Measurement Properties of the Caregiver Reaction Assessment Scale: A Systematic Review and Meta-Analysis

Background

The Caregiver Reaction Assessment Scale is a widely used tool for evaluating the experiences of informal caregivers of older adults. Despite its global application, researchers from different countries have reported varying psychometric properties for the CRA, and a comprehensive evaluation of its overall psychometric quality remains lacking. Given the increasing reliance on informal caregivers in ageing populations worldwide, understanding the reliability and validity of the CRA is critical for improving caregiver support and enhancing care outcomes for older adults.

Objectives

This study aims to (1) systematically review the psychometric properties of the CRA scale using the Consensus-based Standards for the Selection of Health Measurement Instruments methodology and (2) conduct a meta-analysis of Cronbach's alpha across different versions of the CRA scale to assess its internal consistency.

Methods

We systematically searched 10 electronic databases from their inception to May 17, 2024, with an update on February 13, 2025. Two researchers independently screened and extracted data. Methodological quality was assessed using the COSMIN checklist, and a random-effects meta-analysis of Cronbach's alpha was performed. Measurement properties were rated according to updated COSMIN standards, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

Results

A total of 21 studies were included in the review. The meta-analysis revealed acceptable internal consistency for the CRA scale, with Cronbach's alpha values ranging from 0.76 to 0.79. Based on COSMIN standards, one version of the CRA scale is recommended for use, 14 versions are weakly recommended and six versions do not meet validity or consistency standards.

Conclusion

The CRA scale is a reliable tool for assessing the experiences of informal caregivers of older adults and demonstrates potential for broader application in other informal caregiver groups. However, limited research on cross-cultural validity, stability, measurement error and criterion validity highlights the need for future studies to address these gaps by rigorously following COSMIN methodology.

Implications for Practice

The findings suggest that the CRA scale enables researchers and practitioners to more accurately assess the experiences of informal caregivers of older adults, facilitating targeted interventions and support. Future research should focus on localising the scale and testing its cultural adaptability for diverse caregiver populations, ensuring its relevance and effectiveness in global caregiving contexts.

Prospero ID

The review was registered on PROSPERO (registration number: CRD42024508176).