Co esponding au ho : Sindhu J Vayalil
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Res o ing li es, elie ing bu dens: The ole o s oke ehabili a ion in suppo ing and
empowe ing ca egi e s: A e iew
Nee hu M 1 and Sindhu J Vayalil 2, *
1 Depa men o Medical Su gical Nu sing, Bishop Benzige College o Nu sing, Ke ala, India.
2 Depa men o Medical Su gical Nu sing, Me cy College o Nu sing, Ko ayam, Ke ala, India.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1047-1056
Publica ion his o y: Recei ed on 01 July 2025; e ised on 11 Augus 2025; accep ed on 13 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.2903
Abs ac
S oke is one o he majo causes o mo bidi y and mo ali y globally, pu ing a huge s ain on pa ien s, amilies, and
heal hca e sys ems. While s oke ehabili a ion is c i ical o egaining unc ion and imp o ing ou comes o su i o s,
i also places a signi ican bu den on in o mal ca e s. Ca egi e s play an impo an ole in sus aining ehabili a i e
imp o emen s and ensu ing con inui y o ca e, o en a he expense o hei own physical, men al, and social heal h.
This e iew aims o explo e he ex ensi e impac o s oke ehabili a ion on ca egi e s by syn hesizing in o ma ion
om cu en esea ch on ca egi e bu den, coping me hods, and quali y o li e. Key indings show ha ac i e
ca egi e pa icipa ion in ehabili a ion imp o es pa ien adhe ence and ou comes while also inc easing
ca egi e s ess and psychological s ain. Ca egi e s also ha e a subs an ial bu den due o ac o s such as s oke
se e i y, insu icien aining, and es ic ed suppo ne wo ks. S uc u ed home-based p og ams, psychoeduca ion,
pee -suppo g oups, and digi al heal h ea men s a e among he eme ging op ions ha show p omise o lowe ing
ca egi e s ess and inc easing esilience. This e iew emphasises he need o inco po a e ca egi e -cen ed
echniques in o ehabili a ion amewo ks o p omo e op imal eco e y o s oke su i o s while educing
ca egi e s ain.
Keywo ds: S oke Rehabili a ion; Ca egi e Bu den; Quali y o Li e; Home-Based Ca e; Tele-Rehabili a ion; Ca egi e
Suppo .
1. In oduc ion
S oke is a de as a ing neu ological condi ion ha no only a ec s pa ien s bu also places signi ican bu dens on hei
ca egi e s. Acco ding o Global Bu den o Disease(2019), s oke is he second leading cause o dea h and he hi d mos
signi ican cause o dea h and disabili y [1,2]. Almos all s oke su i o s ha e physical, psychological, and li e-al e ing
consequences [3]. App oxima ely 75% o s oke pa ien s expe ience a ying deg ees o mo o , speech, and swallowing
di icul ies, wi h app oxima ely 20% o su i o s being wheelchai -bound o bed idden. Addi ionally, mo e han hal o
s oke pa ien s a e eleased wi h neu ological sequelae ha need long- e m, app op ia e ehabili a ion ea men [4].
Despi e his p og ess in acu e s oke ca e, mo e pa ien s a e su i ing s okes bu o en wi h signi ican disabili ies,
necessi a ing comp ehensi e long- e m ca e s a egies [5]. Ca egi e s play a c i ical ole in sus aining s oke su i o s'
p og ess in ehabili a ion and long- e m well-being. The emphasis in s oke ehabili a ion has shi ed om ocusing
solely on he s oke su i o o a s oke su i o -ca egi e dyad app oach, ecognizing he c i ical ole ca egi e s play
in eco e y [6]. S oke ehabili a ion aims o imp o e pa ien s' physical capaci y, cogni i e unc ion, and emo ional well-
being, all o which a e ypically comp omised a e a s oke. E ec i e ehabili a ion can lead o imp o emen s in mo o
disabili y, cogni i e s a us, and mood, he eby enhancing he o e all eco e y p ocess [7]. Howe e , he le el o
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disabili y and p esence o como bidi ies in pa ien s a e c i ical ac o s ha a ec he ehabili a ion ou comes and he
ex en o ca egi e bu den [8].
