Facilitators and barriers of community reintegration among individuals with stroke: a scoping review

Purpose: This scoping review attempts to identify the factors influencing community reintegration (CR) among individuals with stroke and classify them as facilitators and barriers. Methods: A thorough search was run through PubMed, Scopus, Cochrane, ProQuest, EMBASE, CINHAL, and PEDRO for studies published from 2014 to August 2021. The review was based on Preferred Reporting Items for Systematic Review and Meta-analysis for Scoping Reviews (PRISMA-ScR) guidelines. The retrieved articles were screened for title and abstract using the Rayyan QCRI software. The quality of the included studies was determined using National Heart, Lung, and Blood Institute (NIH) tool. Results: Of the 1466 studies retrieved, 14 that included 1383 stroke individuals fulfilled the eligibility criteria and were selected for review. Based on the scores obtained on the NIH tool for quality assessment, the methodological quality of 6 studies was found to be good, and remaining 8 were fair. Individuals with better motor function, good balance, greater functional independence and quality of life, optimal support from the family and community, longer post-stroke duration, higher levels of education, and employment had higher CR and hence were facilitators of CR. Older age, diabetes mellitus, smoking, severe stroke, impaired cognition, depression, falls, gait impairments, and use of assistive devices were identified as barriers to CR. Conclusion: The review identified factors that were either facilitators or barriers to CR. A multidisciplinary rehabilitation addressing modifiable facilitators and barriers such as motor function, balance, fear of fall, functional dependence, depression, comorbidities, and impaired cognition is necessary to improve CR in stroke survivors.