Impact of intermediate home-based care on functional health of older adults with stroke in low-income and middle-income countries: A systematic review.

Abstract

Background: Intermediate care services are designed to facilitate transition from medical dependence to functional independence, ultimately improving the overall quality of life. Despite the recognized benefits of intermediate care in rehabilitation, data on its impact on functional outcomes for older adults with stroke in low- and middle-income countries are limited. Objective: This systematic review aimed to evaluate the effectiveness and outcomes of an intermediate care model among older adults with stroke. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Scopus, EMBASE, PubMed, CINAHL, MEDLINE, Google Scholar, and reference lists of manually selected articles were searched. Only studies published in English from 2012 to 2023 were included. Randomized controlled trials and quasi-experimental studies focusing on functional improvement in motor function, activities of daily living (ADLs), and quality of life in older adults with stroke receiving home-based or community intermediate care were considered. Data extraction utilized the PICO framework. Three reviewers independently conducted a critical appraisal and risk of bias assessments, with two additional reviewers resolving any discrepancies. Results: Eleven studies from low- and middle-income countries were included. The interventions varied, encompassing exercise programs, therapy sessions, video-based programs, reminiscence therapy, and caregiver-assisted therapy, targeting various aspects of stroke recovery and rehabilitation. The interventions demonstrated positive effects on functional outcomes, significantly improving ADLs and overall quality of life. Conclusions: Despite variability in functional outcomes, the study highlights that implementing home-based intermediate care can be crucial for stroke patients in low-resource settings.