authors provide appropriate justification for the selection of co‐interventionists?

10. If more than one interventionist was involved in delivery of the intervention, did the researchers/authors indicate how delivery of the intervention was standardised across interventionists?*

11. Did the researchers/authors indicate that the intervention was delivered at an appropriate time period for the caregivers, which was in accordance to the overall goal? (e.g. if the goal is to support caregivers who are new to the role then it should be delivered during the early stages of caregiving)

12. Was there any potential risk of intervention contamination across the study groups?*

13. Did the researchers/authors justify the intensity of the intervention (in terms of frequency of delivery and duration of each session)?

14. Duration: Did the researchers/authors indicate that the complete intervention was delivered to the participants i.e. 100% of the intervention was delivered?

15. If the intervention was tailored/modified/adapted, did the researchers/authors indicate why? what? and how?

16. Did the researchers assess consistency in intervention delivery?

17. Did the researchers/authors state that the intervention was delivered in accordance with the trial protocol?

18. Was interventionist training standardised?

19. Did the authors indicate that intervention delivery was monitored?*

20. If yes/PY to item 19, was intervention delivery monitored using an objective measure?

21. Did the authors indicate that caregiver receipt of the intervention was monitored? (i.e. Caregivers’ understanding of and use of the intervention)

22. If ‘yes/PY’ to item 21, was caregiver receipt of the intervention monitored using an objective measure?

N/A: not applicable

Figuras y tablas -
Table 1. Summary of quality ratings for interventions in included studies
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Table 2. Comparator 1: Summary of Risk of Bias by outcome for telephone‐only versus usual care

Comparator 1: Telephone Intervention versus Usual Care

Sequence generation

Allocation concealment

Blinding

Incomplete outcome data (attrition bias)

Selective outcome reporting (reporting bias)

Other potential sources of bias

Quality of Life

Low

Corry 2015; Davis 2011; Shum 2014; Powell 2014; Shaw 2016; Tremont 2008a

Corry 2015; Shum 2014; Powell 2014

Davis 2011; Shum 2014; Powell 2014; Tremont 2008a

Corry 2015; Davis 2011; Shum 2014; Shaw 2016

Corry 2015; Shum 2014; Powell 2014; Shaw 2016

Davis 2011; Shum 2014; Shaw 2016; Tremont 2008a

High

‐

‐

Corry 2015

Tremont 2008a

Davis 2011

Tremont 2008a

Corry 2015; Powell 2014

Unclear

Davis 2011; Shaw 2016; Tremont 2008a

Shaw 2016

Powell 2014

‐

‐

Burden

Low

Corry 2015; Davis 2011; Kwok 2013; Shaw 2016; Toye 2016; Tremont 2008a

Corry 2015; Shum 2014; Toye 2016

Davis 2011; Kwok 2013; Shum 2014; Piamjariyakul 2015; Smith and Toseland 2006; Toye 2016; Tremont 2008a

Corry 2015; Davis 2011; Kwok 2013; Martindale‐Adams 2013; Shum 2014; Piamjariyakul 2015; Shaw 2016; Toye 2016

Connell 2009; Corry 2015; Davis 2011; Kwok 2013; Martindale‐Adams 2013; Shum 2014; Piamjariyakul 2015; Shaw 2016; Toye 2016; Tremont 2008a; Winter 2006

Connell 2009; Davis 2011; Kwok 2013; Martindale‐Adams 2013; Shum 2014; Piamjariyakul 2015; Shaw 2016; Toye 2016; Tremont 2008a

High

Corry 2015

Tremont 2008a

Smith and Toseland 2006

Corry 2015; Smith and Toseland 2006; Winter 2006

Unclear

Connell 2009; Martindale‐Adams 2013; NCT00646217; Shum 2014; Piamjariyakul 2015; Smith and Toseland 2006; Winter 2006

