Effectiveness, Feasibility, Acceptability, and Safety of Digital Interventions in Post-Stroke Rehabilitation: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Abstract

To assess the effects of digital interventions on cognition, emotion, and activities of daily living (ADL) in stroke survivors, alongside evaluating feasibility, acceptability, and safety metrics. We systematically searched 11 English databases for eligible studies published between 2000 and May 2025. Randomized control trials that focused on poststroke digital therapeutics were included. Experimental groups received digital interventions, while control groups underwent standard therapies or placebo. The outcomes included cognition, emotion, ADL, feasibility, acceptability, and safety. Two researchers independently extracted key data from eligible studies. Risk and methodology were assessed using the Cochrane Risk of Bias v2.0 and the PEDro scale. The meta-analysis was conducted using CMA v3.7, following the PRISMA 2020 guidelines. Sixty-three studies (3297 participants) demonstrated significant improvements in overall cognition (g=0.46; 95% CI, 0.24-0.67; P<.001), ADL (g=0.38; 95% CI, 0.19-0.57; P<.001), and specific domains (global cognition, language, visuospatial; all P<.05). Exergaming and computer cognitive training significantly improved overall cognition and memory compared to other digital interventions. Medical sites-based interventions significantly enhanced overall/global cognition versus home-based protocols. Shorter sessions (≤30min) demonstrated superior efficacy in overall cognition to longer durations. Robot-assisted and computer cognitive training maximized ADL gains. Despite significant between-subgroup heterogeneity in emotion outcomes, no within-subgroup efficacy emerged for any digital interventions. Results showed varied recruitment (4.97%-100%) and retention (mostly >75%) across digital interventions. Adherence and attendance were generally high, while safety profiles were mostly favorable with mild adverse events like fatigue or dizziness in some cases. Digital interventions significantly enhance cognition when delivered via clinic-based exergaming or computer cognitive training (≤30min/session), while maximizing ADL improvements through robot-assisted or computer cognitive training in stroke patients. Robust feasibility, acceptability, and favorable safety supports clinical integration.