E o s o minimize he wo ldwide bu den o s oke p io i ize p e en ion ia awa eness p og ams ha a ge isk
ac o s such as hype ension, obesi y, smoking and physical inac i i y [9]. Fu he mo e, p og ams ha ocus on ge ing
people o acu e ca e quickly, sophis ica ed he apies like h omboly ic he apy, and ull ehabili a ion a e e y
impo an o educing he e ec s o s oke [10]. Add essing he wo ldwide bu den o s oke equi es collabo a ion
among go e nmen s, heal hca e o ganiza ions, ad ocacy g oups, and communi ies. Ini ia i es aiming a imp o ing
access o heal hca e, inc easing s oke awa eness, encou aging heal hie li es yles, and de eloping ehabili a ion
se ices a e essen ial in lowe ing he bu den o s oke globally [11].To educe he bu den o s oke and imp o e
ou comes o pe sons su e ing om his de as a ing condi ion, me hods such as p e en ion, ea ly in e en ion, access
o quali y ea men , and comp ehensi e ehabili a ion a e essen ial [5].
By syn hesising exis ing in o ma ion and emphasising new ends, his e iew se es as a aluable esou ce o
physicians, esea che s, and policymake s in ol ed in s oke ca e and ca egi e suppo . Ra he han ollowing he igid
o ma o a sys ema ic e iew, his manusc ip adop s a igo ous, in eg a i e app oach o li e a u e selec ion guided by
de ined inclusion c i e ia emphasizing ele ance, me hodological quali y, o iginali y, and a ocus on ecen inno a ions
in s oke ehabili a ion ha di ec ly o indi ec ly in luence ca egi e ou comes. Recognising ha s oke ehabili a ion
is inhe en ly mul i ace ed, his e iew co e s a wide ange o opics, om acu e ca e ansi ions o long- e m
communi y-based in e en ions, wi h a ocus on ca e s, who a e he ounda ion o s oke eco e y in he home and
communi y se ing.
This e iew pape explo es he in ica e and in e dependen ela ionship be ween s oke ehabili a ion and ca egi e
well-being, o e ing a comp ehensi e o e iew o cu en p ac ices, challenges, and u u e di ec ions. I hen c i ically
examines cu en ehabili a ion app oaches such as ea ly mobiliza ion, physical he apy, occupa ional he apy, speech-
language he apy, cogni i e ehabili a ion, and psychosocial suppo and assesses how hese a ec ca egi e bu den,
ole s ain, and adap a ion. Special a en ion is gi en o how he ehabili a ion p ocess in luences he emo ional,
physical, and economic domains o ca egi e s' li es.
Ca egi e s in de eloping coun ies ace heigh ened challenges due o limi ed access o s uc u ed ehabili a ion
se ices, inancial cons ain s, and inadequa e heal h sys em suppo . Addi ionally, he e iew highligh s inno a ions in
ca egi e suppo models such as ele- ehabili a ion, pee -suppo amewo ks, cul u ally adap ed educa ion p og ams,
and he use o echnology-assis ed ca egi ing ools, which show p omise in educing ca egi e bu den and imp o ing
quali y o li e. Cul u al expec a ions and lack o o mal aining u he exace ba e ca egi e bu den, making s oke
eco e y a complex and demanding esponsibili y in low- esou ce se ings [12]. Emphasis is placed on he need o
ca egi e - ocused ou come me ics in s oke ials, in eg a ion o ca egi e aining in o ea ly ehabili a ion phases,
and he de elopmen o scalable, sus ainable home-based ehabili a ion p og ams ha acknowledge he pi o al ole o
in o mal ca egi e s. By b idging clinical insigh s wi h ca egi e eali ies, his manusc ip aims o con ibu e o a mo e
inclusi e, e idence-based ehabili a ion amewo k ha es o es li es while elie ing he bu dens placed on ca egi e s.
