Repository logo
 

Effectiveness of Remote Interventions to Improve Medication Adherence in Patients after Stroke: A Systematic Literature Review and Meta-Analysis.

Published version
Peer-reviewed

Type

Article

Change log

Authors

Choi, Yan Yee Cherizza  ORCID logo  https://orcid.org/0000-0003-0526-7452
Fineberg, Micah 
Kassavou, Aikaterini 

Abstract

BACKGROUND: Stroke affects more than 30 million people every year, but only two-thirds of patients comply with prescribed medication, leading to high stroke recurrence rates. Digital technologies can facilitate interventions to support treatment adherence. PURPOSE: This study evaluates the effectiveness of remote interventions and their mechanisms of action in supporting medication adherence after stroke. METHODS: PubMed, MEDLINE via Ovid, Cochrane CENTRAL, the Web of Science, SCOPUS, and PsycINFO were searched, and meta-analysis was performed using the Review Manager Tool. Intervention content analysis was conducted based on the COM-B model. RESULTS: Ten eligible studies were included in the review and meta-analysis. The evidence suggested that patients who received remote interventions had significantly better medication adherence (SMD 0.49, 95% CI [0.04, 0.93], and p = 0.03) compared to those who received the usual care. The adherence ratio also indicated the interventions' effectiveness (odds ratio 1.30, 95% CI [0.55, 3.10], and p = 0.55). The systolic and diastolic blood pressure (MD -3.73 and 95% CI [-5.35, -2.10])/(MD -2.16 and 95% CI [-3.09, -1.22]) and cholesterol levels (MD -0.36 and 95% CI [-0.52, -0.20]) were significantly improved in the intervention group compared to the control. Further behavioural analysis demonstrated that enhancing the capability within the COM-B model had the largest impact in supporting improvements in adherence behaviour and relevant clinical outcomes. Patients' satisfaction and the interventions' usability were both high, suggesting the interventions' acceptability. CONCLUSION: Telemedicine and mHealth interventions are effective in improving medication adherence and clinical indicators in stroke patients. Future studies could usefully investigate the effectiveness and cost-effectiveness of theory-based and remotely delivered interventions as an adjunct to stroke rehabilitation programmers.

Description

Keywords

mHealth, medication adherence, stroke patients, telemedicine

Journal Title

Behav Sci (Basel)

Conference Name

Journal ISSN

2076-328X
2076-328X

Volume Title

Publisher

MDPI AG
Sponsorship
National Institute for Health Research (NIHR) (RP-PG-0615-20013)