Nurse-led and nurse-coordinated exercise rehabilitation for functional recovery in post-stroke patients: a systematic literature review

  • Dally Rahman
    Universitas Andalas
    Indonesia
  • Jeki Haryanto 
    Universitas Negeri Padang
    Indonesia

Abstract

Stroke is a leading cause of acquired adult disability, and most survivors retain motor, functional, and psychosocial impairments that constrain independence and quality of life. Although exercise-based rehabilitation is central to recovery, the specific contribution of nursing care to delivering, coordinating, and sustaining exercise rehabilitation remains fragmented across the literature. This systematic literature review synthesized evidence on exercise rehabilitation delivered within post-stroke nursing care and its effectiveness for functional recovery. The review followed the PRISMA 2020 framework, searching the Scopus database for peer-reviewed English-language journal articles published between 2016 and 2025. Of 155 records identified, 15 duplicates were removed, 140 records were screened, 31 full-text reports were assessed, and 13 studies met the eligibility criteria. Included studies comprised randomized and non-randomized controlled trials, a cluster-trial process evaluation, a Delphi consensus study, and case reports, conducted predominantly in Asia. Nurse-delivered, nurse-guided, and nurse-coordinated exercise interventions were consistently associated with improved activities of daily living, motor function, balance, mobility, and quality of life, and were non-inferior to therapist-led rehabilitation. Findings support integrating structured exercise rehabilitation into nursing care while highlighting the need for adequately powered, standardized trials. Future research should establish optimal dose, delivery models, and long-term outcomes.

Keywords
  • Post-stroke
  • Exercise rehabilitation
  • Nursing care
  • Functional recovery
  • Stroke rehabilitation
Lisensing Information
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

