Exploring Dynamics in Post-stroke Motor Rehabilitation: A Systematic Review of Implementation Barriers and Facilitators using the COM-B Model.

Abstract

PurposeThis systematic review aimed to identify barriers and facilitators in post-stroke motor rehabilitation across patient, caregiver, and healthcare professional levels, employing the capability, opportunity, motivation, behavior (COM-B) model and the theoretical domains framework (TDF).Materials and MethodsA systematic search of PubMed, EMBASE, Cochrane Library, Web of Science, and CINAHL, following PRISMA guidelines, covered literature until January 20, 2025. Studies reporting qualitative, quantitative, or mixed-methods data on post-stroke motor rehabilitation barriers and facilitators were included. Quality assessment utilized MMAT 2018.ResultsAnalyzing 48 studies, we found that barriers to post-stroke motor rehabilitation encompassed motor impairments, cognitive issues, resource scarcity, and environmental factors, while facilitators included good physical abilities, resource accessibility, and social support. The COM-B model elucidated the dynamic interplay between capability, opportunity, and motivation, suggesting educational interventions and telerehabilitation as avenues for improvement.ConclusionThis systematic review, guided by the COM-B model, identifies key barriers and facilitators in post-stroke motor rehabilitation. It emphasizes the importance of targeted education, improved telerehabilitation infrastructure, and robust social support systems to address multifaceted challenges.