Systematic review of clinical practice guidelines for the provision of community-based care for adults living with stroke

Stroke is an acute event with complex consequences that require long-term support in the community. The provision of community stroke care is one of the top priorities of the Stroke Priority Setting Partnership for rehabilitation and long-term support (Stroke Association, 2021) as there is little evidence to determine how community-based stroke care should be organised and delivered, and by whom. This systematic review of stroke guidelines aimed to examine quality, content, and scope of recommendations for the provision of community-based care for adult stroke survivors.

A systematic search for stroke guidelines published between 2011 and 2021 was conducted in electronic databases, guideline organizations/repositories, professional societies websites, and Google scholar. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used to appraise methodological quality of guidelines. Key recommendations for the organisation and delivery of community-based care for stroke survivors were synthesised using Content Analysis.

From 16,522 papers, 15 guidelines met the inclusion criteria. Guidelines were rated as high (n=8), moderate (n=3) and low (n=4) quality. Recommendations for the provision of long-term community-based stroke services focused on addressing rehabilitation, life after stroke, secondary prevention and provision of carer support involving multidisciplinary stroke professionals. There was little clarity, however, over what community-based services should comprise, how they should be delivered, when and by whom.

This review reinforced the importance of ongoing stroke rehabilitation and long-term care for stroke survivors living in community but calls for further research to understand stroke survivors’ needs for, and the evidence underpinning, community-based stroke care.