References
  1. An, M., & Shaughnessy, M. (2011). The effects of exercise-based rehabilitation on balance and gait for stroke patients: A systematic review. Journal of Neuroscience Nursing, 43(6), 298. https://doi.org/10.1097/JNN.0b013e318234ea24
  2. Aromataris, E., & Munn, Z. (Eds.). (2020). JBI manual for evidence synthesis. JBI. https://doi.org/10.46658/JBIMES-20-01
  3. Balram, V., Ingleton, R., Parsons, D., George, S., & Van Den Berg, M. (2025). Non-pharmacological interventions to treat mood disturbances post-stroke: a systematic review. Topics in Stroke Rehabilitation, 32(2), 188. https://doi.org/10.1080/10749357.2024.2384325
  4. Bernocchi, P., Vanoglio, F., Baratti, D., Morini, R., Rocchi, S., Luisa, A., & Scalvini, S. (2016). Home-based telesurveillance and rehabilitation after stroke: A real-life study. Topics in Stroke Rehabilitation, 23(2), 106. https://doi.org/10.1080/10749357.2015.1120453
  5. Boyne, P., Welge, J., Kissela, B., & Dunning, K. (2017). Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke: A Meta-Analysis With Meta-Regression. Archives of Physical Medicine and Rehabilitation, 98(3), 581. https://doi.org/10.1016/j.apmr.2016.08.484
  6. Chen, M.-D., & Rimmer, J.H. (2011). Effects of exercise on quality of life in stroke survivors: A meta-analysis. Stroke, 42(3), 832. https://doi.org/10.1161/STROKEAHA.110.607747
  7. Chen, P.-J., Chen, K.-M., Hsu, H.-F., & Belcastro, F. (2022). Types of exercise and training duration on depressive symptoms among older adults in long-term care facilities. Ageing Research Reviews, 77. https://doi.org/10.1016/j.arr.2022.101613
  8. Chen, S., Lv, C., Wu, J., Zhou, C., Shui, X., & Wang, Y. (2021). Effectiveness of a home-based exercise program among patients with lower limb spasticity post-stroke: A randomized controlled trial. Asian Nursing Research, 15(1), 1. https://doi.org/10.1016/j.anr.2020.08.007
  9. Crocker, T., Forster, A., Young, J., Brown, L., Ozer, S., Smith, J., Green, J., Hardy, J., Burns, E., Glidewell, E., & Greenwood, D.C. (2013). Physical rehabilitation for older people in long-term care. Cochrane Database of Systematic Reviews, 2013(2). https://doi.org/10.1002/14651858.CD004294.pub3
  10. De Man-Van Ginkel, J.M., Gooskens, F., Schuurmans, M.J., Lindeman, E., & Hafsteinsdottir, T.B. (2010). A systematic review of therapeutic interventions for poststroke depression and the role of nurses. Journal of Clinical Nursing, 19(23-24), 3274. https://doi.org/10.1111/j.1365-2702.2010.03402.x
  11. Gamble, K., Chiu, A., & Peiris, C. (2021). Core Stability Exercises in Addition to Usual Care Physiotherapy Improve Stability and Balance After Stroke: A Systematic Review and Meta-analysis. Archives of Physical Medicine and Rehabilitation, 102(4), 762. https://doi.org/10.1016/j.apmr.2020.09.388
  12. Ge, L., Zheng, Q.-X., Liao, Y.-T., Tan, J.-Y., Xie, Q.-L., & Rask, M. (2017). Effects of traditional Chinese exercises on the rehabilitation of limb function among stroke patients: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice, 29, 35. https://doi.org/10.1016/j.ctcp.2017.08.005
  13. Graven, C., Brock, K., Hill, K., & Joubert, L. (2011). Are rehabilitation and/or care co-ordination interventions delivered in the community effective in reducing depression, facilitating participation and improving quality of life after stroke?. Disability and Rehabilitation, 33(17-18), 1501. https://doi.org/10.3109/09638288.2010.542874
  14. Gwynne-Mayer, N., Drummond, A.E., Hancox, J., Alrubaia, W., & Taylor, I.M. (2025). Adherence to exercise rehabilitation programmes in stroke survivors: a scoping review. BMJ Open Sport and Exercise Medicine, 11(3). https://doi.org/10.1136/bmjsem-2024-002102
  15. Hermawan, S.M., & Wihardja, H. (2021). Pursuing the need for physical activity in recurrent cva patients during hospitalization: A case report. Jurnal Keperawatan Indonesia, 24(1), 42. https://doi.org/10.7454/jki.v24i1.1074
  16. Hewitt, J., Walters, M., Padmanabhan, S., & Dawson, J. (2016). Cohort profile of the UK Biobank: Diagnosis and characteristics of cerebrovascular disease. BMJ Open, 6(3). https://doi.org/10.1136/bmjopen-2015-009161
  17. Hong, Q. N., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., Gagnon, M.-P., Griffiths, F., Nicolau, B., O’Cathain, A., Rousseau, M.-C., Vedel, I., & Pluye, P. (2018). The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for Information, 34(4), 285. https://doi.org/10.3233/EFI-180221
