The Effectiveness of Community-Based Interventions in Improving Activities of Daily Living and Quality of Life Outcomes in Persons Living with Stroke: a Systematic Review

Purpose: Despite the growth of literature regarding community-based interventions (CBI) in low-to middle-income and high-income countries, its effectiveness in improving outcomes related to activities of daily living (ADL) and quality of life (QOL) in people with stroke is inconclusive. This systematic review compared the effectiveness of community-based interventions with the usual or hospital-based treatments in improving ADL and QOL outcomes in this population. Method: Four databases were systematically searched from inception until December 31, 2020, for relevant experimental studies from high-income and low-to middle-income countries that compared CBI with the usual/hospital rehabilitation on outcomes related to ADLs and QOL in clients with stroke. Results: All the 10 experimental studies that were included came from high-income countries (Italy, United Kingdom, South Korea, Canada, and Australia), involving 1575 participants (806 males, 656 females, 113 not classified) with age range from 22-103 years. Seven articles measured ADL performance, and 10 measured QOL. Results indicated that CBI generally demonstrates improvement in ADL and QOL values similar to usual or hospital-based care. There was wide variability in the interventions described and the outcome measures used for both groups. Risk of bias assessment revealed issues with randomisation, blinding and follow-up. Stroke-specific baseline characteristics such as length of time since diagnosis and laterality varied considerably in all of the studies.