Delivery of selected guideline-based care processes in adult stroke rehabilitation: a systematic review and meta-analysis

Background Clinical practice guidelines provide evidence-based recommendations for stroke rehabilitation, but the extent to which guideline-concordant care is delivered in routine practice remains uncertain. The goal of this study was to estimate the pooled rate of patient- or chart-level delivery of selected guideline-based care processes in adult stroke rehabilitation. Methods A systematic review and meta-analysis was conducted to identify studies reporting patient-, chart-, or care-episode-level adherence to guideline-recommended stroke rehabilitation care. Eligible studies included adults with stroke and reported extractable numerator/denominator data for at least one rehabilitation-relevant guideline-concordant care process. Results Six studies were included in the quantitative synthesis, contributing a combined denominator of 547 patients or patient charts. The included studies assessed overall physical therapy adherence, cognitive screening, depression screening, sexuality-related rehabilitation, community rehabilitation contact, and aerobic-intensity therapy. The six studies evaluated distinct care processes in different rehabilitation settings. Individual adherence estimates ranged from 0.0% to 82.9%. The pooled adherence rate was 35.6% (95% CI: 11.0%-71.3%). Heterogeneity was substantial ( τ 2 = 3.21; I 2 = 97.6%; Q(5) = 136.46, p < 0.001), showing marked variation in rehabilitation domains, settings, and adherence definitions. Conclusion Patient-level adherence to guideline-concordant stroke rehabilitation care appears suboptimal and highly heterogeneous. Given the substantial clinical and construct heterogeneity, the pooled estimate has limited clinical interpretability and primarily provides a descriptive summary of the included care-process measures. These findings highlight persistent evidence-practice gaps in stroke rehabilitation and support the need for targeted implementation strategies, routine audit, and domain-specific quality improvement. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261405899 , PROSPERO CRD420261405899.