Rehabilitation — Starting to Plan a Livable Home as the Fire Is Brought Under Control

You Are Still in Treatment, Yet They Call It Rehabilitation

It has been a few days since your mother collapsed from a stroke. She has passed the critical crisis, but she is still lying in bed, and her right hand holding a spoon keeps slipping. Yet this morning, a therapist came with a prescription from the attending physician and suggested practicing sitting at the edge of the bed. The caregiver is surprised. She is still in treatment, but is this already rehabilitation?

If you picture a house on fire, two tasks are visible. One is putting out the fire. The other is making that house into a place where people can live again. Inspecting the soot-stained walls and pipes, cooking meals again, and welcoming guests are all part of this second task.

The two tasks do not come one after another. Even while the flames are being brought under control, planning begins on which room to use again first. This second task, running side by side alongside finding and fixing the illness, is rehabilitation.

Rehabilitation is the treatment and care that helps a person whose everyday functioning has decreased—or is at risk of decreasing due to illness, injury, or aging—regain and protect their functions, and live their life again. For your mother, it is the work of helping her accomplish tasks like using a spoon that she could no longer do because of her illness. This article follows in turn what rehabilitation seeks to restore, who does that work, and whether that work truly makes a difference.

What Recovery Is Reclaiming

What my mother wants back is not the number for her right-hand grip strength, but eating a meal by herself. That is also what rehabilitation holds on to. Function is what the body and mind accomplish, spanning from physical movement to everyday activities like getting dressed and walking, and even roles within the workplace and family. Rehabilitation has gauged whether treatment went well from the very beginning using this function (PMID 28140419).

There are already many people who need rehabilitation, and as health and population structures change, the number of people whose function declines is growing rapidly (PMID 31128114). In the single year of 2019, 2.41 billion people worldwide lived with conditions that could be helped by rehabilitation (estimate published in Global Burden of Disease study data, PMID 33275908). This is a 63% increase from 1990, and the largest share came from bone, muscle, and joint disorders including lower back pain (PMID 33275908).

The authors who produced this estimate considered that at least one in three people needs rehabilitation at some point while experiencing an illness or injury. And they wrote that this does not fit the common view that treats rehabilitation as a service received by only a few (PMID 33275908). Because rehabilitation looks at what a person accomplishes rather than the name of the disease, it becomes necessary regardless of the type of disease.

Rehabilitation is not just something for families who have experienced a stroke. For conditions where heart blood vessels narrow, there is exercise-focused cardiac rehabilitation. People who received this rehabilitation had a substantial reduction in hospital readmissions for any reason over 6 to 12 months of follow-up compared to those who did not undergo exercise rehabilitation (moderate certainty) (PMID 34741536).

The "(moderate certainty)" in parentheses describes the certainty of the evidence. Evidence certainty is a grade assessing how much we can trust the result based on study design and consistency of findings, divided into high, moderate, low, and very low. Over the same period, myocardial infarction—where a part of the heart muscle dies because it does not receive blood—was also reduced (high certainty). However, it was also pointed out that the result showing reduced hospitalizations might have had its effect inflated by small studies (PMID 34741536).

There are two ways of reclaiming function. Recovery is the return of movement or function in the same way as before the injury. Compensation is accomplishing the same task using another body part or another method instead of the lost way. If the right hand grips a spoon just like before, that is recovery; if a person eats with a thick-handled spoon or the left hand, that is compensation.

Rehabilitation can target both of these. Both rebuilding lost function and learning ways to substitute for that function become goals (cognitive rehabilitation review, PMID 10676752). Tricks for changing movements, assistive devices, and modifying the home environment are methods actually used by therapists (PMID 28721691). However, distinguishing whether the returned movement is in the same way as before is trickier than it seems. Which of the two methods is chosen and when, and how much of the credit goes to the body getting better on its own, is covered in another part of this series, "Neuroplasticity".

Disability Does Not Rest in the Body Alone

Suppose two people have lost strength in their right hand. One lives with family in an apartment equipped with an elevator. The other lives alone on the fifth floor of a building with only stairs. Even if the condition of their hands is identical, the difficulty of grocery shopping and visiting the hospital is vastly different for the two.

