Deans' stroke musings: Economic evaluations of outpatient stroke rehabilitation models: a systematic review of evidence, methods, and gaps

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, May 12, 2026

Economic evaluations of outpatient stroke rehabilitation models: a systematic review of evidence, methods, and gaps

Survivors want recovery statistics NOT COST!

Economic evaluations of outpatient stroke rehabilitation models: a systematic review of evidence, methods, and gaps

Ahmad Al Miaraja,b Send email to ahmad.miaraj.22@ucl.ac.uk ∙ Sonila M. Tominia ∙ Nick Wardc ∙ Rodolfo Catenaa

Affiliations & Notes

Background

Stroke imposes an ongoing burden on patients and health systems, making outpatient rehabilitation essential. The economic efficiency of alternative outpatient models remains uncertain, complicating resource allocation. We systematically reviewed and critically appraised full economic evaluations of outpatient stroke rehabilitation to synthesise evidence on reported cost-effectiveness, assess how costs and outcomes have been measured, and identify key methodological limitations and evidence gaps.

Methods

We conducted a PRISMA-guided systematic review (PROSPERO: CRD420251151991) of full economic evaluations of outpatient stroke rehabilitation. Embase, Emcare, Medline, CINAHL, Cochrane Library, Web of Science, and PubMed were searched, with publication coverage including all available studies published prior to September 2025. Eligible studies included adults with ischemic or haemorrhagic stroke undergoing outpatient rehabilitation and reporting full economic evaluations. We excluded inpatient-only rehabilitation, transient ischaemic attack, partial evaluations, reviews, and non-English publications. Two reviewers independently screened, extracted, and appraised studies. Risk of bias (RoB 2, ROBINS-I) and methodological quality (Drummond checklist) were assessed, with data narratively synthesised by rehabilitation model and evaluation type.

Findings

The search yielded 1800 records, of which 27 studies met inclusion criteria. Across studies, community-based, home-based, and early supported discharge rehabilitation models frequently demonstrated favourable cost-effectiveness when compared with inpatient or outpatient clinic-based rehabilitation. Study settings were global, with over one-third from the UK. Most were randomised controlled trials (56%), with cost-effectiveness analyses predominating (63%). Community- and home-based rehabilitation were most common (each 30%), followed by outpatient clinic-based (22%), early supported discharge (11%), and telerehabilitation (7%). Outcomes clustered into health-related quality of life (41%), functional recovery (37%), and process measures (22%). Methodological quality was mostly moderate (16/27), with seven high and four low. RCTs showed some reporting concerns, while most non-randomised studies carried serious risk of bias.

Interpretation

Evidence from existing economic evaluations suggests that shifting stroke rehabilitation toward outpatient and community-based rehabilitation models may demonstrate more favourable cost-effectiveness profiles in certain contexts, while evidence on telerehabilitation remains limited. However, these findings should be interpreted with caution due to substantial heterogeneity across study designs, comparators, outcomes, and economic evaluation methods. To better inform decision-making, future studies should adopt standardised outcome measures, extend follow-up, and generate context-specific economic evidence, particularly in low- and middle-income countries.