This e iew explo es he mul i ace ed e ec s o ehabili a ion p og ams on he physical, emo ional, and social well-
being o indi iduals ca ing o s oke su i o s. By analyzing o iginal esea ch s udies, he e iew aims o iden i y key
a eas whe e ehabili a ion in e en ions con ibu e o educed ca egi e bu den, imp o ed quali y o li e, and enhanced
coping s a egies. Th ough a syn hesis o ecen e idence, his e iew highligh s he complex ela ionship be ween
s oke ehabili a ion and ca egi e well-being, o e ing insigh s o clinical p ac ice and policy de elopmen .
2. S oke Rehabili a ion: An O e iew
S oke ehabili a ion is an o ganised p ocess ha helps people es o e los abili ies, adap o new di icul ies, and
maximise hei independence and quali y o li e ollowing a s oke. I in ol es a ious he apies, including physical
he apy ( o imp o ing mo emen and coo dina ion), occupa ional he apy ( o de eloping daily li ing skills), and
speech he apy ( o enhancing communica ion), ailo ed o he indi idual's needs. I also includes cogni i e he apy o
imp o e hinking, memo y, and o he men al abili ies. Acco ding o he In e na ional S oke Reco e y and
Rehabili a ion Round able, ischaemic s oke has se e al phases: he hype acu e s oke phase, which begins abou 0-24
hou s a e he s oke; he acu e s oke phase, which las s 1-7 days; he ea ly subacu e s oke phase, which occu s wi hin
he i s 3 mon hs; he la e subacu e s oke phase, which occu s be ween 4 and 6 mon hs; and he ch onic s oke phase,
which begins a 6 mon hs and beyond [13]. Unde s anding hese phases is c i ical o ailo ing ehabili a ion s a egies.
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S oke eams ha wo k in hospi als ypically ope a e wi hin speci ic s oke uni s and comp ise s oke doc o s, nu ses,
physio he apis s (PTs), occupa ional he apis s (OTs), speech and language he apis s (SLTs), and heal hca e and
he apy assis an s [14]. Rehabili a ion can be inpa ien (hospi al-based) o ou pa ien (clinic-based) and may in ol e
home-based he apy depending on he pa ien 's needs and he s age o hei eco e y [12]. Hospi al-based ehab o e s
in ensi e, mul idisciplina y ca e o hose wi h se e e impai men s, while ou pa ien p og ams p o ide s uc u ed
he apy o s able pa ien s. Home-based ehab, including ea ly suppo ed discha ge, allows he apy in a amilia
en i onmen bu may be less in ensi e [15]. The Ame ican Hea Associa ion (AHA) p o ides ecommenda ions on
h ee key ca ego ies o home-based ehabili a ion: ea ly suppo ed discha ge (ESD), which se es as a subs i u e o
ex ended acu e ca e; ehabili a ion a home, which eplaces ins i u ional ehabili a ion; and home exe cise p og ams
aimed a long- e m heal h main enance and isk educ ion [16].
3. The Role o Ca egi e s in S oke Reco e y
In o mal ca egi e s a e he majo suppo sys em o s oke su i o s a e discha ge and a i al componen o he
heal h ca e sys em. An in o mal ca egi e , usually a amily membe , p o ides ca e, o en unpaid, o someone wi h whom
hey ha e a pe sonal ela ionship [17]. Ca egi e s play a c ucial and challenging ole in s oke ehabili a ion. They help
s oke pa ien s eco e physically by assis ing hem wi h exe cises, mobili y, and ehabili a ion egimens, all o which
a e essen ial o es o ing los mo o unc ions. Fu he mo e, ca e s o e emo ional suppo o assis pa ien s in
managing he psychological e ec s o he s oke, including anxie y, us a ion, and despai ha may esul om
diminished independence o impai ed mobili y [18]. Ca egi e s o s oke su i o s o en endu e signi ican emo ional
dis ess (including anxie y and dep ession), ch onic physical exhaus ion (such as a igue and sleep dis u bances), and
inancial ha dship s emming om di ec ca e expenses and los income challenges ha a e compounded by he in ensi y
and du a ion o ca egi ing esponsibili ies [19,20]. When ca egi e s ac i ely pa icipa e in ehabili a ion, hey help
hem by coo dina ing ollow-up appoin men s and suppo ing home exe cise egimens, which signi ican ly enhance
pa ien adhe ence, bu his in ol emen also in oduces addi ional inancial and ime commi men s ha con ibu e o
ca egi e bu den [21].
