Delivery of selected guideline-based care processes in adult stroke rehabilitation: a systematic review and meta-analysis
- 1Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University, Madinah, Saudi Arabia
- 2King Salman Center for Disability Research, Riyadh, Saudi Arabia
- 3Department of Health Rehabilitation, College of Applied Medical Sciences at Shaqra, Shaqra University, Shaqra, Saudi Arabia
Abstract
BackgroundClinical practice guidelines provide evidence-based recommendations for stroke rehabilitation, but the extent to which guideline-concordant care is delivered in routine practice remains uncertain. The goal of this study was to estimate the pooled rate of patient- or chart-level delivery of selected guideline-based care processes in adult stroke rehabilitation.MethodsA systematic review and meta-analysis was conducted to identify studies reporting patient-, chart-, or care-episode-level adherence to guideline-recommended stroke rehabilitation care. Eligible studies included adults with stroke and reported extractable numerator/denominator data for at least one rehabilitation-relevant guideline-concordant care process.ResultsSix studies were included in the quantitative synthesis, contributing a combined denominator of 547 patients or patient charts. The included studies assessed overall physical therapy adherence, cognitive screening, depression screening, sexuality-related rehabilitation, community rehabilitation contact, and aerobic-intensity therapy. The six studies evaluated distinct care processes in different rehabilitation settings. Individual adherence estimates ranged from 0.0% to 82.9%. The pooled adherence rate was 35.6% (95% CI: 11.0%-71.3%). Heterogeneity was substantial (τ2 = 3.21; I2 = 97.6%; Q(5) = 136.46, p < 0.001), showing marked variation in rehabilitation domains, settings, and adherence definitions.ConclusionPatient-level adherence to guideline-concordant stroke rehabilitation care appears suboptimal and highly heterogeneous. Given the substantial clinical and construct heterogeneity, the pooled estimate has limited clinical interpretability and primarily provides a descriptive summary of the included care-process measures. These findings highlight persistent evidence-practice gaps in stroke rehabilitation and support the need for targeted implementation strategies, routine audit, and domain-specific quality improvement.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261405899, PROSPERO CRD420261405899.
Related
- Front-loaded and mixed delivery models in hybrid cardiac rehabilitation: a systematic review and meta-analysis
- Enhancing Cardiac Rehabilitation Referral at Discharge Using EHR-Based Decision Support for Guideline-Eligible Patients
- From Molecular State to Clinical Outcomes After Spinal Cord Injury: A Scoping Review of Selected Fluid Biomarkers and Rehabilitation Relevance
- Digital training to support delivery of an evidence-based cardiac rehabilitation programme for heart failure: a mixed-methods evaluation of healthcare professionals' training experiences and intervention fidelity.
- Digital and algorithmic strategies for guideline-directed medical therapy initiation and up-titration in adults with heart failure with reduced ejection fraction: a systematic review
BibTeX
@article{aljohani2026delivery,
title = {{Delivery of selected guideline-based care processes in adult stroke rehabilitation: a systematic review and meta-analysis}},
author = {Marwan M. A. Aljohani and Marwan M. A. Aljohani and Abdullah Ibrahim Alhusayni},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1963143},
url = {https://doi.org/10.3389/fmed.2026.1963143},
note = {CC BY},
}
RIS
TY - JOUR
TI - Delivery of selected guideline-based care processes in adult stroke rehabilitation: a systematic review and meta-analysis
AU - Marwan M. A. Aljohani
AU - Marwan M. A. Aljohani
AU - Abdullah Ibrahim Alhusayni
PY - 2026
DA - 2026/10/27
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1963143
UR - https://doi.org/10.3389/fmed.2026.1963143
AB - BackgroundClinical practice guidelines provide evidence-based recommendations for stroke rehabilitation, but the extent to which guideline-concordant care is delivered in routine practice remains uncertain. The goal of this study was to estimate the pooled rate of patient- or chart-level delivery of selected guideline-based care processes in adult stroke rehabilitation.MethodsA systematic review and meta-analysis was conducted to identify studies reporting patient-, chart-, or care-episode-level adherence to guideline-recommended stroke rehabilitation care. Eligible studies included adults with stroke and reported extractable numerator/denominator data for at least one rehabilitation-relevant guideline-concordant care process.ResultsSix studies were included in the quantitative synthesis, contributing a combined denominator of 547 patients or patient charts. The included studies assessed overall physical therapy adherence, cognitive screening, depression screening, sexuality-related rehabilitation, community rehabilitation contact, and aerobic-intensity therapy. The six studies evaluated distinct care processes in different rehabilitation settings. Individual adherence estimates ranged from 0.0% to 82.9%. The pooled adherence rate was 35.6% (95% CI: 11.0%-71.3%). Heterogeneity was substantial (τ2 = 3.21; I2 = 97.6%; Q(5) = 136.46, p < 0.001), showing marked variation in rehabilitation domains, settings, and adherence definitions.ConclusionPatient-level adherence to guideline-concordant stroke rehabilitation care appears suboptimal and highly heterogeneous. Given the substantial clinical and construct heterogeneity, the pooled estimate has limited clinical interpretability and primarily provides a descriptive summary of the included care-process measures. These findings highlight persistent evidence-practice gaps in stroke rehabilitation and support the need for targeted implementation strategies, routine audit, and domain-specific quality improvement.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261405899, PROSPERO CRD420261405899.
SN - 2296-858X
ER -