Contextualized Clinical Practice Guidelines for Poststroke Motor Rehabilitation in India: Framework and Endorsement...

Existing Indian stroke rehabilitation clinical practice guidelines (CPGs) focus predominantly on physiotherapy and provide limited guidance on health system integration, care pathways, and implementation. This study aimed to develop an evidence-based, contextually relevant CPG for motor rehabilitation across the stroke continuum in India, identify priority recommendations, and assess implementation feasibility.

A three-phase mixed-methods study was conducted across tertiary, secondary, and community-based rehabilitation settings in India. A scoping review, focus group discussions, and systematic synthesis of existing guidelines were undertaken. Participants included rehabilitation professionals with ≥10 years of experience, persons with lived experience of stroke, and key stakeholders. Recommendations were classified according to evidence strength and implementation feasibility.

Rehabilitation pathways were fragmented, with limited post-discharge access and no standardized referral systems. Sixty clinical questions were refined into nine PICO questions and two practice points. Eighty-four recommendations were synthesized from high-quality international guidelines meeting AGREE-II/AGREE-REX thresholds of ≥60%. Using a modified Alper tool, 50 recommendations supported interventions, 13 advised against routine use, and the remainder had limited or unclear evidence. Using the Adopt-Contextualize-Adapt framework, 39 recommendations were suitable for adoption, 32 required contextualization, and 13 required adaptation.

A stakeholder-informed, contextually adapted stroke rehabilitation CPG was developed for India, addressing key evidence and implementation gaps and providing a scalable framework to improve rehabilitation quality, continuity, and accessibility.