Stroke rehabilitation evidence and comorbidity: a systematic scoping review of randomized controlled trials

Abstract

Background:Most strokes occur in the context of other medical diagnoses. Currently, stroke rehabilitation evidence reviews have not synthesized or presented evidence with a focus on comorbidities and correspondingly may not align with current patient population. The purpose of this review was to determine the extent and nature of randomized controlled trial stroke rehabilitation evidence that included patients with multimorbidity. Methods: A systematic scoping review was conducted. Electronic databases were searched using a combination of terms related to "stroke" and "rehabilitation. " Selection criteria captured inpatient rehabilitation studies. Methods were modified to account for the amount of literature, classified by study design, and randomized controlled trials (RCTs) were abstracted. Results: The database search yielded 10771 unique articles. Screening resulted in 428 included RCTs. Three studies explicitly included patients with a comorbid condition. Fifteen percent of articles did not specify additional conditions that were excluded. Impaired cognition was the most commonly excluded condition. Approximately 37% of articles excluded patients who had experienced a previous stroke. Twenty-four percent excluded patients one or more Charlson Index condition, and 83% excluded patients with at least one other medical condition. Conclusions: This review represents a first attempt to map literature on stroke rehabilitation related to co/multimorbidity and identify gaps in existing research. Existing evidence on stroke rehabilitation often excluded individuals with comorbidities. This is problematic as the evidence that is used to generate clinical guidelines may not match the patient typically seen in practice. The use of alternate research methods are therefore needed for studying the care of individuals with stroke and multimorbidity.

Clinical decision-making on spinal cord injury-associated pneumonia: a nationwide survey in Germany

“…different characteristics of distinct patient populations. Higher rates of elderly stroke patients with underlying cardiac and/or pulmonary diseases [27,28] are complicating the interpretation of the chest X-ray and thus limit its diagnostic value. Consequently, the stroke consensus group-modified diagnostic CDC recommendations for stroke-associated pneumonia [29].…”

Multimorbidity in Stroke

“…This may contribute to the poorer outcomes and increased costs reported in those with multimorbidity and stroke. Stroke rehabilitation trials often exclude those with comorbidity resulting in a lack of evidence about how best to manage these individuals 35 .…”

A multimodal training with visual biofeedback in subacute stroke survivors: a randomized controlled trial

“…A well-recognized limitation of the majority of RCTs on stroke patients is that the mean age of the participants is significantly lower than the average age of stroke population. 4 Conversely, in this RCT the mean age of the participants perfectly matches the average age of stroke population (73 years) 28 and this might favor the generalizability of the results.…”

“…Neurorehabilitation units are the primary services used in the subacute phase after stroke to promote functional recovery and regain independence. 1 The prevalent old age of stroke survivors (about 50% aged >75 years and 30% >85 years) 2,3 and the high prevalence of comorbidities (stroke occurs in isolation in <6% of patients) 4 negatively influences the success rate of rehabilitation, 2,5 making the treatment and recovery for stroke increasingly complex. To maximize functional gains and shorten the length of hospital stays, it is generally recommended to start rehabilitation as soon as patients are clinically stable, no later than 30 days after stroke.…”