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Background <p>Stroke survivors frequently experience persistent and overlapping functional impairments. Effective rehabilitation is essential to optimizing recovery and minimizing disability after stroke. Clinical practice guidelines offer evidence-based recommendations to support the delivery of standardized, high-quality care. However, most existing systematic reviews of stroke rehabilitation guidelines focus on single impairments.</p> Objective <p>This review aimed to evaluate the quality and clinical applicability of stroke rehabilitation guidelines and to summarize recommendations relevant to the complex and long-term needs of post-stroke patients across multiple domains, such as cognition, motor function, swallowing, speech, and mood.</p> Methods <p>Clinical practice guidelines and expert consensus published between 2015 and 2025 were searched in databases and guideline websites. The quality and applicability of the guidelines were independently evaluated by five investigators using the Appraisal of Guidelines for Research &amp; Evaluation II (AGREE II) and the Appraisal of Guidelines Research &amp; Evaluation Recommendation Excellence (AGREE-REX). Recommendations classified as “strong” or “Class I/Class IIa, Level of Evidence A/B” for stroke rehabilitation were extracted based on the International Classification of Functioning, Disability and Health (ICF) core set for stroke.</p> Results <p>Twelve guidelines were included in this review. AGREE‑REX scores showed a similar proportion of high‑quality and moderate‑quality guidelines, while most guidelines achieved class A according to AGREE II. The lowest AGREE II domain score was “applicability,” while “values and preferences” scored lowest on AGREE-REX. Thirty-nine consistent and 24 inconsistent recommendations were identified. Consistent recommendations included multidisciplinary teams (MDTs) providing comprehensive services and interventions such as enriched environments, psychological therapy, aerobic exercise, and progressive position transfer training for dual or multifunctional impairments. Differences were noted in tele-rehabilitation, acupuncture, rehabilitation timing, and strength of psychological therapy recommendations.</p> Conclusion <p>Despite the high quality of stroke rehabilitation guidelines, they often lack applicability and fail to incorporate patient and caregiver preferences. This study streamlined redundant recommendations into integrated strategies for multiple impairments based on the ICF core set. Further research is needed to clarify the optimal dose and efficacy of psychological therapy and acupuncture.</p>

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Recommendations for rehabilitation of post-stroke multifunctional disorders: a systematic review of clinical practice guidelines

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月23日

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  • Yan Liu,
  • Shimei Li,
  • Lan Pan,
  • Qianqian Yang,
  • Xinran Peng,
  • Qi Zhang

摘要

Background

Stroke survivors frequently experience persistent and overlapping functional impairments. Effective rehabilitation is essential to optimizing recovery and minimizing disability after stroke. Clinical practice guidelines offer evidence-based recommendations to support the delivery of standardized, high-quality care. However, most existing systematic reviews of stroke rehabilitation guidelines focus on single impairments.

Objective

This review aimed to evaluate the quality and clinical applicability of stroke rehabilitation guidelines and to summarize recommendations relevant to the complex and long-term needs of post-stroke patients across multiple domains, such as cognition, motor function, swallowing, speech, and mood.

Methods

Clinical practice guidelines and expert consensus published between 2015 and 2025 were searched in databases and guideline websites. The quality and applicability of the guidelines were independently evaluated by five investigators using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and the Appraisal of Guidelines Research & Evaluation Recommendation Excellence (AGREE-REX). Recommendations classified as “strong” or “Class I/Class IIa, Level of Evidence A/B” for stroke rehabilitation were extracted based on the International Classification of Functioning, Disability and Health (ICF) core set for stroke.

Results

Twelve guidelines were included in this review. AGREE‑REX scores showed a similar proportion of high‑quality and moderate‑quality guidelines, while most guidelines achieved class A according to AGREE II. The lowest AGREE II domain score was “applicability,” while “values and preferences” scored lowest on AGREE-REX. Thirty-nine consistent and 24 inconsistent recommendations were identified. Consistent recommendations included multidisciplinary teams (MDTs) providing comprehensive services and interventions such as enriched environments, psychological therapy, aerobic exercise, and progressive position transfer training for dual or multifunctional impairments. Differences were noted in tele-rehabilitation, acupuncture, rehabilitation timing, and strength of psychological therapy recommendations.

Conclusion

Despite the high quality of stroke rehabilitation guidelines, they often lack applicability and fail to incorporate patient and caregiver preferences. This study streamlined redundant recommendations into integrated strategies for multiple impairments based on the ICF core set. Further research is needed to clarify the optimal dose and efficacy of psychological therapy and acupuncture.