  18. Howlett, O.A., Lannin, N.A., Ada, L., & Mckinstry, C. (2015). Functional electrical stimulation improves activity after stroke: A systematic review with meta-analysis. Archives of Physical Medicine and Rehabilitation, 96(5), 934. https://doi.org/10.1016/j.apmr.2015.01.013
  19. Jun, E.-M., Roh, Y.H., & Kim, M.J. (2013). The effect of music-movement therapy on physical and psychological states of stroke patients. Journal of Clinical Nursing, 22(1-2), 22. https://doi.org/10.1111/j.1365-2702.2012.04243.x
  20. Koç, A. (2015). Exercise in patients with subacute stroke: A randomized, controlled pilot study of home-based exercise in subacute stroke. Work, 52(3), 541. https://doi.org/10.3233/WOR-152156
  21. Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159. https://doi.org/10.2307/2529310
  22. Li, N., Wang, J., Zheng, M., & Ge, Q. (2021). Application Value of Rehabilitation Nursing in Patients with Stroke Based on the Theory of Interactive Standard: A Randomized Controlled Study. Evidence-based Complementary and Alternative Medicine, 2021. https://doi.org/10.1155/2021/9452765
  23. Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6(7), e1000100. https://doi.org/10.1371/journal.pmed.1000100
  24. Lv, X., & Chen, H. (2022). Effect of Virtual Reality Combined with Intelligent Exercise Rehabilitation Machine on the Nursing Recovery of Lower Limb Motor Function of Patients with Hypertensive Stroke. Journal of Healthcare Engineering, 2022. https://doi.org/10.1155/2022/2106836
  25. Machado, N., Wingfield, M., Kramer, S., Olver, J., Williams, G., & Johnson, L. (2022). Maintenance of Cardiorespiratory Fitness in People With Stroke: A Systematic Review and Meta-analysis. Archives of Physical Medicine and Rehabilitation, 103(7), 1410. https://doi.org/10.1016/j.apmr.2022.01.151
  26. Mao, Y.-C., Li, H.-H., Tao, S., Zhang, W.-W., Zhang, L.-H., Geng, D.-Q., Ren, N., & Gao, L.-Y. (2025). Clinical Effectiveness of Multimodal Exercise Combined with Supportive Music and Imagery in the Management of Poststroke Mood Disorders. Journal of Neuroscience Nursing, 57(2), 61. https://doi.org/10.1097/JNN.0000000000000798
  27. Mehrholz, J., Thomas, S., Kugler, J., Pohl, M., & Elsner, B. (2020). Electromechanical-assisted training for walking after stroke. Cochrane Database of Systematic Reviews, 2020(10). https://doi.org/10.1002/14651858.CD006185.pub5
  28. Mi, Y., Qu, S., Huang, J., Yin, Y., Luo, S., Li, W., & Wang, X. (2024). Effective evaluations of community nursing on rehabilitation for stroke survivors: A meta-analysis. Geriatric Nursing, 57, 80. https://doi.org/10.1016/j.gerinurse.2024.03.004
  29. Miller, S.M., Hui-Lio, C., & Taylor-Piliae, R.E. (2020). Health Benefits of Tai Chi Exercise: A Guide for Nurses. Nursing Clinics of North America, 55(4), 581. https://doi.org/10.1016/j.cnur.2020.07.002
  30. Nadeem, I., Butt, S.K., Mubeen, I., & Razzaq, A. (2024). Effects of core muscles strengthening exercises with routine physical therapy on trunk balance in stroke patients: A randomized controlled trial. Journal of the Pakistan Medical Association, 74(5), 848. https://doi.org/10.47391/JPMA.9660
  31. Nagai, K., & Yamaguchi, F. (2017). Improved functional independence measure facilitates return to home after paralyzed upper-limb training: A case report. Journal of Physical Therapy Science, 29(5), 954. https://doi.org/10.1589/jpts.29.954
  32. Ono, K., Nishimoto, J., Imura, T., Mitsutake, T., Inoue, Y., Tanaka, S., & Tanaka, R. (2023). The effects of walking training with poles on walking ability: A systematic review and meta-analysis of randomized controlled trials. PM and R, 15(8), 1026. https://doi.org/10.1002/pmrj.12886
  33. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71
  34. Putra, K.A.N., Suyasa, I.G.P.D., Kamaryati, N.P., & Dharmapatni, N.W.K. (2024). Development of a self-care guideline to prevent rehospitalization in stroke patients: a modified Delphi study. Jurnal Ners, 19(1), 21. https://doi.org/10.20473/jn.v19i1.48937
  35. Salbach, N.M., Wood-Dauphinee, S., Desrosiers, J., Eng, J.J., Graham, I.D., Jaglal, S.B., Korner-Bitensky, N., MacKay-Lyons, M., Mayo, N.E., Richards, C.L., Teasell, R.W., Zwarenstein, M., & Bayley, M.T. (2017). Facilitated interprofessional implementation of a physical rehabilitation guideline for stroke in inpatient settings: Process evaluation of a cluster randomized trial. Implementation Science, 12(1). https://doi.org/10.1186/s13012-017-0631-7
  36. Saraiva, J., Rosa, G., Fernandes, S., & Fernandes, J.B. (2023). Current Trends in Balance Rehabilitation for Stroke Survivors: A Scoping Review of Experimental Studies. International Journal of Environmental Research and Public Health, 20(19). https://doi.org/10.3390/ijerph20196829
