Efficacy and Implementation of Digital Health Interventions in Improving Cognitive, Psychological, and Quality of Life Among Stroke Survivors: A Systematic Review and Meta-Analysis.

Abstract

Post-stroke cognitive impairment, depression, and anxiety significantly contribute to long-term disability, yet conventional interventions often face barriers in accessibility and personalization. Digital health interventions (DHIs) have emerged as promising adjuncts to stroke rehabilitation, and previous reviews have synthesized their effects across several rehabilitation outcomes. This systematic review and meta-analysis updated this evidence by separately evaluating global cognitive performance, depression, anxiety, quality of life (QoL), and implementation-related indicators among adult stroke survivors. We searched PubMed, Web of Science, Scopus, Embase, CINAHL, PsycINFO, and grey literature sources from inception to May 15, 2026. Twenty-six randomized controlled trials involving 1855 participants were included. Data were pooled using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and risk of bias was assessed using the Cochrane tool. DHIs significantly improved global cognitive performance (SMD = 0.49, 95% CI [0.33, 0.65]) and reduced depression (SMD = -0.35, 95% CI [-0.56, -0.13]) and anxiety (SMD = -0.45, 95% CI [-0.70, -0.20]). The pooled effect on QoL was not statistically significant and showed substantial heterogeneity (SMD = 0.72, 95% CI [-0.51, 1.94]). Exploratory subgroup analyses suggested possible variation by DHI modality, stroke phase, and intervention duration, but these findings should be interpreted cautiously. Implementation outcomes indicated generally good feasibility and adherence, though reach varied and safety reporting was incomplete. No significant publication bias was detected. DHIs may serve as adjuncts to stroke rehabilitation, but further well-powered RCTs with standardized protocols and prespecified comparative designs are needed.