Objective:

To evaluate the feasibility, usability, and patient engagement of digital health and wearable interventions for secondary prevention among stroke survivors. 

Background:

Digital health interventions, including mobile applications, telehealth services, and wearable sensors, have emerged as promising tools to support risk factor management after stroke. However, implementation challenges are not well characterized.

Design/Methods:

A systematic review of MEDLINE, Embase, and CENTRAL (inception to September 2025) identified studies involving adults with prior stroke or transient ischemic attack using digital or wearable tools for secondary prevention. Feasibility outcomes included recruitment, retention, device use adherence, and patient/provider satisfaction.

Results:

Nine studies (n=318 participants; mean age 59 years; 41% women), including three feasibility-only pilots, reported usability data. Average completion was 84% (CI: 77-89%), and device adherence ranged from 60-90%. Overall attrition was 14% (95% CI 9–21%). Common barriers included device setup complexity, Bluetooth connectivity issues, cognitive/visual deficits, and alert fatigue. Facilitators of sustained engagement included simplified user interfaces, caregiver involvement, brief check-ins, and closed-loop workflows with nurse/pharmacist follow-up. Programs with defined escalation protocols achieved higher sustained engagement (median follow-up 3 months [range 2–9]). Across studies, patient satisfaction and perceived usefulness were high, though engagement declined over time without reinforcement. 

Conclusions:

Digital secondary-prevention programs are feasible after stroke when paired with reliable onboarding, accessibility support, and timely human feedback. Addressing usability and workflow barriers is critical to sustaining participation and scaling these tools in secondary prevention programs.