Journal of medical Internet research · 2025
The Effectiveness of Nurse-Led Telecare Consultations Among Patients Who Have Experienced a Stroke: Systematic Review and Meta-Analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Wong Arkers Kwan Ching, Zhou Shi Yi, Tao Xingjuan, Tsui Nok Yi, Kwok Vivian Wai Yan, Wang Robbie Mian, Bayuo Jonathan
Аннотация
BACKGROUND: Nurse-led telecare consultations have emerged as a promising approach for the long-term management of stroke survivors, particularly in the context of COVID-19 pandemic-related disruptions. While several studies have explored its use, the effectiveness of nurse-led telecare consultations in post-acute stroke care remains unclear.
OBJECTIVE: This study aimed to evaluate the effectiveness of nurse-led telecare consultation for poststroke management among stroke survivors who were discharged from the hospital and lived in the community.
METHODS: A systematic search was conducted across 6 databases-CINAHL, MEDLINE, PsycINFO, PubMed, Embase, and CENTRAL-for randomized controlled trials published from inception to February 2025. Included studies examined nurse-led telecare consultations compared to usual care among stroke survivors living in the community. Studies involving individuals who were hospitalized or institutionalized were excluded, along with reviews, abstracts without full texts, non-English or non-Chinese articles, and studies not meeting the criteria for randomized controlled trials. Primary and secondary outcomes included blood pressure (BP), psychological burden, quality of life, medication adherence, health care service use, stroke recurrence, survivor functioning, and coping. Continuous outcomes were analyzed using mean differences (MDs) or standardized MDs with 95% CIs under a random-effects model and dichotomous outcomes using odds ratios with 95% CIs via the Mantel-Haenszel method. Heterogeneity was assessed using the chi-square test and I2 statistics.
RESULTS: In total, 9 studies involving 2524 participants were included. Ischemic stroke was the most common type (n=1568, 62.13%) of stroke. Meta-analysis showed that nurse-led telecare significantly increased the likelihood of achieving target BP (odds ratio 2.33, 95% CI: 1.83-2.98; P<.001). For continuous outcomes, pooled analyses showed nonsignificant but directionally favorable reductions in systolic BP (MD -4.83, 95% CI -12.51 to 2.85; I2 =92%), diastolic BP (MD -6.41, 95% CI -13.76 to 0.93; I2=97%), and low-density lipoprotein cholesterol (MD 0.01, 95% CI -0.08 to 0.09; I2=97%). Heterogeneity was substantial for several key outcomes (I2>90% for systolic BP and diastolic BP). Some outcomes, such as medication adherence and stroke recurrence, were reported by only 1 (11.11%) study. Additional benefits were observed in coping ability and reduced hospital readmissions, but findings for psychological well-being and quality of life were mixed.
CONCLUSIONS: Nurse-led telecare consultations may support better BP management and coping and reduce hospital readmissions among community-dwelling stroke survivors. However, the pooled effects for continuous outcomes were inconclusive, and heterogeneity remained high. Therefore, these findings should be interpreted with caution, and further high-quality trials with standardized outcome measures and longer-term follow-up are warranted to confirm effectiveness.
TRIAL REGISTRATION: PROSPERO CRD42023492692; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023492692.
OBJECTIVE: This study aimed to evaluate the effectiveness of nurse-led telecare consultation for poststroke management among stroke survivors who were discharged from the hospital and lived in the community.
METHODS: A systematic search was conducted across 6 databases-CINAHL, MEDLINE, PsycINFO, PubMed, Embase, and CENTRAL-for randomized controlled trials published from inception to February 2025. Included studies examined nurse-led telecare consultations compared to usual care among stroke survivors living in the community. Studies involving individuals who were hospitalized or institutionalized were excluded, along with reviews, abstracts without full texts, non-English or non-Chinese articles, and studies not meeting the criteria for randomized controlled trials. Primary and secondary outcomes included blood pressure (BP), psychological burden, quality of life, medication adherence, health care service use, stroke recurrence, survivor functioning, and coping. Continuous outcomes were analyzed using mean differences (MDs) or standardized MDs with 95% CIs under a random-effects model and dichotomous outcomes using odds ratios with 95% CIs via the Mantel-Haenszel method. Heterogeneity was assessed using the chi-square test and I2 statistics.
RESULTS: In total, 9 studies involving 2524 participants were included. Ischemic stroke was the most common type (n=1568, 62.13%) of stroke. Meta-analysis showed that nurse-led telecare significantly increased the likelihood of achieving target BP (odds ratio 2.33, 95% CI: 1.83-2.98; P<.001). For continuous outcomes, pooled analyses showed nonsignificant but directionally favorable reductions in systolic BP (MD -4.83, 95% CI -12.51 to 2.85; I2 =92%), diastolic BP (MD -6.41, 95% CI -13.76 to 0.93; I2=97%), and low-density lipoprotein cholesterol (MD 0.01, 95% CI -0.08 to 0.09; I2=97%). Heterogeneity was substantial for several key outcomes (I2>90% for systolic BP and diastolic BP). Some outcomes, such as medication adherence and stroke recurrence, were reported by only 1 (11.11%) study. Additional benefits were observed in coping ability and reduced hospital readmissions, but findings for psychological well-being and quality of life were mixed.
CONCLUSIONS: Nurse-led telecare consultations may support better BP management and coping and reduce hospital readmissions among community-dwelling stroke survivors. However, the pooled effects for continuous outcomes were inconclusive, and heterogeneity remained high. Therefore, these findings should be interpreted with caution, and further high-quality trials with standardized outcome measures and longer-term follow-up are warranted to confirm effectiveness.
TRIAL REGISTRATION: PROSPERO CRD42023492692; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023492692.