Connell 2009; Davis 2011; Kwok 2013;Martindale‐Adams 2013; NCT00646217; Piamjariyakul 2015;Shaw 2016; Smith and Toseland 2006; Tremont 2008a; Winter 2006

Connell 2009; Martindale‐Adams 2013; NCT00646217; Shaw 2016; Winter 2006

Connell 2009; NCT00646217; Smith and Toseland 2006; Winter 2006

NCT00646217

NCT00646217

Skill Acquisition: caregiver competence

Low

Pfeiffer 2014

Pfeiffer 2014

Pfeiffer 2014

Pfeiffer 2014

Pfeiffer 2014; Winter 2006

Pfeiffer 2014

High

Winter 2006

Unclear

Winter 2006

Winter 2006

Winter 2006

Winter 2006

Skill Acquisition: preparedness to care

Low

Corry 2015; Toye 2016

Corry 2015; Toye 2016

Piamjariyakul 2015; Toye 2016

Corry 2015; Piamjariyakul 2015; Toye 2016

Corry 2015; Piamjariyakul 2015; Toye 2016

Piamjariyakul 2015; Toye 2016

High

Corry 2015

Corry 2015

Unclear

Piamjariyakul 2015

Piamjariyakul 2015

Skill Acquisition: Caregiver Problem‐Solving

Low

Corry 2015; Pfeiffer 2014

Corry 2015; Pfeiffer 2014

Pfeiffer 2014; Smith and Toseland 2006

Corry 2015; Pfeiffer 2014

Corry 2015; Pfeiffer 2014

Pfeiffer 2014

High

Corry 2015

Smith and Toseland 2006

Corry 2015; Smith and Toseland 2006

Unclear

Smith and Toseland 2006

Smith and Toseland 2006

Smith and Toseland 2006

Psychological Health: Depression

Low

Bishop 2014;Davis 2011; Pfeiffer 2014; Powell 2014; Tremont 2008a; Vazquez 2016; Wilz 2016a

Shum 2014; Pfeiffer 2014; Powell 2014

Bishop 2014; Davis 2011; Shum 2014; Pfeiffer 2014; Piamjariyakul 2015;Powell 2014; Smith and Toseland 2006; Tremont 2008a; Vazquez 2016; Wilz 2016a

Davis 2011;

Martindale‐Adams 2013;

Shum 2014;

Pfeiffer 2014;

Piamjariyakul 2015; Vazquez 2016; Wilz 2016a

Bishop 2014; Connell 2009; Davis 2011; Martindale‐Adams 2013; Shum 2014; Pfeiffer 2014; Piamjariyakul 2015; Powell 2014; Tremont 2008a; Vazquez 2016; Winter 2006

Davis 2011; Martindale‐Adams 2013; Shum 2014; Pfeiffer 2014; Piamjariyakul 2015; Tremont 2008a; Vazquez 2016

High

Tremont 2008a).

Smith and Toseland 2006

Connell 2009; Powell 2014; Smith and Toseland 2006; Wilz 2016a; Winter 2006

Unclear

Connell 2009; Martindale‐Adams 2013; NCT00646217; Shum 2014; Piamjariyakul 2015; Smith and Toseland 2006; Winter 2006

Bishop 2014; Connell 2009; Davis 2011; Martindale‐Adams 2013; NCT00646217; Piamjariyakul 2015; Smith and Toseland 2006; Tremont 2008a; Vazquez 2016; Wilz 2016a; Winter 2006

Connell 2009;NCT00646217;Martindale‐Adams 2013; Winter 2006

Connell 2009; Bishop 2014; NCT00646217; Powell 2014; Smith and Toseland 2006; Winter 2006

