Overview
Le Danseur M (2020) provided an overview of stroke rehabilitation, emphasizing the holistic approach involving nursing care, interdisciplinary collaboration, and psychosocial support to enhance patient outcomes (PMID: 32014164).
Epidemiology
Evidence suggests that approximately 25%–30% of strokes occur in people of working age (≤65 years) in Australia, New Zealand, and the UK, equating to an estimated 12,750 strokes annually in Australia and 38,000 strokes annually in the UK (Walters et al., 2020; PMID: 32532772).
According to the Global Burden of Disease study, the number of people with stroke increased by 68% between 1990 and 2010 (Lin et al., 2019). This trend indicates a growing disease burden despite declines in age-standardised mortality rates globally.
In China, although age-standardised mortality has tended to decline, the total number of stroke deaths has shown a slow upward trend, indicating a continued significant burden (Lin et al., 2019).
Globally, the absolute numbers of people affected by stroke have risen significantly, with substantial healthcare costs attributed to both direct and indirect expenses, highlighting the necessity for efficient rehabilitation methods such as early supported discharge [PMID: 26452543].
Given the reliance on discharge destination as a surrogate marker for Modified Rankin Scale (MRS) scores in large epidemiological datasets such as the Nationwide Inpatient Sample, understanding this relationship is crucial for accurate outcome interpretation (PMID: 22446290).
Among 262 surveyed physical therapists, 54% reported using Arabic-validated SOMs within the first week of therapy, indicating a significant uptake that could influence stroke rehabilitation practices among Arabic-speaking populations (Almarwani M, Alhamyani R, Journal of Evaluation in Clinical Practice, 2025; PMID: 39930752).
Clinical Presentation
Through enhanced understanding and skill development facilitated by the iWalk toolkit, physical therapists demonstrated improved confidence in administering walk tests, potentially leading to more precise clinical assessments of patients' walking capabilities post-stroke (Salbach NM et al., 2021; PMID: 34636908).
Peer support groups, as discussed by Kessler et al. (2014) [PMID: 24935460], provide a platform where stroke survivors gain a deeper understanding of their condition from peers, often leading to normalization of experiences and improved psychological adjustment post-stroke.
The SCSI's detailed scales focusing on self-care maintenance, monitoring, and management provide clinicians with nuanced insights into patient self-care capabilities, facilitating targeted clinical interventions (PMID: 37078619).
Stroke patients exhibiting social withdrawal might see improvements in their ability to engage socially through occupation-based rehabilitation approaches, as highlighted by recent systematic reviews (Proffitt et al., 2022; PMID: 35849050).
The study included patients with moderate to severe upper limb impairment (Fugl-Meyer Upper Limb Scale score ≤50) and positive motor evoked potentials (MEP+), demonstrating that these patients can benefit from self-directed upper limb repetitive engagement programs like SURE (PMID: 34281405).
Diagnosis
Although primarily designed for post-stroke evaluation, the FDDT demonstrated higher sensitivity to detect executive dysfunction compared to cognitive screens, suggesting its potential utility in identifying subtle deficits during initial diagnosis (PMID: 32869647).
Management
The study highlights that despite the challenges posed by the COVID-19 pandemic, exercise training remains a vital component of stroke rehabilitation, emphasizing the need for adapting programs to ensure safety while maintaining therapeutic benefits (Moncion et al., 2022). PMID: 34711094.
A realist evaluation of the iWalk toolkit found that physical therapists were significantly more likely to administer walk tests post-intervention compared to pre-intervention, with notable improvements observed more prominently in outpatient rehabilitation settings than in acute care settings (Salbach NM et al., 2021; PMID: 34636908).
The adaptation and validation of the SASC19 Homesat subscale in Malay highlights the importance of culturally appropriate tools to assess patient satisfaction with outpatient stroke care services, potentially guiding improvements in management practices within public healthcare systems (PMID: 32563246).
Post-acute stroke rehabilitation services encompass inpatient rehabilitation (IR) delivered in hospital settings and community rehabilitation (CR), including early supported discharge (ESD), which facilitates early discharge from acute hospitals with continued rehabilitation support at home (Walters et al., 2020; PMID: 32532772).
