JMIR Publications

ABSTRACT

Background:

A gap exists between the development of digital health technologies (DHTs) and the actual needs and capabilities of patients with stroke, which could hinder the successful adoption and implementation of DHTs. It is essential to understand clinical perspectives in order to effectively integrate DHTs into post-stroke care.

Objective:

To synthesise evidence on clinical perspectives on the use of DHTs in post-stroke self-management and rehabilitation, and to frame these perspectives within the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework.

Methods:

A systematic literature search was conducted across six electronic databases (PubMed, MEDLINE, Embase, Scopus, CINAHL and Web of Science) from their inception until October 2025. Two reviewers independently screened the records. Eligible studies were English-language, peer-reviewed, primary research using qualitative, quantitative or mixed methods designs, which reported on the clinical perspectives of DHTs in post-stroke care. Study quality was independently appraised using the Mixed Methods Appraisal Tool (MMAT). Qualitative content analysis was undertaken to identify and categorise determinants, which were subsequently mapped to the NASSS framework.

Results:

Of 15,262 records identified, 42 studies (24 quantitative, 8 qualitative, and 10 mixed-methods), published between 2019 and 2025, met the inclusion criteria. Overall, patients, caregivers, healthcare professionals, and members of the public reported generally positive attitudes towards the use of DHTs in post-stroke care. However, multiple unmet needs and expectations related to implementation were identified. Regulatory and political contexts were notably underrepresented across studies. Based on these findings, key perspectives and recommendations were synthesised to adapt and extend a conceptual model within the NASSS framework.

Conclusions:

Future research and implementation efforts should address the diverse needs of stroke patient subgroups when integrating digital interventions into clinical practice. Implementation strategies should explicitly assess alignment with the NASSS framework and demonstrate how stakeholder priorities and concerns are incorporated throughout the development process. Clinical Trial: The protocol was registered with PROSPERO under registration number CRD420251112158.