Digital Health Technologies for Community-Based Stroke Rehabilitation: A Scoping Review of Implementation Status, Barriers, and Facilitating Strategies (Preprint)

BACKGROUND Stroke is a leading cause of long-term disability, and sustained, high-intensity rehabilitation is critical for functional recovery. Community- and home-based rehabilitation is increasingly supported by digital health technologies (DHTs), including telerehabilitation platforms, mobile applications, virtual reality (VR) systems, robotics, and wearable devices. However, evidence regarding real-world implementation of these technologies within community settings remains fragmented and no existing review has systematically mapped their implementation status, associated barriers, facilitators and implementation strategies. OBJECTIVE This scoping review aimed to (1) map the current implementation landscape of DHTs for community-based stroke rehabilitation, including geographic distribution, technology types, delivery settings, study designs, and follow-up assessment arrangements; (2) characterize the reporting of implementation-related outcomes and stratify included studies according to the depth of their implementation data; and (3) synthesize barriers, facilitators, and implementation strategies reported by stroke survivors, caregivers, and clinicians. METHODS We systematically searched PubMed, Web of Science, SinoMed, and CNKI for English- and Chinese-language original studies published between January 2016 and August 2026. Eligible studies evaluated DHTs for community- or home-based stroke rehabilitation and reported implementation-related outcomes. Screening, data extraction, and synthesis were undertaken in accordance with the PRISMA-ScR checklist. Implementation evidence was coded into eight predefined categories (Cat.1–8) and each study was assigned to one of three levels of evidence richness (L1–L3): Level 1 (basic-level evidence extraction), Level 2 (moderate-depth evidence extraction), and Level 3 (in-depth evidence extraction containing participant-reported qualitative material). Thematic synthesis of barriers, facilitators, and implementation strategies was restricted to the 22 Level-3 studies with formal qualitative data, guided by five predefined thematic domains. RESULTS Of 1,942 records identified, 111 studies met the inclusion criteria. The majority were conducted in North America (n = 45, 40.5%) and recruited participants with chronic phase stroke (n = 57, 51.4%); 76 studies (68.5%) delivered interventions exclusively at home. Mobile applications represented the most prevalent technology modality (n = 56). Only 26 studies (23.4%) reported follow-up assessments of ≥1 month post intervention. Adherence was the most frequently reported implementation outcome (n = 87, 78.4%), while safety (n = 25, 22.5%), health-economic (n = 4, 3.6%), and intervention fidelity (n = 3, 2.7%) outcomes were rarely reported. Sixty-four studies (57.7%) were assigned to Level 1, 25 (22.5%) to Level 2, and 22 (19.8%) to Level 3. The thematic synthesis of qualitative data identified barriers and facilitators spanning five predefined thematic domains: technology-system, individual-participant, caregiver and social context, clinical service delivery, and intervention content, and generated 28 actionable implementation strategies. CONCLUSIONS DHTs for community-based stroke rehabilitation are expanding rapidly, yet the implementation evidence remains largely superficial. Data on safety, health-economics, and long-term follow-up are critically scarce, and only one-fifth of included studies contain in-depth formal qualitative enquiry. Future research should draw on implementation-science frameworks, standardize the reporting of implementation-outcomes, and prioritize rigorous qualitative evaluation to facilitate sustainable real-world uptake. CLINICALTRIAL digital health; telerehabilitation; stroke rehabilitation; community-based rehabilitation; implementation science; barriers and facilitators; mobile applications; scoping review