The word disability encompasses this difference as well. Disability is a term that refers collectively to bodily impairment, activity limitations, and restrictions on social participation, and it arises when a physical condition meets the surrounding environment and the person's own circumstances. Bodily impairment means that the body itself is injured. Activity limitation means that it has become difficult to accomplish certain tasks because of that, and participation restriction means losing the roles one used to hold at a workplace, in a family, or in a neighborhood.

There is a name for this perspective on disability. The biopsychosocial model is a perspective that views health and functional problems as being forged together by the body, the mind, and the social and environment. This perspective brings the fact that the environment broadly affects bodily function, activity, and participation into the fold of care (PMID 40399189).

What organizes function and disability into a single set of frameworks from this perspective is the ICF. The ICF (International Classification of Functioning, Disability and Health) is a classification published by the WHO in 2001, and is a framework that describes function and its constraints within the biopsychosocial model.

If you compare it to a house, the three layers of the ICF and their surroundings become visible. The walls, plumbing, and electrical wiring are body functions and structures. Cooking and washing inside the house are activities, and the life in which the resident goes to work and welcomes guests is participation. Around them are environments such as the steep slope in front of the house, stairs without an elevator, and neighbors. There are also personal conditions such as the resident's age, personality, and life history. The ICF groups these two together and calls them context, and assistive devices or artificial limbs are also placed on the environmental side.

Applied to a mother, the loss of strength in her right hand is a bodily impairment, her inability to button her own buttons is an activity limitation, and her inability to perform her role of preparing meals for her grandchildren is a participation restriction. The height of the bathroom threshold and whether there is family to help belong to the environment, while the mother's age and way of life belong to personal conditions.

All three layers and context are used when recording a stroke as well. Experts selected 130 items to be used in recording stroke patients with the ICF (39 experts from 12 countries, PMID 15370761). Among them, body functions and structures numbered 46, activities and participation numbered 51, and the environment numbered 33. Experts considered that nearly two-thirds of items outside the body are needed just to record a single stroke patient.

The process of returning to life after losing an arm or a leg is the same. Physical problems such as pain, artificial limbs, mental health, and environments that are difficult to navigate intertwine to dictate that process (PMID 39389641).

Even with the same body, if the environment changes, the magnitude of disability changes. Therefore, various existing models that centered on disease management and tried to connect multiple cares into one fall short for individuals with disabilities. This is because people with disabilities face needs spanning multiple domains alongside social barriers (PMID 40399189). The places rehabilitation touches are also all three layers and context.

Who Is on the Rehabilitation Team

In the first week of admission, a caregiver meets various professionals one by one. Those handling rehabilitation include rehabilitation physicians, therapists each in charge of movement, daily routines, and communication, makers of braces and artificial limbs, and psychology specialists (PMID 28140419). When these people gather around a single patient, they form a team. A multidisciplinary team is a team where specialists from multiple fields take charge of one patient together and coordinate with each other to provide care.

A dedicated stroke care team handles problems that commonly arise after a stroke in a set manner, with the goal of coordinated care (PMID 32324916). Canadian stroke guidelines use the term interprofessional team for the same setup (PMID 41257448). Sometimes they are distinguished by calling it multidisciplinary when each profession sets goals separately, and interprofessional when they set goals together from the start. In this article, the two are grouped together and called a multidisciplinary team.

Among the roles of the physician in rehabilitation are organizing medical issues and pinpointing the practical, economic, and social resources and barriers that help or hinder rehabilitation (non-English review, PMID 25096738). The rehabilitation prescription written by a doctor is a communication tool linking the doctor and the rehabilitation team. Through this prescription, the direction of treatment is set, and risks that may arise for the patient during treatment are reduced (PMID 22537690).

Physical therapy is a treatment that builds abilities to move and transfer the body—such as sitting, standing, walking, and balancing—through exercise and training, and sometimes uses physical means like heat or electricity for pain or movement. The effects of physical therapy have mainly been evaluated through randomized trials. A randomized trial is a test where participants are divided as if by drawing lots, comparing the side that received the treatment with the side that did not receive it or received a different treatment.

