Recurrent stroke contributes to the high burden of stroke. Secondary prevention guidelines recommend addressing modifiable risk factors. Despite the increased use of tele-interventions with individuals after stroke, the use of these interventions for behavior changes and self-management in secondary prevention has a low level of evidence in these guidelines.

To critically appraise and consolidate evidence from systematic reviews (SR) on the effectiveness of theoretically informed person-centered tele-interventions for behavior change and self-management in stroke secondary prevention.

An overview of SR that followed the Cochrane Guidelines was performed, involving the identification, screening, and synthesis of SR (with and without meta-analyses) and of eligible primary studies from the SR. When it was possible, meta-analyses were performed with data from primary studies for the outcomes of interest: primary (reduction in mortality, recurrent stroke and other cardiovascular events), secondary (adherence to health behaviors), and tertiary (control of cardiovascular risk factors).

12 SR and 14 primary studies were included. Seven SR were rated as having a high risk of bias, mainly because they did not define the eligibility criteria. Six SR performed meta-analyses with the outcomes of interest. Only one SR performed meta-analysis with primary outcomes (mortality, recurrent stroke and other cardiovascular events), and no significant difference between groups was found. Secondary outcomes: significant improvement was found for medication adherence, but it was not found for management of depressive symptoms. Tertiary outcomes: meta-analyses were performed for systolic and diastolic blood pressure (SBP and DBP), cholesterol and blood glucose and significant improvements were found for SBP and low-density lipoprotein (LDL). The methodological quality of the primary studies showed that blinding of participants and personnel, and of outcome assessment were the domains with the highest risk of bias. Meta-analyses of tele-interventions compared with usual care were performed for recurrent stroke, medication and healthy eating adherence, physical activity participation, and control of cardiovascular risk measures (SBP, DBP, total cholesterol and triglyceride). A significant difference between group, favoring tele-intervention, was identified for improve in medication adherence (mean difference, MD: 0.41; confidence interval of 95%, 95%CI: 0.16, 0.65; I²: 69%) and healthy eating adherence (standardized MD, SMD: 0.41; 95%CI: 0.19, 0.63; I²: 17%), and for the decrease in SBP (MD: -9.18; 95%CI: -12.96, -5.39; I²: 0%).

Theoretically informed person-centered tele-interventions for stroke secondary prevention resulted in significant improvement in medication and healthy eating adherence, and a decrease in SBP. Future studies using these interventions should consider other risk factors related to stroke secondary prevention.

This overview contributes to increasing the strength of recommendation of the use of theoretically informed person-centered tele-interventions in stroke secondary prevention. Furthermore, it guides future research indicating the need to investigate the effect of strategies involving these interventions on other outcomes that did not show significant improvement.