Effectiveness of dyadic interventions in improving outcomes for adults with multiple long-term conditions and/or frailty and their informal carers: A systematic review protocol

Aim: To synthesise current evidence on the effectiveness of dyadic (pair-based) interventions in improving outcomes for adults with multiple long-term conditions (MLTC) and/or frailty (aged ≥55 years) and their informal carers. Methods: The review protocol followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines, with the protocol registered with PROSPERO (CRD420251144604). MEDLINE, Embase, PsycINFO, CINAHL Plus, CENTRAL, ClinicalTrials.gov will be searched for experimental and quasi-experimental studies examining the effectiveness of community-based dyadic interventions for adults with MLTC (≥2 long-term conditions within an individual) and/or frailty (aged ≥55 years) and their informal carers (spouses/partners, other family members or relatives) published since 2010 and up to September 2025. Dyadic interventions will be defined as pair-based interventions that directly involve informal carers and care recipient adults with MLTC and/or frailty using various techniques targeted at carers, care recipients, or both to change outcomes for at least one member of the carer/care recipient pair (or dyad). Database searches will be followed by a manual search of the reference lists of included studies and lists of papers citing included studies in order to identify additional studies. Two reviewers will independently screen titles and abstracts against the selection criteria and independently screen full texts using Covidence software. Methodological quality will be assessed using the Cochrane Risk of Bias (RoB) 2.0 tool for experimental studies and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool for quasi-experimental studies. Synthesis of evidence will be quantitative. If meta-analysis is not possible, we will follow Cochrane recommendations for quantitative Synthesis Without Meta-Analysis (SWiM) guidance. Conclusion: The findings will address the evidence gap in dyadic implementation research in later life and help inform clinical decision-making, policy development and program planning for adults with MLTC and/or frailty and their carers, particularly in primary care and other community health settings.