A 2014 review compiling 467 randomized trials covering physical therapy after a stroke found that the evidence of effectiveness was strong for various trainings concerning walking, arm and hand activities, and physical fitness. This judgment is based on criteria set by the review itself (PMID 24505342). However, the effects mostly stayed within the specific functions and activities that were actually trained (PMID 24505342). The story of muscle weakness, stiffness, and gait is picked up by another part in this series, "Paralysis and Spasticity".

Occupational therapy is a treatment that helps people regain the ability to perform everyday tasks such as dressing, eating, and washing. Here, activities of daily living are self-care tasks that a person performs independently every day, such as eating, dressing, washing, going to the bathroom, and transferring the body. The goal of occupational therapy after a stroke is to increase the ability to accomplish these activities of daily living. In addition to evaluation and training, occupational therapists use tips to change movements, assistive devices, and environmental modifications (PMID 28721691).

Broader household chores such as grocery shopping or meal preparation are also areas that occupational therapy covers. Cognitive problems such as attention and memory are also addressed, but the effectiveness on cognitive problems is not yet clear (PMID 35349186).

Speech therapy is a formal treatment aimed at improving language and communication skills, and through that, raising a person to the level of conversing in daily life and participating in society. How speech and language differ, what speech therapy does, and how swallowing breaks down are continued in another part of this series, "Swallowing, Speech and Language".

Nurses are the largest professional group working beside stroke patients (PMID 24102924). Yet the scope of nurses participating in rehabilitation was narrow. Body care and condition monitoring came first, and patients and families had to receive separate explanations about what role nurses play in rehabilitation (PMID 24102924). This is the result of reading together 16 qualitative studies that listened to people's experiences through interviews or observation.

The authors concluded that the share nurses can add to rehabilitation needs to be reconsidered, and that when rehabilitation can be safely started should be included within it. Furthermore, they considered that incorporating rehabilitation skills into nursing could greatly help improve outcomes (PMID 24102924).

Which profession takes charge of what and what qualifications are required vary by country and hospital, and there are many overlapping areas. Regardless of job titles, what has a thick pile of evidence for effectiveness in people hospitalized with stroke is inpatient care organized as a team of multiple professions (PMID 32324916).

Goals Are Set Together With the Patient

The therapist asks the mother what she wants to be able to do again. The mother answers that she wants to cook a meal for her grandchildren with her own hands. This answer becomes the starting point of the rehabilitation plan.

The purpose of rehabilitation is an independent and meaningful life with the greatest possible function. A review notes that rehabilitation goals should always be what matters most to the patient, which can differ from what professionals consider important (non-English review, PMID 25096738). A review synthesizing guidelines also emphasizes that stroke rehabilitation should be tailored to the individual and focused on their needs and goals (PMID 41443215).

When patients and physical therapists speak of being "patient-centered," working toward goals set by the patient is built into it (PMID 28820617). The Canadian stroke best practice recommendations involved people with lived experience of stroke in their creation. These recommendations were written with the goal of helping people regain their life roles and leisure (PMID 41257448).

If we break down "cooking a meal for the grandchildren" across three layers and context, the tasks split apart. The role within the family is participation, preparing side dishes while standing and moving plates is activity, and the strength of the right hand and sense of body balance are the body. The kitchen layout and tools are the environment. For the same goal, physical therapy takes charge of practicing standing and endurance, while occupational therapy handles kitchen tasks and tools. The physician identifies medical problems and practical barriers standing in the way of this plan.

The evidence for how much setting goals together changes outcomes is still weak. Even that evidence is indirect evidence that mixed goal setting with other methods. Four methods, including goal setting, showed a small effect in helping people keep up with physical therapy consistently. However, the certainty of the evidence was low, and most studies were of people with bone, muscle, and joint conditions (PMID 38773659).

Self-management programs are programs that help patients learn to manage their disease and daily life on their own. Nearly all self-management programs after stroke included education and goal setting. These programs showed a small effect on quality of life (moderate certainty) and did not clearly increase confidence in one's ability to succeed (low certainty) (PMID 40275483). Tailoring goals with the patient has taken root as a principle of rehabilitation, but how they should be tailored to yield better results remains unsolved.