Wilz 2016a

NCT00646217

Bishop 2014; NCT00646217

Psychological Health: Anxiety

Low

Shum 2014

Shum 2014; Smith and Toseland 2006

Shum 2014

Shum 2014

Shum 2014

High

Smith and Toseland 2006

Smith and Toseland 2006

Unclear

Shum 2014; Smith and Toseland 2006

Smith and Toseland 2006

Smith and Toseland 2006

Psychological Health: Coping

Low

Powell 2014

Powell 2014

Powell 2014

Powell 2014

High

Powell 2014

Unclear

Powell 2014

Psychological Health: Stress

Low

Shum 2014

Shum 2014

Shum 2014

Connell 2009; Shum 2014

Connell 2009; Shum 2014

High

Unclear

Connell 2009; Shum 2014;

Connell 2009;

Connell 2009;

Connell 2009;

Knowledge and Understanding: Knowledge

Low

Powell 2014; Tremont 2008a

Powell 2014

Powell 2014; Tremont 2008aSmith and Toseland 2006

Tremont 2008a

High

Tremont 2008a

Powell 2014; Smith and Toseland 2006; Tremont 2008a

Powell 2014; Smith and Toseland 2006

Unclear

Smith and Toseland 2006

Smith and Toseland 2006; Tremont 2008a

Powell 2014; Smith and Toseland 2006

Health Status and Well‐Being: Physical Health

Low

Bishop 2014; Pfeiffer 2014; Toye 2016

Pfeiffer 2014; Toye 2016

Bishop 2014; Pfeiffer 2014; Toye 2016

Martindale‐Adams 2013; Pfeiffer 2014; Toye 2016)

Bishop 2014; Pfeiffer 2014

Martindale‐Adams 2013; Pfeiffer 2014; Toye 2016

High

Martindale‐Adams 2013; Toye 2016

Unclear

Martindale‐Adams 2013; NCT00646217

Bishop 2014;Martindale‐Adams 2013; NCT00646217

Martindale‐Adams 2013; NCT00646217

Bishop 2014

NCT00646217

NCT00646217

Bishop 2014; NCT00646217

Health Status and Well‐Being: Self‐efficacy

Low

Corry 2015; Kwok 2013; Tremont 2008a

Corry 2015

Kwok 2013; Tremont 2008a

Corry 2015; Kwok 2013

Connell 2009; Corry 2015; Kwok 2013

Connell 2009; Kwok 2013; Tremont 2008a

High

Corry 2015

Tremont 2008a

Tremont 2008a

Corry 2015

Unclear

Connell 2009; NCT00646217

Connell 2009; Kwok 2013; NCT00646217; Tremont 2008a

Connell 2009; NCT00646217

Connell 2009; NCT00646217

NCT00646217

NCT00646217

Health Status and Well‐Being: Social Activity

Low

Powell 2014

Powell 2014

Powell 2014

Powell 2014

High

Powell 2014

Unclear

Powell 2014

Satisfaction

Low

Davis 2011; Pfeiffer 2014; Tremont 2008a

Pfeiffer 2014

Davis 2011; Pfeiffer 2014; Tremont 2008a

Davis 2011; Martindale‐Adams 2013; Pfeiffer 2014

Davis 2011; Martindale‐Adams 2013; Pfeiffer 2014

Davis 2011; Martindale‐Adams 2013; Pfeiffer 2014; Tremont 2008a

High

Tremont 2008a

Tremont 2008a

Unclear

Martindale‐Adams 2013

Davis 2011; Martindale‐Adams 2013; Tremont 2008a

Martindale‐Adams 2013

Economic data

Low

Toye 2016

Toye 2016

Toye 2016; Wray 2010

Toye 2016

Toye 2016; Wray 2010

Toye 2016

High

Unclear

Wray 2010

Wray 2010

Wray 2010

Wray 2010

Figuras y tablas -
Table 2. Comparator 1: Summary of Risk of Bias by outcome for telephone‐only versus usual care
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Table 3. Comparator 2: Summary of risk of bias by outcome for telephone‐only versus non‐telephone professional support intervention

Sequence generation

Allocation concealment

Blinding

Incomplete outcome data (attrition bias)

Selective outcome reporting (reporting bias)