  37. Shaughnessy, M., Michael, K., & Resnick, B. (2012). Impact of treadmill exercise on efficacy expectations, physical activity, and stroke recovery. Journal of Neuroscience Nursing, 44(1), 27. https://doi.org/10.1097/JNN.0b013e31823ae4b5
  38. Sterne, J. A. C., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., Cates, C. J., Cheng, H.-Y., Corbett, M. S., Eldridge, S. M., Hernán, M. A., Hopewell, S., Hróbjartsson, A., Junqueira, D. R., Jüni, P., Kirkham, J. J., Lasserson, T., Li, T., McAleenan, A., ... Higgins, J. P. T. (2019). RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ, 366, l4898. https://doi.org/10.1136/bmj.l4898
  39. Stivala, A., & Hartley, G. (2014). The effects of a pilates-based exercise rehabilitation program on functional outcome and fall risk reduction in an aging adult status-post traumatic hip fracture due to a fall. Journal of Geriatric Physical Therapy, 37(3), 136. https://doi.org/10.1519/JPT.0b013e3182abe7a9
  40. Taki, S., Iwamoto, Y., Imura, T., Mitsutake, T., & Tanaka, R. (2022). Effects of gait training with the Hybrid Assistive Limb on gait ability in stroke patients: A systematic review of randomized controlled trials. Journal of Clinical Neuroscience, 101, 186. https://doi.org/10.1016/j.jocn.2022.04.001
  41. Teodoro, J., Fernandes, S., Castro, C., & Fernandes, J.B. (2024). Current Trends in Gait Rehabilitation for Stroke Survivors: A Scoping Review of Randomized Controlled Trials. Journal of Clinical Medicine, 13(5). https://doi.org/10.3390/jcm13051358
  42. Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8, 45. https://doi.org/10.1186/1471-2288-8-45
  43. Tranfield, D., Denyer, D., & Smart, P. (2003). Towards a methodology for developing evidence-informed management knowledge by means of systematic review. British Journal of Management, 14(3), 207. https://doi.org/10.1111/1467-8551.00375
  44. van Nimwegen, D., Hjelle, E.G., Bragstad, L.K., Kirkevold, M., Sveen, U., Hafsteinsdóttir, T., Schoonhoven, L., Visser-Meily, J., & de Man-van Ginkel, J.M. (2023). Interventions for improving psychosocial well-being after stroke: A systematic review. International Journal of Nursing Studies, 142. https://doi.org/10.1016/j.ijnurstu.2023.104492
  45. Vloothuis, J., Mulder, M., Nijland, R.H.M., Konijnenbelt, M., Mulder, H., Hertogh, C.M.P.M., van Tulder, M., Kwakkel, G., & van Wegen, E. (2015). Caregiver-mediated exercises with e-health support for early supported discharge after stroke (CARE4STROKE): Study protocol for a randomized controlled trial. BMC Neurology, 15(1). https://doi.org/10.1186/s12883-015-0440-z
  46. Vloothuis, J.D.M., Mulder, M., Veerbeek, J.M., Konijnenbelt, M., Visser-Meily, J.M., Ket, J.C., Kwakkel, G., & van Wegen, E.E. (2016). Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database of Systematic Reviews, 2016(12). https://doi.org/10.1002/14651858.CD011058.pub2
  47. Wang, J., Zhang, Y., Chen, Y., Li, M., Yang, H., Chen, J., Tang, Q., & Jin, J. (2021). Effectiveness of rehabilitation nursing versus usual therapist-led treatment in patients with acute ischemic stroke: A randomized non-inferiority trial. Clinical Interventions in Aging, 16, 1173. https://doi.org/10.2147/CIA.S306255
  48. Wu, Z., Xu, J., Yue, C., Li, Y., & Liang, Y. (2020). Collaborative Care Model Based Telerehabilitation Exercise Training Program for Acute Stroke Patients in China: A Randomized Controlled Trial. Journal of Stroke and Cerebrovascular Diseases, 29(12). https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105328
  49. Yingying, P., Zang, L., Wang, X., & Yang, X. (2022). Effect of Continuous Care Combined with Constraint-Induced Movement Therapy Based on a Continuing Care Health Platform on MBI and FMA Scores of Acute Stroke Patients. Journal of Healthcare Engineering, 2022. https://doi.org/10.1155/2022/5299969
  50. Yuet Wong, F.K., Wang, S.L., Ng, S.S.M., Lee, P.H., Ching Wong, A.K., Li, H., Wang, W., Wu, L., Zhang, Y., & Shi, Y. (2022). Effects of a transitional home-based care program for stroke survivors in Harbin, China: a randomized controlled trial. Age and Ageing, 51(2). https://doi.org/10.1093/ageing/afac027
  51. Zhang, L., Shen, T., Zhou, Y., Xie, X., Wang, J., & Gao, H. (2024). Multidisciplinary management based on clinical nursing pathway model for the treatment of hypertensive intracerebral hemorrhage: A randomized controlled trial. Medicine (United States), 103(12), E37644. https://doi.org/10.1097/MD.0000000000037644

Downloads

PDF

Statistic

Abstract Views
: 13 times
PDF
: 7 times