4. Impac o S oke Rehabili a ion on Ca egi e s
The eco e y p ocess o a s oke pa ien signi ican ly impac s ca egi e s ess and bu den, wi h bo h he successes and
challenges o ehabili a ion di ec ly in luencing he ca egi e 's expe ience. Many s udies ha e shown ha home
ehabili a ion can be as e ec i e as, o e en mo e e ec i e han, ins i u ional ca e.
Ca egi e s may endu e s ess and s ain as a esul o gi ing leng hy ca e o hei pa ien s. This bu den is comp ised o
physical, social, psychological, and economic issues. Ca egi e s mus manage he dual challenge o ca ing o a disabled
s oke su i o while also adjus ing hei li es yle. The equi emen s o a s oke su i o di e widely, encompassing
physical needs (such as walking and ans e ing om bed o chai o chai o oile ), communica ion needs (bo h e bal
and non e bal in e ac ions wi h amily and iends), nu sing needs (including eeding, changing clo hes, and pe sonal
hygiene), as well as emo ional and psychological adap a ions o he e ec s o he s oke, along wi h inancial conce ns
(like job loss and medical expenses) [22].
Anxie y and dep ession can a ise quie ly. Repo s indica e ha he p e alence o anxie y and dep essi e symp oms
among p ima y ca egi e s o s oke pa ien s anges om 30% o 45% and 20% o 50%, espec i ely. Nume ous s udies
ha e indica ed ha ca egi e s' anxie y o dep essi e symp oms ad e sely a ec hei socioeconomic s a us, physical
heal h, and o e all quali y o li e. When p ima y ca egi e s expe ience anxie y o dep ession, hei abili y o o e
e ec i e suppo o s oke su i o s may diminish, po en ially hinde ing he pa ien s' ehabili a ion p ocess and
nega i ely impac ing hei disease p ognosis [23].
5. Fac o s In luencing Ca egi e Bu den
A s oke a ec s no jus he indi iduals who su i e bu also he in o mal ca egi e s, who a e esponsible o he
majo i y o ca e du ing he eco e y pe iod [16]. The e ec s o s oke ad e sely in luence he physical, emo ional, social,
and inancial heal h o ca egi e s, which in u n impac s he heal h s a us and quali y o li e o s oke su i o s.
Resea ch indica es ha 25–46% o ca egi e s ace conside able dis ess du ing he ini ial six mon hs o p o iding ca e
as hey shi om acili y-based o home-based en i onmen s. Se e al ac o s a e belie ed o a ec ca egi e bu den,
including he socio-demog aphics o he ca egi e , he na u e o hei ela ionship wi h he pa ien , du a ion o
ca egi ing, sha ed li ing wi h he pa ien , obliga ions ou side he ca egi ing ole, dis ac ions om wo k, social
engagemen s, and amily ou ines [24].
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Globally, dep ession can be seen no jus in he s oke su i o bu also in hei ca egi e . I le un ea ed, dep ession
can lead o a diminished quali y o li e and a heigh ened bu den o bo h he ca egi e and he su i o . The inc eased
bu den has been linked o highe le els o pa ien dep ession, insu icien suppo and lack o ime o hemsel es [5].
Recen ad ancemen s in s oke ehabili a ion ha e e ec i ely dec eased se e e disabili ies and he need o
ins i u ional ca e, esul ing in a g ea e numbe o disabled indi iduals li ing a home, suppo ed by ca egi e s who
o en eel unp epa ed, misin o med, and dissa is ied wi h he le el o assis ance a ailable pos -discha ge [25].
