Findings
Traditional RCTs face high costs, long timelines, recruitment challenges, and lack of diversity.
Recruitment efficiency in stroke trials has decreased over the past 25 years.
Digital tools for stroke prevention often lack quality and interactive functionality.
Decentralized RCTs present challenges in data quality and require validation.
Regulatory and compliance requirements vary significantly across regions.

Recommendations
Adopt decentralized RCTs with a patient-centric approach.
Leverage digital technologies to improve trial efficiency and participant experience.
Ensure participant engagement and education in trial design.
Provide high-quality training and support for decentralized procedures.

Regulatory Considerations
Collaborate with regulatory agencies early in trial design.
Compliance with varying international standards is necessary.
Rapid evolution of technology outpaces regulatory changes.
Cross-border data standards and privacy rules must be observed.