Digital health interventions for family caregivers of stroke survivors: a systematic review and meta-analysis of randomized controlled trials

Stroke survivors often require substantial long-term care after hospital discharge, and family caregivers frequently experience caregiver burden, depressive symptoms, and reduced caregiving preparedness, often with limited support. Digital health interventions (DHIs) may offer scalable support, but their effects on caregiver outcomes remain uncertain. To systematically evaluate the effects of DHIs on caregiver burden, depressive symptoms, and caregiving competence among family caregivers of stroke survivors. We searched seven databases from inception to July 2026 for randomized controlled trials evaluating DHIs for family caregivers of stroke survivors. Two reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects meta-analyses were conducted using standardized mean differences (SMDs). The primary synthesis included outcomes assessed at the end of the intervention; follow-up outcomes were analyzed separately when comparable time points were available. Seventeen RCTs involving 1603 participants were included. At the end of the intervention, DHIs were associated with lower caregiver burden (SMD = − 0.55, 95% CI [− 0.91, − 0.18], p < 0.01) and fewer depressive symptoms (SMD = − 0.24, 95% CI [− 0.40, − 0.08], p < 0.01) than control conditions. Evidence for caregiving competence was limited and inconsistent because of the small number of studies and variation in outcome measurement. Follow-up evidence was sparse and heterogeneous. DHIs may reduce caregiver burden and depressive symptoms among family caregivers of stroke survivors at the end of the intervention. However, confidence in these findings is limited by low-to-moderate certainty of evidence, heterogeneity in intervention characteristics and outcome measurement, and sparse follow-up data; therefore, the sustainability of these benefits remains uncertain. Evidence for caregiving competence remains insufficient. Future RCTs should use standardized caregiver-centered outcome measures, clearly prespecified assessment time points, and detailed reporting of intervention components to clarify which DHI features are most likely to benefit caregivers. The protocol was prospectively registered with the International Prospective Register of Systematic Reviews (ID CRD420251176274).