This systematic review aims to identify trajectories of long-term unmet needs among community-dwelling stroke survivors, offering targeted intervention points for healthcare providers (Lin et al., 2019).
A mixed methods realist evaluation study protocol investigates the effectiveness of ESD services in real-world settings, indicating that ESD facilitates discharge from hospital and delivers stroke specialist rehabilitation at home, potentially reducing hospital stay length and dependency risk [PMID: 31196123].
Successful ESD implementation necessitates multidisciplinary collaboration and organizational changes to shift budget investments from acute to community care effectively [PMID: 31196123].
The ReAcT study, published in Clinical Rehabilitation (PMID: 29582712), highlights that despite guidelines advocating for high-frequency and intensity therapy post-stroke to improve recovery rates, actual therapy provision falls short in most English stroke units, raising questions about implementation barriers and contextual factors affecting therapy delivery.
A cluster randomized trial evaluated the process evaluation of implementing a physical rehabilitation guideline for stroke in inpatient settings through facilitated interprofessional strategies. Facilitation aimed to overcome barriers such as team functioning, communication, and the complexity of treatment recommendations, thereby improving adherence and functional recovery (PMID: 28764752).
Facilitators can organize training sessions to build clinicians' capacity and conduct regular check-ins to maintain motivation, thereby aiding in the practical application of extensive stroke rehabilitation guidelines (PMID: 28764752).
Given the poor reintegration levels observed, targeted rehabilitation strategies are recommended for older survivors with diabetes, utilizing assistive mobility devices (especially wheelchairs) and addressing employment status both before and after stroke to improve community reintegration (Akosile et al., 2016; PMID: 27917211).
The study indicates that the type of assistive mobility device used, especially wheelchairs, correlates strongly with community reintegration scores among Nigerian stroke survivors (Akosile et al., 2016; PMID: 27917211).
The CARE4STROKE study protocol investigates the effects of caregiver-mediated exercises (CME) integrated with e-health support added to usual care in hospital stroke units, rehabilitation centers, and nursing homes, aiming to enhance early supported discharge (ESD) and patient outcomes [PMID: 26452543].
Given the high costs associated with inpatient rehabilitation services, integrating caregiver-mediated exercises with e-health support in stroke rehabilitation could promote early supported discharge and reduce overall healthcare expenditures [PMID: 26452543].
Kessler et al. (2014) [PMID: 24935460] found that peer support, based on shared experiences, can significantly decrease feelings of isolation and fear among stroke survivors, thereby promoting engagement in recovery processes and providing crucial information about community services following hospital discharge.
Complications
Emerging data suggest that multi-system complications from COVID-19 can persist for up to six months post-infection, potentially overlapping with the multi-system effects seen in stroke recovery, thus complicating rehabilitation efforts (Moncion et al., 2022). PMID: 34711094.
Ineffective self-management practices among stroke survivors may lead to complications including social isolation, mood disturbance, and reduced mobility, underscoring the importance of structured self-management interventions (Boger EJ, Demain S, Latter S, Disability and Rehabilitation, 2013; PMID: 23167558).
Prognosis & Follow-up
Exercise training facilitates functional recovery, cognitive function, and cardiovascular health markers, which are beneficial for stroke patients, even considering potential long-term effects from COVID-19 (Moncion et al., 2022). PMID: 34711094.
The iWalk toolkit, comprising a mobile app, educational video, and guide, aimed to enhance therapists' knowledge and skills regarding walk tests (10MWT and 6MWT), leading to increased clinical implementation and potentially better patient outcomes in walking rehabilitation (Salbach NM et al., 2021; PMID: 34636908).
The study validates the English version of the Dutch Satisfaction with Stroke Care Questionnaire (SASC-19) Homesat subscale into Malay for use among Malaysian stroke survivors receiving long-term care at public primary healthcare facilities (PMID: 32563246). This tool measures satisfaction with various aspects of post-stroke outpatient care, which is crucial for understanding patient experiences and improving care continuity beyond the acute phase.
Validation of the SASC19 Homesat subscale in Malay underscores the importance of regular satisfaction assessments to ensure continuity of care and potentially enhance long-term prognosis for stroke patients in Malaysia (PMID: 32563246).
