Arch Psychiatr Nurs. 2026 Aug;63:152143. doi: 10.1016/j.apnu.2026.152143. Epub 2026 May 20.
ABSTRACT
BACKGROUND: Post-stroke psychological disorders impede rehabilitation and long-term wellbeing. Nurses are positioned across the care continuum to deliver psychosocial and self-management support. We synthesized the effectiveness of nurse-led interventions on depression, anxiety, sleep quality, neurological recovery, and health-related quality of life (HRQoL).
METHODS: Following PRISMA 2020, we searched MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, Scopus, CENTRAL, trial registries, and grey sources to 29 September 2025. Randomized and comparative studies of nurse-led/delivered interventions in adults with stroke were eligible. Outcomes were pooled as standardized mean differences (SMDs) using random-effects (DerSimonian-Laird); heterogeneity was assessed with I2 and Q, and small-study effects with Egger's test (when ≥10 studies). Risk of bias used RoB 2/ROBINS-I.
RESULTS: Eighteen studies met criteria. For depression (17 studies; n = 1916), nursing interventions produced a large improvement (SMD -1.17, 95% CI -1.65 to -0.70; p < 0.001) with very high heterogeneity (I2 = 95%); Egger's test suggested small-study effects (intercept -7.36; p = 0.042). Anxiety (5 studies; n = 580) showed a non-significant pooled effect (SMD -1.06, -2.16 to 0.05; p = 0.061; I2 = 97%). Neurological recovery (4 studies; n = 419) showed no clear benefit (SMD 1.01, -1.45 to 3.47; p = 0.422; I2 = 98.9%). Sleep quality (3 studies; n = 349) improved modestly (SMD -0.27, -0.50 to -0.03; p = 0.025; I2 = 16.1%). HRQoL (6 studies; n = 951) improved substantially (SMD 1.15, 0.52-1.78; p < 0.001; I2 = 93.5%).
CONCLUSIONS: Nurse-led interventions are associated with meaningful reductions in depressive symptoms and gains in HRQoL, with smaller but reliable improvements in sleep; effects on anxiety and neurological impairment are uncertain.
PMID:42608083 | DOI:10.1016/j.apnu.2026.152143