Families are also inside this process. Patients and families have many things they want to ask about what the disease has left behind in the body and mind, hospital procedures and treatments, and the days ahead. Some patients are also in a state where it is difficult to communicate with words (PMID 12764962). Yet families were most negative about the way rehabilitation-related professions in hospitals treated and supported them, especially the way they provided information (survey of 107 stroke patient families, PMID 20854585). The 2026 U.S. stroke rehabilitation guidelines added caregiver support into a newly overhauled recommendation area (PMID 42657476).

From Hospital to Home

Just like your mother’s practice of sitting up, stroke rehabilitation takes place across both the acute treatment phase and the long period that follows it (PMID 41443215). When and how to move is determined by a physician through a rehabilitation prescription tailored to the patient's condition. This prescription is also used to reduce risks that may arise during treatment (PMID 22537690).

Moving early and often is not always better. Getting patients out of bed and moving very early immediately after a stroke is called very early mobilization. High-dose very early mobilization, which had patients do this more often and more extensively within 24 hours of onset, reduced the odds of a good outcome at 3 months compared to usual dedicated stroke unit care (PMID 25892679). Odds is a value obtained by dividing the number of people who achieved a good outcome by the number of people who did not, meaning that the side achieving good outcomes decreased.

This trial randomly divided 2,104 people across 56 stroke units. The authors noted that future recommendations should be refined by analyses examining the relationship between the amount of movement and outcomes (PMID 25892679). Cochrane is an international organization that brings together trials addressing the same question using a set method and combines their results, and an article produced in this way is called a Cochrane review. A Cochrane review addressing very early mobilization within 48 hours of onset also concluded that very early mobilization did not increase the number of people surviving in a good condition (PMID 30321906).

Rehabilitation does not end with hospital discharge. Canadian guidelines provide guidance on planning a seamless system from the moment a stroke occurs until returning to the community, delivered by an interprofessional team well-versed in stroke (PMID 41257448).

When stroke patients living at home received treatment-focused rehabilitation services such as physical therapy and occupational therapy, out of every 100 people, 7 avoided outcomes of worsening in activities of daily living or becoming dependent on others (PMID 12535444). This is the calculation of a 2003 review combining 14 clinical trials targeting patients within 1 year of onset or discharge. This calculation assumed that 37.5% would experience bad outcomes without treatment, and the treatment contents varied across studies (PMID 12535444).

Rehabilitation to retrain the body after a hip fracture improved the ability to get around outside (moderate certainty). However, this is still preliminary evidence, and the effectiveness of psychological and home-based methods is unclear (PMID 34973944).

After the home come the workplace and the neighborhood. The 2026 US guidelines newly refined recommendations covering fall prevention, social participation, and safe return to work and driving (PMID 42657476). Rehabilitation focused on leisure activities after a stroke may increase leisure participation. However, because there are few studies and the results are inconsistent, the certainty of the evidence is low (PMID 42698306).

Even during rehabilitation, a stroke can happen again. The emergency signals at the moment of a new collapse and what to do at that time are organized in What a Stroke Actually Is — Blocked, Burst, and the Clock.

Do Organized Teams Actually Make a Difference

When 100 stroke patients are cared for by a coordinated team, about two more are alive one year later than if 100 had received other care. Six more are living at home, and six more are living without others' help (PMID 32324916). The compared other care was usually a general ward. This is the difference between the two groups, recalculated per 100 people, from a 2020 Cochrane review that gathered 29 randomized controlled trials and 5,902 people. This timeframe is the median of the follow-up periods that varied across studies.

Organized inpatient care is inpatient care in which multiple professions form a single team to care for stroke patients together according to a set protocol. That format comes in three types. A stroke unit is a ward that gathers only stroke patients to be cared for by such a team. The remaining two are a stroke team that moves around various wards without a dedicated ward, and a rehabilitation ward that looks after various illnesses that leave disabilities, including stroke, together (PMID 32324916).

Stroke patients who received organized inpatient care were more likely to be alive, live without help from others, and live at home one year later (moderate certainty) (PMID 32324916). This benefit appeared to be independent of age, sex, initial stroke severity, and stroke type. And it was most clearly confirmed in separate, dedicated stroke units (PMID 32324916).

