Smith and Toseland 2006.

Methods	A randomised study (study dates not reported)
Participants	Ninety‐seven caregivers of frail older persons, adult child caregivers (n = 61) and spouse caregivers (n= 36) from a 16‐county area that included urban, suburban, and rural settings, New York, USA. Participants were recruited via newspaper advertisements, direct mailings, appearances before civic and religious organisations, radio announcements and referrals from geriatrics professionals. Caregivers were included if they had a minimum score of 7 or higher on the Caregiver Strain Index. Care‐recipients had to exhibit two or more activities of daily living (ADL)/instrumental activities of daily living (IADL) impairments as reported by the caregiver. Thirty‐one adult child caregivers and 33 spouses received the intervention. The mean adult child caregiver age in years in the intervention group was 54 and in the control group was 54.9. Years spent in education was 14.3 for the intervention group and 15 for the control group. Most were female (77.4% in the intervention group and 96.7% in the control group). Male caregivers accounted for 22.6% in the intervention group and 3.3% in the control group. Most were of white race or ethnicity (87.7% in the intervention group and 96.7% in the control group); black race or ethnicity accounted for 12.9% of the intervention group and 3.3% of the control group. Relationship status ranged from married (intervention group 35.3%, control group 46.2%), single/never married (intervention group 17.6%, control group 23.1%), divorced (intervention group 29.4%, control group 30.8%), separated (intervention group 11.8%, control group 0%) and widowed (intervention group 5.9%, control group 0%). The mean spouse caregiver age in years in the intervention group was 70.2 and in the control group was 66.2. Years spent in education was 14.1 for the intervention group and 14.3 for the control group. Most were female (86.4% in the intervention group and 92.9% in the control group). Male caregivers accounted for 13.6% in the intervention group and 7.1% in the control group. Most were of white race or ethnicity (90.5% in the intervention group and 85.7% of the control group); black race/ethnicity accounted for 9.5% of the intervention group and 7.1% of the control group. Relationship status ranged from married (intervention group 95.2%, control group 100%), single/never married, divorced, separated, and widowed (0% across groups) and 'other' accounted for 4.8% of the intervention group and 0% of the control group).
Interventions	Intervention: The telephone support group (TSG) intervention (group‐delivered) (n = 31) Aim: To evaluate the effectiveness of a telephone support Interventionist(s): License Master’s prepared social worker (who had several years of clinical geriatric social work experience) led all groups. Mode of delivery: Telephone Duration: Weekly for 12 weeks. Each weekly session lasted 90 minutes (15 minutes for hook‐up and 75 for group meeting). Content: A multicomponent intervention that includes education about the effects of chronic illness and about emotion‐focused coping strategies, problem‐solving, and support. A leader’s manual and a participant workbook was developed. The leader’s manual was used to train the group leader and a workbook was given to each member in the TSG arm of the study. The leader instructed members to turn to the appropriate pages in the workbook each week during telephone meetings and to follow along using the structured agendas and the educational materials provided. The first half of each weekly meeting began with conference call connections using a voice‐over internet provider. After the initial period in which the leader called each member in turn, the group leader gave a brief overview of the previous meeting. Following this was a ‘‘check‐in’’ with group members regarding their progress on target goals between meetings. In order to help group members develop supportive relationships beyond the TSG program, the leader asked each of them to select a telephone buddy to call between group meetings. Conversations between telephone buddies were to focus on caregiving issues and the coping and problem‐solving skills that participants were learning. Emotion‐focused coping strategies were taught and practiced during the first half of each weekly TSG meeting. The group leader introduced problem‐focused coping skills during the second half of each meeting and practised them with the members. Standardisation: Delivery was monitored, with one interventionist for all groups, and a leaders manual was used to train the group leader. Comparison group: Usual services offered by the senior services centre (n = 30)
Outcomes	1. Burden: Zarit Burden Interview (ZBI), a 22‐item Likert‐type scale that measures the total strain, role strain, and personal strain that caregivers experience as a result of the impact of the patient’s disabilities on their life. For each item, caregivers indicate how often they have felt a certain way: (0) never, (1) rarely, (2) sometimes, (3) quite frequently, or (4) nearly always. Higher scores signified greater burden. 2. Psychological health (depression): Center for Epidemiologic Studies–Depression Scale (CES‐D). Respondents were asked how frequently they had experienced 20 different events in the past 7 days. These events were indicative of depression. Each event had a score of 0 (happened rarely or not at all) to 3 (most or all of the time). Higher scores indicated more depression. 3. Psychological health (anxiety): State–Trait Anxiety Inventory (STAI) —This scale measures anxiety for caregivers. It presents 20 statements that people use to describe themselves and asks caregivers the extent to which they agree (4) or disagree (1) with each statement. The final score is a summary of the answers to the 20 statements. Higher scores indicated more anxiety. 4. Skill acquisition (problem‐solving): Pressing Problems Index (PPI). Researchers developed the 18‐item PPI in order to assess the extent to which participants’ health and social service problems were being addressed. The PPI contains a list of problems that caregivers frequently encounter when caring for a family member with a chronic illness. For each problem, we asked the caregiver how stressful the problem was, from (0) not at all to (4) extremely; how much their stress had changed, from ‐3 (much worse) to 3 (completely better); how effective they had been in dealing with this problem, from 0 (not at all effective) to 4 (extremely effective); and how much their effectiveness had changed from ‐3 (much worse) to 3 (completely better). Higher scores indicated better problem‐solving. 5. Knowledge and understanding (knowledge): the 'Community Services Inventory' subscales (of services and how to access them); higher scores indicated greater knowledge. Outcome data were collected at the end of intervention and within 2 weeks of completing the intervention.
Notes	For the outcome 'problem‐solving', the reported results for 'how effective' were used in the analysis for this review. Mean scores for the two subscales of the 'Community Services Inventory' subscales were used for the analysis. Unpublished data was requested; the author replied on 11 October 2017 stating that the data was no longer available. Funding source: Project supported in part by United States Administration on Aging Grant (p.620)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information to assess
Allocation concealment (selection bias)	Unclear risk	Insufficient information to assess
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Unable to blind due to nature of the intervention
Blinding of outcome assessment (detection bias) All outcomes	Low risk	"Interviewers remained blind to the participants’ assigned condition ..." (p.622).
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Insufficient information on post‐test data to assess
Selective reporting (reporting bias)	High risk	Adult children subsample only, reported as this group ‘drove the overall effects’ (p.625)
Other bias	High risk	Adult child demographics showed significant differences between groups in terms of education with the control group having more years of education than intervention group (table 3, p.626).