The Efficacy of Telemedicine for Secondary Prevention and Management Among Stroke Survivors: A Systematic Review and Meta-analysis

Abstract

Stroke has high mortality and high recurrence rate. Telemedicine usage is rapidly growing as a strategy to optimize stroke secondary prevention by managing stroke risk factors. In order to comprehensively assess the impact of telemedicine intervention, an updated review of more outcomes is required. This systematic review and meta-analysis of randomized controlled trials (RCTs) aim to assess the telemedicine effects on systolic blood pressure, diastolic blood pressure, stroke recurrence, and mortality in post-stroke patients. A literature search of RCTs related to telemedicine intervention from PubMed, Science Direct, Scopus, Web of Science, and ProQuest from 2018 to 2022 was included in this study. The quality of the study was evaluated using the Cochrane RoB 2 tool. We presented the pooling analysis of our result in the form of mean difference (MD) and odd ratio (OR) with 95% CI using RevMan 5.4 software. Six trials involving 3,942 patients met the eligibility criteria to conduct the meta-analysis. Telemedicine intervention had a significant effect on the change of systolic (MD -6.05; 95% CI -6.23, -5.87; p < 0.00001; I 2 =84%) and diastolic (MD -2.76; 95% CI -4.13, -1.39; p < 0.0001; I 2 =89%) blood pressure control. Telemedicine intervention was also associated with lower stroke recurrence (OR 0.82; 95% CI 0.42, 1.59; p=0.55; I 2 = 70%) and mortality rate (OR 0.87; 95% CI 0.68, 1.12; p=0.28; I 2 =0%). Therefore, telemedicine applications may be a promising strategy to optimize the implementation of stroke secondary prevention. More up-to-date trials with higher quality are needed to confirm our findings and assess the other outcomes of telemedicine intervention, such as cost-effectiveness, medical adherence, and quality of life outcomes.