When comparing the three setups, this review counts death, dependent living, and institutional care together as a "poor outcome" (PMID 32324916). In direct comparisons with general wards, both stroke units and mixed rehabilitation wards reduced poor outcomes (moderate certainty) (PMID 32324916). In a network meta-analysis combining multiple comparisons, both models also showed fewer poor outcomes. However, the certainty was moderate for stroke units and low for mixed rehabilitation wards (PMID 32324916). Mobile stroke teams may have made little to no difference compared to general wards (low certainty) (PMID 32324916).

Clues to where the difference comes from emerged from complications. In organized care, there were more frequent reports of oxygen administration, measures to prevent food or saliva from going down the wrong pipe, and the use of antipyretics and analgesics. Infections, including chest infections, and pressure ulcers, where skin is damaged from lying down for a long time, were less common (PMID 17690313). Dying from complications caused by being unable to move was also less frequent (PMID 17690313).

This result came from a 2007 study that updated a review of 31 controlled clinical trials, re-analyzing only studies that reported relevant data for each item (7 to 17 studies). The authors concluded that organized care appears to reduce the risk of death by preventing and treating complications, especially infections (PMID 17690313). What the coordinated team does includes protecting the body this way, in addition to exercise. To use the initial metaphor, organized inpatient care is treatment where one team simultaneously puts out fires and rebuilds the household, and the preceding numbers are the combined result of both.

The limits are clear as well. The result for which the complication analysis explained the benefit was death, and what was examined were also measures reported in early inpatient care and complications (PMID 17690313). Therefore, including rehabilitation elements such as walking or activities of daily living training, these analyses cannot tease apart how much each element contributed to independence and returning home one year later. The evidence regarding patients' perceived health status was of very low certainty, and there were no data on satisfaction (PMID 32324916). There was no sign of prolonged hospital stays, but uncertainty around this result was also large (PMID 32324916).

The evidence for treatment methods looks different depending on what is asked, through what kind of trial, and with what yardstick. The earlier 2014 review selected only trials with a low risk of bias. Risk of bias is the risk that results tilted to one side because of loopholes in the study design. This analysis judged 53 types of training, such as walking training and arm and hand training, one by one against its own criteria (PMID 24505342). The 2025 Cochrane review excluded arm function trials and trials that used only a single component. It then evaluated overall physical rehabilitation, which mixes multiple components, using GRADE, a grading system that rates the certainty of evidence as seen earlier (PMID 39932103).

Half of the trials included in this review came from China, and about one-third of the studies used in the main outcome analysis had a high risk of bias (PMID 39932103). The authors concluded that multi-component physical rehabilitation after stroke is likely to improve function and movement. However, when compared with receiving no such intervention, most results were of low certainty, with substantial variation in participants and treatments across studies, and many small trials (PMID 39932103). Occupational therapy targeting activities of daily living also improved those abilities and reduced the risk of deterioration. However, the quality of the evidence was low, and the authors noted that these studies do not reliably indicate the magnitude of the effect (PMID 28721691).

Even evidence-based care is not received by everyone. The mid-term review of the European Stroke Action Plan noted that gaps remain particularly in access to stroke units, rehabilitation, and post-discharge follow-up care (PMID 41614539). The benefits of organized care have accumulated with moderate certainty, but what makes it effective within that care and whether everyone receives that care remain open questions.

Where to Look Next

Another part in this series, Neuroplasticity, covers how to tell recovery from compensation, the extent of natural improvement versus what therapy adds, and how much is needed. Paralysis and Spasticity handles muscle weakness and stiffness, walking and falls, while Swallowing, Speech and Language covers swallowing, speech, and language.

If you want to know ICF more deeply, it continues to Why Hold Several Rulers Against One Person — An Introduction to the ICF Framework. What we use to measure rehabilitation outcomes is covered by How Do We Measure Recovery — An Introduction to Rehabilitation Outcome Measures, and the boundary between compensation and recovery is handled by How Deep Is the Recovery — Between Compensation and True Recovery. Stroke itself and emergency signs are in What a Stroke Actually Is — Blocked, Burst, and the Clock.

