Determinants influencing the implementation of home-based stroke rehabilitation: a systematic review

Home-based rehabilitation is a promising alternative to regular center-based stroke rehabilitation. The objective of this study was to identify what is currently known about determinants that influence the implementation of home-based stroke rehabilitation (HBSR) in clinical practice.

A systematic review of determinants of HBSR was conducted, using a framework for innovation (including determinants related to the innovation, the user, the organization, and the socio-political context). Reviews, meta-analyses, and qualitative studies were included. Studies were selected if they concerned: home-based rehabilitation of stroke patient's (motor) function, changes in in-person service delivery (> 24 h to 12 months post-stroke) and determinants of implementation.

A total of 88 studies were identified, of which 7 studies met the inclusion criteria. Identified determinants of implementation of HBSR were: intervention effectiveness, the exact nature of the medical condition, satisfaction with services, coordination of services, inter-professional collaborations, availability of appropriate training equipment, and costs. However, none of the studies had the primary aim to identify determinants of implementation.

A more complete and detailed overview of existing determinants of HBSR is needed to assist professionals and organizations in decision-making on HBSR implementation and development of suitable strategies for implementation. Implications for Rehabilitation Committed professionals and a smooth transfer to the home-environment are essential elements for home-based rehabilitation or early supported discharge. The determinants related to the client include age, needs, stability and severity of the stroke as well as the living conditions. Clients and care givers should be involved in the recovery process including the decision for early discharge and home-based rehabilitation. It is necessary that essential therapy equipment be provided and that the travel times and costs of therapists are reimbursed.