Other potential sources of bias

Burden

Low

Glueckauf 2012

Glueckauf 2012

Glueckauf 2012

Glueckauf 2012

High

Unclear

Glueckauf 2012

Glueckauf 2012

Psychological Health: Depression

Low

Glueckauf 2012

Glueckauf 2012

Gallagher‐Thompson 2007

Glueckauf 2012

Gallagher‐Thompson 2007

Glueckauf 2012

Gallagher‐Thompson 2007

High

Unclear

Glueckauf 2012

Gallagher‐Thompson 2007

Glueckauf 2012

Gallagher‐Thompson 2007

Gallagher‐Thompson 2007

Psychological Health: Stress

Low

Gallagher‐Thompson 2007

Gallagher‐Thompson 2007

Gallagher‐Thompson 2007

High

Unclear

Gallagher‐Thompson 2007

Gallagher‐Thompson 2007

Gallagher‐Thompson 2007

Health Status and Well‐Being: Physical Health

Low

Glueckauf 2012

Glueckauf 2012

Glueckauf 2012

Glueckauf 2012

High

Unclear

Glueckauf 2012

Glueckauf 2012

Health Status and Well‐Being: Self‐efficacy

Low

Gallagher‐Thompson 2007

Gallagher‐Thompson 2007

Gallagher‐Thompson 2007

High

Unclear

Gallagher‐Thompson 2007

Gallagher‐Thompson 2007

Gallagher‐Thompson 2007

Figuras y tablas -
Table 3. Comparator 2: Summary of risk of bias by outcome for telephone‐only versus non‐telephone professional support intervention
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Table 4. Comparator 1: Telephone Intervention versus Usual Care (Results as reported by study authors)

Outcome and time point

Study

Result (as presented by study authors)

Notes/comments

QoL

End of intervention

Shum 2014

Intervention group mean 67.87, n = 70, versus control group mean 67.42, n = 69

No data available for each group SD or 95% CI

Short‐term

Shum 2014

Intervention group mean 73.25 versus control group 70.84, N = 140

Reported numbers assessed by group, n = 68 intervention group and n = 67 control group. No data available for each group SD or 95% CI

Burden

End of intervention

Shum 2014

Intervention group mean 17.37, n = 70 versus control group mean 26.26, n = 69, P < 0.001

No data available for each group SD. Reported mean change data with 95% CI

Winter 2006

Mean and SD:

Intervention group mean 31.7, SD 15.2 versus control group mean 31.7, SD 17.3, N = 81, P = 0.49

No data available for the numbers by study group. No response from author contact

Short‐term

Shum 2014

Intervention group mean 8.6 versus control group mean 17.34, N = 140,

P < 0.001

Reported numbers assessed by group, n = 68 intervention group and n = 67 control group. No data available for each group SD

Skill Acquisition: Competence

End of intervention

Winter 2006

Intervention group mean 13.52, SD 2.85 versus control mean 14.17, SD 2.57, total N = 94, P = 0.932

No data available for the numbers by study group. No response from author contact

Psychological Health: Caregiver Depression

End of intervention

Winter 2006

Intervention group mean 18.17, SD 7.19 versus control group 20.2, SD 7.2, N = 94, P = 0.121

No data available for the numbers by study group. No response from author contact

Shum 2014

Intervention group mean 4.57, n = 70 versus control group mean 7.45, n = 69, P = 0.013

No data available for each group SD

Bishop 2014

intervention mean ‐0.16, SD 2.6 versus control mean ‐1.22, SD 3.1, P > 0.05

Mean change data from baseline only provided. No mean difference for each arm available. No data available for the numbers in each group, SD or 95% CI

Psychological Health: Caregiver Depression

Short‐term

Shum 2014

Intervention group mean 2.41, versus control group mean 4.21, N = 70, P = 0.144

Reported numbers assessed by group, n = 68 intervention group and n = 67 control group. No data available for each group SD

