A rapid realist review of post-stroke rehabilitation for young adults

Introduction: Stroke is a significant global burden of disease. Despite the increased risk with age, there is an increasing prevalence trend of stroke in individuals under 65. With a growing rate of stroke survival in young adults, recovery and rehabilitation has become important aspect of stroke management. Previous studies suggest that post-stroke rehabilitation is more suited to older adults and not to be age-appropriate for young adults, resulting in their unmet needs. Little is known about post-stroke rehabilitation provision for young adults.

Aims and Objectives: A rapid realist review was conducted to understand post-stroke rehabilitation for young adults aged between 18 and 45: what works (or not), for whom, why and in what circumstances?

Methods: We followed Saul et al (2013)’s rapid realist review methodology. The literature search had two stages: (1) An initial search of nine databases (2000-2022): CINAHL, MEDLINE, EMBASE, PsycINFO, ASSIA, AMED, PEDro, Cochrane Library and Web of Science, (2) A secondary search to find relevant literature or documents that could illuminate the development of the realist causal explanations. Extracted data were analysed using retroductive reasoning to establish programme theories in form of context-mechanism-outcome (CMO) configurations.

Outcomes: Thirty-two articles were included as a final result. We identified three theory areas overarching five CMO configurations that can explain how stroke rehabilitation works (or not) for young adults, including (1) the relationship between young adults and their therapists/peer supporters, (2) person-centred approach in goal setting, and (3) returning to ‘new normal’. An understanding of age-appropriate needs and person-centred approach in rehabilitation delivery are
required to enable post-stroke rehabilitation that works for young adults, leading to desirable outcomes.

Conclusion: This review highlights the complex factors involved in post-stroke rehabilitation for young adults. Evidence on how employers can support young adults returning to work post-stroke is lacking and warrants further exploration.