This scoping review aimed to systematically synthesize and characterize the existing evidence on long-term utilization of specialized healthcare services (neurology, physical medicine and rehabilitation, and allied health professions) and describe rates of utilization beyond six months post-stroke.
A scoping review was conducted following PRISMA-ScR guidelines. PubMed, CINAHL, Scopus, and Web of Science databases were searched for studies published between 2010 and 2023. Inclusion criteria encompassed research on community-dwelling adult stroke survivors in the chronic phase, reporting utilization of stroke-related medical or rehabilitative services. Data on the methodological landscape of the reviewed research, including sources of data, chronicity of stroke, timing and duration of assessment segments, and utilization outcomes were collected.
Fourteen studies met the inclusion criteria, encompassing 204,879 participants from 12 countries. Substantial heterogeneity was observed in study characteristics and approaches, including differences in sources of data collected (e.g., self-report, medical records) and measurement format (e.g., unit and timing of assessment). Utilization rates of all reviewed health services in the chronic phase (i.e., >6 months post-stroke) were low across studies. Stroke-related services utilization rates were generally low: 4–18% for neurology, 4.8–16% for physical therapy, 4.1–11.9% for occupational therapy, and 5.1–29.8% for speech-language therapy. All longitudinal studies reported a decline in utilization rates. Physical therapy utilization, for instance, dropped by 50% within 6–12 months post-stroke. From the first to the second year post-stroke, utilization declined by approximately 20–30% across all allied health services. From the second year post-stroke to the 10th year, the rate of persons with stroke who utilized rehabilitation services at least once in two years reduced by at least 6%.
This scoping review uncovers a substantial gap between recommended long-term stroke care and actual service utilization, characterized by consistently low and declining rates of neurology and allied health service use. This trend raises concerns about the long-term support and recovery of stroke survivors and reveals possible missed opportunities for functional improvement and secondary prevention that could enhance the quality of life for these individuals.
Addressing these issues requires developing sustainable post-stroke care models that address enduring medical and rehabilitative needs throughout the chronic phase. This may be achieved through a multifaceted approach: targeted outreach programs, education for patients and healthcare providers, and policy changes to ensure that rehabilitation services are not only available but also actively utilized by those in need. Integrating technology like telehealth can facilitate ongoing support, monitoring, and access to resources, helping patients maintain rehabilitation progress.
long-term
healthcare utilization