Source Papers

• "Rehabilitation: The health strategy of the 21st century." (2018) — PMID 28140419 — Rehabilitation has taken function as its outcome from the beginning, providing an overview where practitioners include rehabilitation medicine, occupational therapy, physical therapy, speech therapy, assistive devices/prosthetics, and psychology (includes author's view).
• "Rehabilitation the Health Strategy of the 21st Century, Really?" (2019) — PMID 31128114 — The scope of people needing rehabilitation (those experiencing or likely to experience functional limitation due to aging or health conditions) — the same scope as rehabilitation's definition in this piece, and the need for rehabilitation is already high and growing further.
• "Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019" (2021) — PMID 33275908 — In 2019, 2.41 billion people had conditions that would benefit from rehabilitation, a 63% increase compared to 1990, with musculoskeletal conditions the largest, and at least one in three people needing it (estimate).
• "Exercise-based cardiac rehabilitation for coronary heart disease." (2021) — PMID 34741536 — Cochrane: Exercise-based cardiac rehabilitation significantly reduces all-cause hospitalizations and reduces myocardial infarction at 6 to 12 months of follow-up, and total mortality may be slightly reduced.
• "Setting goals for cognitive rehabilitation." (1999) — PMID 10676752 — A review stating that cognitive rehabilitation can aim for both the reconstruction of impaired functions and training in compensation strategies.
• "Occupational therapy for adults with problems in activities of daily living after stroke." (2017) — PMID 28721691 — Cochrane: The goal of occupational therapy is to improve ADL ability, and methods include assessment, training, adaptation techniques, assistive technology, and environmental modification; low-quality evidence for improved ADL and decreased risk of deterioration fails to reliably inform the size of the effect.
• "Use of the ICF in integrated care for people with disabilities: A scoping review using the SELFIE framework." (2025) — PMID 40399189 — The bio-psycho-social model of the ICF addresses the impact of environmental factors on body functions, activities, and participation, and disease-management-centered integrated care models fall short for people with disabilities.
• "ICF Core Sets for stroke." (2004) — PMID 15370761 — Consensus by 39 experts from 12 countries resulting in 130 comprehensive stroke core set categories (41 body functions, 5 structures, 51 activities and participation, and 33 environments).
• "Reintegration Following Amputation: A Biopsychosocial Approach." (2024) — PMID 39389641 — Return to life after amputation is driven by the interaction of mental health, environmental, and physical factors (pain, prosthetics), along with early screening by a multidisciplinary team.
• "Organised inpatient (stroke unit) care for stroke: network meta-analysis." (2020) — PMID 32324916 — Cochrane latest edition: 29 RCTs with 5,902 participants, generally compared to general wards showing an increase per 100 people at 1 year of 2 surviving, 6 returning home, and 6 independent (moderate certainty), regardless of age, sex, severity, or type, most pronounced in dedicated units, mobile teams uncertain, very low-certainty evidence for subjective health, no satisfaction data, and length of stay uncertain.
• "[Rehabilitation based on the bio-psychosocial model concerns health condition, functioning and contextual factors]." (2014) — PMID 25096738 — Non-English review: The purpose of rehabilitation is an independent and meaningful life with maximal function, the goal is what matters most to the patient, and the physician organizes medical issues and identifies resources and barriers.
• "Safety precautions in the rehabilitation medicine prescription." (2012) — PMID 22537690 — A rehabilitation prescription serves as a communication tool between the physician and the rehabilitation team to set the direction of treatment and reduce risks.
• "What is the evidence for physical therapy poststroke? A systematic review and meta-analysis." (2014) — PMID 24505342 — 467 RCTs, self-assessed certainty of evidence: strong evidence in interventions related to gait, arm-hand activity, ADLs, and physical fitness, with effects generally limited to functions and activities actually trained.
• "Occupational therapy for cognitive impairment in stroke patients." (2022) — PMID 35349186 — Cochrane: The effect of occupational therapy on cognitive impairment is unclear, covering BADLs, IADLs (shopping, meal preparation), and cognitive domains.
• "Nursing practice in stroke rehabilitation: systematic review and meta-ethnography." (2014) — PMID 24102924 — Nurses are the largest profession yet their participation in rehabilitation is limited, and patients and families need role explanations (16 qualitative studies); authors' conclusion: redefining nurses' roles and integrating rehabilitation skills can significantly improve outcomes.