Psychological Health: Caregiver Anxiety

End of intervention

Shum 2014

Intervention group mean 3.97, n = 70 versus control group 6.41, n = 69

No data available for each group SD or 95% CI

Short‐term

Shum 2014

Intervention group mean 1.15 versus control group 2.90, N = 140

Reported numbers assessed by group, n = 68 intervention group and n = 67 control group. No data available for each group SD or 95% CI

Psychological Health: Caregiver Stress

End of intervention

Shum 2014

Intervention group mean 9.06, n =70 versus control group 12.45, n = 69

Reported numbers assessed by group, n = 68 intervention group and n = 67 control group. No SD or 95% CI

Short‐term

Shum 2014

Intervention group mean 3.71 versus control group 7.79, N = 140

Reported numbers assessed by group, n = 68 intervention group and n = 67 control group. No data available for each group SD or 95% CI

Health Status and Well‐Being: Physical Health

End of intervention

Bishop 2014

Mean change ‐0.84, SD 4.5 intervention and mean change 1.74, SD 3.8 control group; P < 0.10

Mean change data only provided. No participant number, means or standard deviation score reported. No response from author contact

Family Functioning

End of intervention

Bishop 2014

Mean change scores from baseline of 2.7, SD 6.4 and ‐2.8, SD 4.0: P < 0.05

Mean change data from baseline only provided. No mean difference for each arm available. No participant number, means or standard deviation score reported. No response from author contact

Cost

End of intervention

Toye 2016

Intervention mean 352.53 Australian Dollars, SD = 81.5, n = 62 versus control mean 15.89 Australian Dollars, SD = N/A, n = 69

Reported figures for total acute care costs which included hospital admissions, ED presentations, and ambulance services, and were not isolated to the intervention costs. Communication with the author resulted in retrieving further cost data specific to intervention costs (e.g. nurses time, cost, of training and telephone charges, etc).

Short‐term

Wray 2010

Mean (SD) and study numbers (US Dollars):

Intervention mean 7008.3 SD 9226.2, n = 83 versus control mean 8831.4 SD 13,245.8, n = 75

Cost utility analysis, mean, SD and study group numbers provided by the authors

Medium‐term

Wray 2010

Mean (SD) and study numbers (US Dollars):

Intervention mean 6783.9, SD 7767, n = 83 versus control mean 5648, SD 6353.4, n = 75

CI:Confidence interval
ED: Emergency department
N/A: Not applicable
SD: Standard deviation

Figuras y tablas -
Table 4. Comparator 1: Telephone Intervention versus Usual Care (Results as reported by study authors)
Ir a la tabla de la revisión
Comparison 1. Telephone intervention versus Usual care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Quality of Life Show forest plot

4

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Quality of life (End of intervention)

4

364

Std. Mean Difference (IV, Random, 95% CI)

‐0.02 [‐0.24, 0.19]

2 Quality of life (Short‐term follow‐up) Show forest plot

1

128

Mean Difference (IV, Random, 95% CI)

0.0 [‐4.43, 4.43]

2.1 Quality of life (Short‐term follow‐up ≤ 3 months)

1

128

Mean Difference (IV, Random, 95% CI)

0.0 [‐4.43, 4.43]

3 Burden Show forest plot

10

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 End of intervention

9

788

Std. Mean Difference (IV, Random, 95% CI)

‐0.11 [‐0.30, 0.07]

3.2 Medium‐term follow up > 3 to ≤ 6 months

2

147

Std. Mean Difference (IV, Random, 95% CI)

0.00 [‐0.32, 0.33]

4 Burden (Short‐term follow‐up) Show forest plot

1

128

Mean Difference (IV, Random, 95% CI)

‐0.20 [‐0.75, 0.35]

4.1 Short‐term follow‐up ≤ 3 months

1

128

Mean Difference (IV, Random, 95% CI)

‐0.20 [‐0.75, 0.35]

5 Skill acquisition: Problem‐Solving Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 End of intervention

3

236

Std. Mean Difference (IV, Random, 95% CI)

0.25 [‐0.21, 0.71]

