Chronic stroke rehabilitation interventions in primary healthcare settings: a scoping review

Abstract

OBJECTIVES: This scoping review intended to map the existing literature on chronic stroke rehabilitation interventions in primary healthcare (PHC) settings, with a particular focus on intervention dosage-frequency, intensity, type and duration-as well as the mode of delivery, which encompasses intervention location, format and provider. DESIGN: A scoping review was conducted following the guidelines outlined in the Joanna Briggs Institute Manual for Evidence Synthesis. DATA SOURCES: A comprehensive search of 16 databases was conducted on the EBSCOhost platform on 10 February 2022. A supplementary Google search was conducted to identify grey literature up to 19 November 2022. ELIGIBILITY CRITERIA: Sources published in English between 2010 and 2022 with full-text availability, addressing interventions for chronic stroke survivors delivered by various stakeholders in PHC, community or home-based settings. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened the identified sources to determine eligibility for inclusion. Data were extracted independently, compared between reviewers, analysed and synthesised narratively with descriptive statistics. RESULTS: In total 34 sources are included in the review, with most (n=28) originating from high-income countries. Interventions predominantly targeted the body function and structure component of the International Classification of Functioning, Disability and Health framework (n=29) through physical exercise (n=21). However, few interventions addressed the activity (n=17) and participation (n=11) components. Contextual factors (n=9) were seldom considered in intervention design. Intervention dosage varied widely. Most interventions were delivered by the multidisciplinary team (n=9) and were provided either at home (n=16) or in the community (n=13). Individual sessions (n=18) were more commonly offered than group sessions (n=8). CONCLUSIONS: The optimal dosage for chronic stroke interventions remains uncertain, and current interventions, along with their modes of delivery, are often misaligned with PHC settings. Further research is essential to establish best practices in both well-resourced and under-resourced environments to address the current evidence gap and to enable the development of effective rehabilitation protocols that meet the needs of chronic stroke survivors and their families in PHC settings.