The role of community during critical care transitions from hospital-to-home: a rapid review of evidence involving stroke caregivers

Purpose Stroke care transitions, particularly from hospital to home, place significant demands on essential care partners (ECPs) (caregivers) – commonly family or friends – who provide unpaid support without adequate training or resources. Despite their critical role, few transitional care interventions adequately support ECPs. This rapid review aims to identify and synthesize community-involved and intersectoral care transition interventions that include stroke ECPs, in alignment with the Discharge Assistance and Supports at Home (DASH) model’s principles of cross-sector collaboration, volunteerism and leisure as a modality of care. Design/methodology/approach A rapid review was conducted following updated Cochrane guidance for effectiveness reviews and PRISMA-P reporting standards. Searches were conducted across multiple databases, and studies were screened, extracted and synthesized. Eligible studies included interventions that engaged ECPs in post-stroke care transitions and involved community-based organizations, volunteers or leisure-based approaches. Data were analysed thematically. Findings The findings of the rapid review identified the settings and contexts of the interventions – including when, where, with whom and how they were implemented – as well as the nature of the interventions, key human factors such as facilitators, the involvement of community-based organizations, volunteers and leisure activities, and critical insights into what worked, for whom and why. Research limitations/implications Three key insights emerged from this rapid review to inform better support for ECPs: first, a growing yet underdeveloped shift towards tailored, ECP-centred approaches as essential – not optional – components of stroke care; second, the reinforcing cycle between education, support and self-care; and third, the importance of embedding transitional interventions within broader intersectoral health system and community contexts. These insights from this rapid review will inform the development of a research agenda aimed at identifying and addressing the specific supports ECPs require during critical transition periods – particularly the shift from hospital to home. Originality/value This rapid review offers a novel synthesis of stroke care transition interventions that meaningfully engage ECPs through community involvement, cross-sector collaboration and leisure-based approaches – an underexplored area in current literature. By aligning findings with the DASH model, the review advances understanding of how volunteerism and community assets can support ECPs during hospital-to-home transitions. The study highlights a critical shift towards ECP-centred care, emphasizing the need for systemic, tailored supports. These insights contribute original value by informing future research and practice that recognize ECPs as essential stakeholders in post-stroke recovery, not merely as informal or peripheral caregivers.