6 Skill acquisition: Preparedness to Care Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

6.1 End of intervention

2

208

Std. Mean Difference (IV, Random, 95% CI)

0.37 [0.09, 0.64]

7 Skill acquisition: Preparedness to Care (medium‐term follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

7.1 Medium‐term follow‐up > 3 months to ≤ 6 months

1

17

Mean Difference (IV, Random, 95% CI)

‐0.30 [‐1.02, 0.42]

8 Skill acquisition:Competence Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

8.1 End of intervention

1

107

Mean Difference (IV, Random, 95% CI)

4.10 [‐2.19, 10.39]

9 Psychological health: Depression Show forest plot

10

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

9.1 End of intervention

9

792

Std. Mean Difference (IV, Random, 95% CI)

‐0.37 [‐0.70, ‐0.05]

9.2 Medium‐term follow‐up > 3 months to ≤ 6 months

3

227

Std. Mean Difference (IV, Random, 95% CI)

‐0.05 [‐0.56, 0.45]

10 Psychological health: Anxiety Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

10.1 End of intervention

1

61

Mean Difference (IV, Random, 95% CI)

‐4.00 [‐11.68, ‐0.32]

11 Psychological health: Coping Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

11.1 End of intervention

1

121

Mean Difference (IV, Random, 95% CI)

1.0 [‐0.45, 2.45]

12 Psychological health: Stress Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

12.1 End of intervention

1

137

Mean Difference (IV, Random, 95% CI)

‐0.10 [‐0.30, 0.10]

12.2 Medium‐term follow‐up > 3 to ≤ 6 months

1

130

Mean Difference (IV, Random, 95% CI)

0.10 [‐0.11, 0.31]

13 Knowledge and understanding: Knowledge Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

13.1 End of intervention

1

61

Mean Difference (IV, Random, 95% CI)

1.90 [‐0.63, 4.43]

14 Health status and well‐being: Physical health Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

14.1 End of intervention

2

248

Std. Mean Difference (IV, Random, 95% CI)

‐0.09 [‐0.35, 0.17]

15 Health status and well‐being: Self‐efficacy Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

15.1 End of intervention

2

175

Std. Mean Difference (IV, Random, 95% CI)

0.04 [‐0.26, 0.33]

16 Health status and well‐being: Self‐efficacy (Medium‐term follow‐up) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

16.1 Medium‐term follow‐up > 3 to ≤ 6 months

1

130

Mean Difference (IV, Random, 95% CI)

0.0 [‐0.29, 0.29]

17 Health status and well‐being: Social activity Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

17.1 End of intervention

1

121

Mean Difference (IV, Random, 95% CI)

0.04 [‐0.10, 0.18]

18 Satisfaction: Satisfaction with supports Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

18.1 End of intervention

3

291

Std. Mean Difference (IV, Random, 95% CI)

0.10 [‐0.24, 0.44]

19 Family functioning Show forest plot

1

141

Mean Difference (IV, Random, 95% CI)

0.20 [‐0.04, 0.44]
Figuras y tablas -
Comparison 1. Telephone intervention versus Usual care
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Comparison 2. Telephone versus non‐telephone support intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Burden Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 End of intervention

1

11

Mean Difference (IV, Random, 95% CI)

‐0.20 [‐0.74, 0.34]

2 Depression Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 End of intervention

1

11

Mean Difference (IV, Random, 95% CI)

‐4.3 [‐9.57, 0.97]

2.2 Unknown time point

1

45

Mean Difference (IV, Random, 95% CI)

1.20 [‐5.35, 7.75]

3 Stress Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 Unknown time point

1

45

Mean Difference (IV, Random, 95% CI)

‐0.60 [‐3.17, 1.97]

4 Physical Health Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 End of intervention

1

11

Mean Difference (IV, Random, 95% CI)

1.9 [‐0.65, 4.45]
Figuras y tablas -
Comparison 2. Telephone versus non‐telephone support intervention
Ir a la tabla de la revisión