Digital health interventions for stroke survivor–caregiver dyad on multiple outcomes: A systematic review and meta-analysis (Preprint)

BACKGROUND Stroke frequently results in persistent physical, psychological, and functional impairments that extend beyond survivors to their family caregivers. Stroke survivors and caregivers often experience interrelated challenges, including depression, anxiety, caregiving burden, fatigue, and difficulties in long-term disease management. Digital health interventions may provide accessible and continuous support for survivor–caregiver dyads; however, their effectiveness across patient and caregiver outcomes remains unclear. OBJECTIVE o assess the efficacy of digital health interventions in improving psychosocial outcomes for stroke survivor–caregiver dyads. METHODS Eleven of the 1840 records identified through the database search met the inclusion criteria. The meta-analysis demonstrated that digital health interventions significantly reduced caregiver depression [SMD = −0.66, 95% CI (−0.93, −0.38), P < 0.001, I² = 41%], patient depression [SMD = −1.06, 95% CI (−1.94, −0.18), P = 0.02, I² = 89%], and patient anxiety [SMD = −0.94, 95% CI (−1.70, −0.18), P = 0.02, I² = 86%]. However, no significant effects were observed for patient ADL, caregiver burden–strain, caregiver quality of life, caregiver fatigue, or caregiver self-efficacy. The evidence for caregiver depression was rated as moderate quality, while the evidence for patient depression and anxiety was rated as very low quality according to the GRADE criteria. RESULTS Eleven of the 1840 records identified through the database search met the inclusion criteria. The meta-analysis demonstrated that digital health interventions significantly reduced caregiver depression [SMD = −0.66, 95% CI (−0.93, −0.38), P < 0.001, I² = 41%], patient depression [SMD = −1.06, 95% CI (−1.94, −0.18), P = 0.02, I² = 89%], and patient anxiety [SMD = −0.94, 95% CI (−1.70, −0.18), P = 0.02, I² = 86%]. However, no significant effects were observed for patient ADL, caregiver burden–strain, caregiver quality of life, caregiver fatigue, or caregiver self-efficacy. The evidence for caregiver depression was rated as moderate quality, while the evidence for patient depression and anxiety was rated as very low quality according to the GRADE criteria. CONCLUSIONS Digital health interventions can help alleviate caregiver depression and may also improve patient depression and anxiety to some extent, but their effects on other psychosocial outcomes remain limited. The evidence base is constrained by methodological concerns, heterogeneity, and the small number of available studies. Further high-quality, large-scale randomised controlled trials are needed to confirm these findings and establish optimal intervention characteristics.