Effects of transitional care interventions on rehospitalization, functional outcomes, and quality of life in stroke survivors: an updated systematic review and meta-analysis of randomized controlled trials

OBJECTIVE: To evaluate the effects of transitional care interventions on rehospitalization, functional outcomes, quality of life, mortality, and disability in stroke survivors. METHODS: This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement and registered in PROSPERO (CRD420251266063). PubMed, Web of Science, Embase, the Cochrane Library, and CINAHL were searched from inception to May 13, 2026. Additional searches were conducted in ClinicalTrials.gov, Google Scholar, and grey literature sources. Randomized controlled trials comparing transitional care interventions with usual care in adult stroke survivors were included. Dichotomous outcomes were pooled as risk ratios (RRs), and continuous outcomes were pooled as standardized mean differences (SMDs), both with 95% confidence intervals (CIs). Subgroup analyses were conducted according to follow-up duration. Sensitivity analyses, small-study-effect assessment, and GRADE certainty assessment were performed where appropriate. RESULTS: Twenty-four randomized controlled trials involving 3,520 stroke survivors were included. Transitional care interventions reduced overall rehospitalization compared with usual care (RR = 0.59, 95% CI 0.40-0.88), with a more consistent effect within 3 months after discharge (RR = 0.49, 95% CI 0.29-0.82). Transitional care interventions improved activities of daily living (ADL) in the primary analysis (SMD = 0.43, 95% CI 0.20-0.67), although heterogeneity was substantial; after sensitivity analysis, the effect remained statistically significant but was attenuated (SMD = 0.22, 95% CI 0.07-0.37). Quality of life (QoL) improved overall (SMD = 0.67, 95% CI 0.37-0.96), particularly within 3 months (SMD = 0.74, 95% CI 0.54-0.94). No significant mortality reduction was observed (RR = 0.86, 95% CI 0.53-1.39). Transitional care interventions were associated with lower short-term disability measured by the modified Rankin Scale (mRS; SMD = -0.59, 95% CI -0.99 to -0.19), but this finding was limited by substantial heterogeneity. The certainty of evidence was moderate for short-term rehospitalization and short-term QoL, and low for ADL, mortality, and disability. CONCLUSION: Transitional care interventions probably reduce short-term rehospitalization and improve short-term QoL in stroke survivors. They may also improve ADL and short-term disability, but these findings should be interpreted cautiously because of heterogeneity, risk of bias, and possible small-study effects. Current evidence does not establish a clear mortality benefit.