JMIR Publications

ABSTRACT

Background:

Stroke is a leading cause of long-term disability, and sustained, high-intensity rehabilitation is critical for functional recovery. Community- and home-based rehabilitation is increasingly supported by digital health technologies (DHTs), including telerehabilitation platforms, mobile applications, virtual reality (VR) systems, robotics, and wearable devices. However, evidence regarding real-world implementation of these technologies within community settings remains fragmented and no existing review has systematically mapped their implementation status, associated barriers, facilitators and implementation strategies.

Objective:

This scoping review aimed to (1) map the current implementation landscape of DHTs for community-based stroke rehabilitation, including geographic distribution, technology types, delivery settings, study designs, and follow-up assessment arrangements; (2) characterize the reporting of implementation-related outcomes and stratify included studies according to the depth of their implementation data; and (3) synthesize barriers, facilitators, and implementation strategies reported by stroke survivors, caregivers, and clinicians.

Methods:

We systematically searched PubMed, Web of Science, SinoMed, and CNKI for English- and Chinese-language original studies published between January 2016 and August 2026. Eligible studies evaluated DHTs for community- or home-based stroke rehabilitation and reported implementation-related outcomes. Screening, data extraction, and synthesis were undertaken in accordance with the PRISMA-ScR checklist. Implementation evidence was coded into eight predefined categories (Cat.1–8) and each study was assigned to one of three levels of evidence richness (L1–L3): Level 1 (basic-level evidence extraction), Level 2 (moderate-depth evidence extraction), and Level 3 (in-depth evidence extraction containing participant-reported qualitative material). Thematic synthesis of barriers, facilitators, and implementation strategies was restricted to the 22 Level-3 studies with formal qualitative data, guided by five predefined thematic domains.

Results:

Of 1,942 records identified, 111 studies met the inclusion criteria. The majority were conducted in North America (n = 45, 40.5%) and recruited participants with chronic phase stroke (n = 57, 51.4%); 76 studies (68.5%) delivered interventions exclusively at home. Mobile applications represented the most prevalent technology modality (n = 56). Only 26 studies (23.4%) reported follow-up assessments of ≥1 month post intervention. Adherence was the most frequently reported implementation outcome (n = 87, 78.4%), while safety (n = 25, 22.5%), health-economic (n = 4, 3.6%), and intervention fidelity (n = 3, 2.7%) outcomes were rarely reported. Sixty-four studies (57.7%) were assigned to Level 1, 25 (22.5%) to Level 2, and 22 (19.8%) to Level 3. The thematic synthesis of qualitative data identified barriers and facilitators spanning five predefined thematic domains: technology-system, individual-participant, caregiver and social context, clinical service delivery, and intervention content, and generated 28 actionable implementation strategies.

Conclusions:

DHTs for community-based stroke rehabilitation are expanding rapidly, yet the implementation evidence remains largely superficial. Data on safety, health-economics, and long-term follow-up are critically scarce, and only one-fifth of included studies contain in-depth formal qualitative enquiry. Future research should draw on implementation-science frameworks, standardize the reporting of implementation-outcomes, and prioritize rigorous qualitative evaluation to facilitate sustainable real-world uptake. Clinical Trial: digital health; telerehabilitation; stroke rehabilitation; community-based rehabilitation; implementation science; barriers and facilitators; mobile applications; scoping review