Nurse-initiated transitional care interventions to support the transition from hospital to home amongst older stroke survivors and caregivers: A systematic review and meta-analysis.

Abstract

ObjectiveTo explore and describe the components and underpinning theories of nurse-initiated transitional (hospital-to-home) care and to evaluate the effects of interventions on activities of daily living (ADLs), quality of life (QoL), depression, anxiety, self-efficacy, stroke-related knowledge, patient satisfaction and healthcare service utilisation in older stroke survivors and self-efficacy, caregiver burden, QoL and satisfaction with care in caregivers.Data sourcesMEDLINE, CINAHL, Cochrane Library, Health and Medical Collection, Nursing and Allied Health, Web of Science, Health Source: Nursing/Academic Edition and Scopus databases were searched in February 2024 and updated in March 2026.Review methodsRandomised controlled trials (RCTs) and cluster-RCTs were included. Risk of bias was assessed using the Cochrane Risk of Bias tool, and evidence quality was rated with GRADE. Meta-analysis was undertaken using random-effects models.ResultsSeventeen trials were included. Transitional care interventions were guided by various theoretical frameworks and had multiple components. Interventions improved ADLs at 1 month (standardised mean difference (SMD) 0.54; 95% CI 0.12-0.97, four studies) and 3 months (SMD 0.43; 95% CI 0.12-0.74, seven studies), increased patient satisfaction and reduced hospital readmissions up to 3 months. Interventions may improve the Mental Component Score at 1 month, Role Limitations due to Physical Problems and General Health of QoL at 6 months. The certainty of evidence was low to very low.ConclusionNurse-initiated transitional care can improve ADLs and QoL, while reducing hospital readmissions among older stroke survivors during the hospital-to-home transition. Multicomponent interventions combining home visits and follow-up phone calls may enhance improvements in ADLs. High-quality studies are needed to clarify long-term effects.PROSPERO IDCRD42024517619.