In the AVERT trial, twelve-month outcomes for working age stroke survivors did not reveal significant differences in disability and health-related quality of life between those receiving very early intensive mobilization plus usual care and those receiving usual care alone (Walters et al., 2020; PMID: 32532772).
Approximately 24%–74% of stroke survivors in developed countries require long-term care due to their level of disability, indicating significant ongoing needs post-stroke (Lin et al., 2019).
The study aims to explore whether health and cost benefits of ESD interventions are achieved in practice, suggesting that successful ESD implementation can lead to improved prognoses and reduced dependency among stroke patients [PMID: 31196123].
Special Populations
Given the overlapping multi-system effects of COVID-19 and stroke, rehabilitation programs must incorporate safety protocols and tailored exercise plans to address the unique challenges faced by post-stroke patients with COVID-19 history (Moncion et al., 2022). PMID: 34711094.
The effectiveness of the iWalk toolkit varied between acute care and outpatient rehabilitation settings, indicating that implementation strategies might need customization for different patient populations to maximize benefits (Salbach NM et al., 2021; PMID: 34636908).
This study focuses on adapting stroke care satisfaction measurement tools for use among Malaysian stroke survivors in community healthcare settings, emphasizing the relevance of culturally tailored assessments for specific populations (PMID: 32563246).
Working age stroke survivors (defined as ages 18–65) face distinct rehabilitation challenges and have unique expectations regarding recovery, impacting personal well-being, financial burdens, and societal costs (Walters et al., 2020; PMID: 32532772).
National audit reports indicate variability in ESD service provision, with some regions lacking ESD services altogether, underscoring the importance of context-specific adaptations for diverse patient needs [PMID: 31196123].
The mixed-methods approach in the ReAcT study (PMID: 29582712) revealed that insufficient therapy is observed across different levels of stroke severity, indicating that special considerations and adaptations may be necessary for diverse patient populations to meet therapeutic goals effectively.
Due to the heterogeneous nature of stroke-related deficits among patients, health providers face challenges in prioritizing treatments from comprehensive guidelines, necessitating tailored facilitation approaches to address variable patient needs effectively (PMID: 28764752).
Key Recommendations
To address the unique challenges posed by the COVID-19 pandemic, stroke rehabilitation services are advised to create tailored guidelines for exercise programs, emphasizing safety measures such as physical distancing to support safe rehabilitation (Moncion et al., 2022). PMID: 34711094. (Evidence: Moderate)
Given the toolkit's success in improving walk test administration among physical therapists across various settings, it is recommended that similar toolkits be adopted to standardize and enhance stroke rehabilitation practices focusing on walking assessments (Salbach NM et al., 2021; PMID: 34636908). (Evidence: Strong)
Given the fragmented nature of post-stroke care in Malaysia, incorporating validated tools like the SASC19 Homesat subscale in Malay can provide critical insights into patient satisfaction and guide improvements in long-term stroke care management (PMID: 32563246). (Evidence: Moderate)
Given the variability in ESD service delivery, there is a critical need for aligning practical implementations with evidence-based models to ensure sustained health benefits and equitable service access [PMID: 31196123]. (Evidence: Strong)
Based on the insights from the ReAcT study (PMID: 29582712), key recommendations should focus on addressing barriers to therapy implementation and enhancing multidisciplinary approaches to ensure stroke survivors receive adequate therapeutic interventions as per guidelines. (Evidence: Expert opinion)
To improve adherence to stroke rehabilitation guidelines, employing facilitators from core interdisciplinary teams (such as physical and occupational therapists, nurses, and speech-language pathologists) can address implementation challenges and enhance patient outcomes (PMID: 28764752). (Evidence: Moderate)
Based on the findings, key recommendations for rehabilitation include tailored interventions aimed at improving mobility, vocational skills, and social reintegration for older stroke survivors with diabetes, using wheelchairs, and experiencing employment disruptions (Akosile et al., 2016; PMID: 27917211). (Evidence: Moderate)
Studies referenced by Kessler et al. (2014) [PMID: 24935460] emphasize the critical importance of comprehensive training for peer supporters to maximize the benefits of peer support programs, noting that certain program aspects, like open discussions, may have mixed reception among participants. (Evidence: Moderate)
References
0 papers cited of 157 indexed.