• "Rehabilitation Guidelines in Stroke." (2025) — PMID 41443215 — Stroke rehabilitation is needed in both the acute and long-term phases, emphasizing personalization and patient-goal orientation.
• "Patient-centeredness in physiotherapy: What does it entail? A systematic review of qualitative studies." (2017) — PMID 28820617 — Patient-centered physiotherapy involves working toward goals set by the patient.
• "Canadian Stroke Best Practice Recommendations ... Part One: Stroke Rehabilitation Planning for Optimal Care Delivery, 7th Edition Update 2025." (2026) — PMID 41257448 — A seamless multidisciplinary team system from onset to community reintegration, developed with stakeholder involvement, aiming to resume life roles and leisure.
• "Efficacy of interventions and techniques on adherence to physiotherapy in adults: an overview of systematic reviews and panoramic meta-analysis." (2024) — PMID 38773659 — Four methods including goal setting have a small effect on physiotherapy adherence (SMD 0.24), with low certainty of evidence, mostly in musculoskeletal conditions.
• "Do self-management interventions improve self-efficacy and health-related quality of life after stroke? A systematic review." (2025) — PMID 40275483 — 44 RCTs, education and goal setting as main components, small effect on quality of life (moderate), no significant improvement in self-efficacy (low).
• "Good practice for keeping stroke patients and carers informed." (2003) — PMID 12764962 — Patients and caregivers have many questions about the disease's impact, procedures, and future outlook, and some experience communication barriers.
• "Family caregivers' perceptions of hospital-based allied health services post-stroke" (2010) — PMID 20854585 — 107 caregivers, most negative toward the involvement and support of rehabilitation professions, especially regarding information provision.
• "2026 Guideline for Adult Stroke Rehabilitation and Recovery" (2026) — PMID 42657476 — Replacing the 2016 guidelines, updating recommendations for comorbidities, fractures, fall prevention, technology-based rehabilitation, caregiver support, participation, return to work, and driving, and specifying knowledge gaps.
• "Therapy-based rehabilitation services for stroke patients at home." (2003) — PMID 12535444 — 14 RCTs with 1,617 home-dwelling stroke patients, 7 avoided a bad outcome per 100 people (37.5% baseline in no treatment), with heterogeneous interventions.
• "Community Reintegration After Rehabilitation for Hip Fracture: A Systematic Review and Meta-analysis." (2022) — PMID 34973944 — Physical retraining increases outdoor mobility (moderate certainty), cognitive and care model interventions have no effect, and psychological and home-based interventions are unclear.
• "The Effectiveness of Rehabilitation Interventions on Improving Leisure Participation Following Stroke: A Systematic Review." (2026) — PMID 42698306 — Leisure rehabilitation may increase leisure participation, but the number of studies is small and heterogeneity is high, resulting in low certainty.
• "Does the prevention of complications explain the survival benefit of organized inpatient (stroke unit) care?" (2007) — PMID 17690313 — Secondary analysis of a review of 31 controlled trials (7 to 17 trials per item): organized care increased oxygen, swallowing prevention measures, and antipyretics, decreased chest infections, other infections, and pressure ulcers, suggesting that preventing and treating complications (especially infections) reduces mortality.
• "Physical rehabilitation approaches for the recovery of function and mobility following stroke." (2025) — PMID 39932103 — Cochrane (GRADE) 267 RCTs: authors' conclusion that combined physical rehabilitation approaches are likely to improve function and mobility, though individual results compared to no treatment are mostly of low certainty due to heterogeneity and small study sizes.
• "Stroke Action Plan for Europe 2018-2030 (SAP-E): mid-term review and update." (2026) — PMID 41614539 — Particular gaps in Europe regarding access to dedicated units, rehabilitation, and follow-up care.
• "Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial." (2015) — PMID 25892679 — RCT of 2,104 participants across 56 wards: high-dose very early mobilization reduced the odds of a good 3-month outcome compared to usual care (OR 0.73), and recommendations should be refined through dose-response analyses.
• "Very early versus delayed mobilisation after stroke." (2018) — PMID 30321906 — Cochrane: Very early mobilization within 48 hours does not increase survival or good recovery, and deaths and poor outcomes may be similar or slightly higher (moderate certainty).