Early emotional interventions for post-stroke functional prognosis: a systematic review and meta-analysis

Background Post-stroke emotional disorders (PSEDs) impair functional recovery, but the optimal type and timing of early interventions remain unclear. This study aimed to determine the efficacy of early emotional interventions on functional outcomes in stroke patients and to examine whether benefits differ by intervention type and timing of initiation. Methods In this systematic review and meta-analysis, we searched seven databases for randomized controlled trials (RCTs) up to November 2025. We included adults with acute/subacute stroke (≤ 3 months) assigned to an emotional intervention (pharmacological, psychological, neuromodulation, or combined) versus control. The primary outcome was the change in Barthel Index (BI) at follow-up. Results Thirty-eight RCTs ( n = 12,020 participants) were included. The weighted mean difference (WMD) in BI score improvement was 6.8 (95% CI: 5.2–8.4) favoring interventions over control. The WMD was 8.2 (95% CI: 5.7–10.7) for cognitive behavioral therapy [ k = 12], 9.1 (95% CI: 6.5–11.7) for combined interventions [ k = 5], 6.5 (95% CI: 4.1–8.9) for rTMS [ k = 7], and 4.2 (95% CI: 1.8–6.6) for SSRIs [ k = 14]. Initiation of intervention within 2 weeks post-stroke yielded a greater WMD of 10.3 (95% CI: 7.8–12.8) compared to 5.8 (95% CI: 3.6–8.0) for later initiation ( p < 0.01). Conclusion Early emotional interventions significantly improve functional recovery after stroke, with the greatest benefit observed for cognitive behavioral therapy and combined interventions initiated within 2 weeks of stroke onset. These findings support the integration of targeted emotional interventions into early standard care.