Effectiveness, feasibility, acceptability and safety of digital interventions for poststroke survivors: a systematic review and meta-analysis of randomized controlled trials (Preprint)
Authors: Liu Shuangyue , Li Min , Ding Jilin , Ji Qipei , Niu Yanning , Yang Xiao , Ai Shuangchun , Li Siyuan 
Published: November 2024

BACKGROUND

Digital interventions have demonstrated encouraging outcomes for post-stroke recovery, yet there's a lack of agreement regarding their efficacy and viability.

OBJECTIVE

Therefore, this review focused on evaluating its effectiveness in cognitive abilities, mental wellness, and life dependence among poststroke survivors, documenting its feasibility, acceptability, and safety metrics.

METHODS

Eleven English databases were systematically searched to find studies released between January 1, 2000, and March 10, 2024. An evaluation was conducted on randomized controlled trials in adults with stroke to assess how digital interventions impact cognitive, mood, and daily living activities. Two independent reviewers assessed studies for qualification and gathered information. The Cochrane risk of bias 2 method was employed to evaluate risk of bias. The PEDro scale was utilized to assess the methodology of these studies. This meta-analysis was conducted employing CMA 4.0.

RESULTS

Twenty-nine RCTs met the criteria were included in the systematic analysis. The effect size of daily living activities (Hedges’ g, random effects model) in digital interventions versus control was moderate and statistically significant, g = 0.306 (95%CI 0.129 to 0.483). No significant effects were found for cognitive abilities, and mental health. Moderator analyses indicated that chronic patients performed less effectively compared to those in acute or subacute stages in achieving cognitive recovery. In terms of life independence, training fewer than two sessions or 3-4 sessions proved less effective than five sessions. In most studies, the refusal rates for participation were minimal, under 25%, excepting one study of web-based platform. Satisfaction with digital interventions was comparably high to traditional therapies. Most responses were positive, with new technologies requesting body conditions. Many studies reached high adherence levels (over 70%) and high attendance rates (over 75%). This was lower for some technologies (e.g. web-based platform). The cause of dropout was attributed to personal factors, health issues, and technical challenges. Many digital programs required a variety of occupational therapists. Despite the general safety of digital interventions, typical symptoms including fatigue, nausea, and muscular discomfort were reported. Experiencing fatigue was bearable without impacting the treatments.

CONCLUSIONS

Digital interventions are modestly effective at improving life independence in stroke patients, and training five times per week specifically effective. Despite digital interventions had an insignificant impact on cognitive abilities, there was a notable improvement in overall and global cognitive abilities in patients with acute or subacute conditions. Within the realm of mental health, digital methods proved to be as effective as conventional therapy. In summary, existing research indicates that employing digital methods for stroke patients is both achievable and secure.

CLINICALTRIAL

This review’s protocol was registered in the PROSPERO database, under the identifier CRD42024519587.