Effects of recreational therapy on psychological and social outcomes among stroke survivors: a systematic review and meta-analysis

Purpose To investigate the effects of recreational therapy on psychological and social outcomes in stroke survivors and identify key intervention features.Methods Eleven databases were systematically searched up to 15 April 2026. Two reviewers independently performed study selection, risk of bias assessment using Cochrane RoB 2.0, and evidence grading via GRADE. Meta-analyses were conducted with RevMan 5.4.Results Nineteen studies were included. Recreational therapy significantly improved depressive symptoms (SMD = −0.46, 95% CI: −0.65 to −0.28; p < 0.01, I2 = 44%, low certainty), social participation (SMD = 0.53, 95% CI: 0.07–0.99; p = 0.02, I2 = 87%, moderate certainty), but had no significant effect on anxiety (SMD = −0.32, 95% CI: −0.92 to 0.29; p = 0.31, I2 = 79%, moderate certainty) or quality of life (SMD = 0.77, 95% CI: −0.05 to 1.59, p = 0.07, I2 = 94%, very low certainty). Art-based recreational therapy may alleviate depressive symptoms. Available studies failed to show a meaningful sustained effect beyond 3 months.Conclusions Recreational therapy may improve depressive symptoms and social participation in stroke survivors, particularly with interventions ≤3 months. Given the very low to moderate evidence quality, well-designed studies are needed to confirm long-term effectiveness.