Ca egi e equi emen s di e based on age. Younge ca egi e s a e mo e likely o seek in o ma ion and aining and
end o exp ess c i icism owa ds he heal hca e sys em, whe eas olde ca egi e s equi e suppo o os e a posi i e
mindse and a e less likely o oice discon en wi h he heal hca e sys em. Ca egi e s equi e suppo om amily o
iends o emo ional and physical help, and hey also depend on heal hca e p o ide s o assis hem in es ablishing and
sus aining his suppo o e ime [5].
6. Rehabili a ion Modali ies and Ca egi e In ol emen
Rehabili a ion in e en ions o s oke should begin as soon as possible a e he e en , e en du ing he acu e phase, as
his is linked o be e ou comes. Passi e ange-o -mo ion exe cises, including mobilisa ion, and cogni i e s imula ion
ac i i ies can all be used as ea ly me hods. The goal o hese ea ly in e en ions is o a oid seconda y complica ions,
encou age neu al plas ici y, and p epa e o u u e ehabili a ion e o s.
Meanwhile, collabo a ing wi h he pa ien and hei ca egi e s o se ehabili a ion goals helps c ea e a clea ocus o
he apy. These goals a e cus omized, achie able, and gea ed owa d enhancing unc ional abili ies based on ecognized
impai men s. A mul idisciplina y eam o p o essionals, including physio he apis s, occupa ional he apis s, speech-
language pa hologis s, psychologis s, and social wo ke s, is equi ed.
This collabo a i e me hod ensu es a comp ehensi e assessmen and ecogni ion o ehabili a ion needs om mul iple
pe spec i es. Each specialis o e s dis inc knowledge, aiding in he o mula ion o a comp ehensi e ehabili a ion plan
designed o add ess he pa ien ’s speci ic impai men s and objec i es. Addi ionally, in ol ing amily membe s o
ca egi e s om he ou se enables hem o unde s and he ehabili a ion p ocess, ecei e guidance on how o assis he
pa ien , and os e a suppo i e a mosphe e when he pa ien is discha ged. The ea ly iden i ica ion o s oke
ehabili a ion equi emen s h ough a comp ehensi e, in e disciplina y s a egy es ablishes he ounda ion o a
ocused, ailo ed, and p omp ehabili a ion plan, g ea ly in luencing he eco e y jou ney o s oke su i o s [26].
Figu e 1 Mul idisciplina y Componen s o S oke Rehabili a ion. The diag am illus a es he co e elemen s o a
comp ehensi e s oke ehabili a ion p og am, including physio he apy, occupa ional he apy, speech and language
he apy, psychological he apy, cogni i e he apy, and assis i e echnology
A ca egi e -led exe cise p og am holds p omise o enhancing body unc ion, ac i i ies, and pa icipa ion in indi iduals
who ha e expe ienced a s oke. Fu he mo e, ca egi e s become mo e ac i ely engaged in he ehabili a ion p ocess,
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which may boos hei sense o empowe men , lessen ca egi e bu den, and suppo he mo e om ehabili a ion
se ings (such as hospi als, ehabili a ion cen es, o nu sing homes) o a home en i onmen [27]. Va ious in e en ions
aimed a aiding s oke ca egi e s, such as o e ing educa ion, counselling, emo ional suppo , o assis ance in accessing
se ices h ough in o ma ion packages, social wo ke s, specialis nu ses, o amily suppo wo ke s, ha e yielded
minimal bene i s o pa ien s and only sligh imp o emen s in he psychological and social aspec s o ca egi e s.
P o iding aining o ca egi e s in essen ial skills needed o daily managemen o disabled s oke su i o s may help
alle ia e he ca egi ing bu den [25]. The indings om he con olled ial in B ad o d indica e ha physio he apy
conduc ed a home o s oke pa ien s is mo e success ul han hospi al ehabili a ion in dec easing disabili y. Pa ien s
who ecei ed home ca e had educed dep ession le els, expe ienced ewe complica ions, and we e mo e likely o s ay
a home [28]. A collabo a i e e o among heal hca e disciplines is c i ical o deli e ing comp ehensi e educa ion and
helping s oke su i o s and ca egi e s. Add essing hese challenges, heal hca e p o essionals can wo k along wi h
ca egi e s owa d educing s oke ecu ences and minimizing long- e m disabili y [29].
7. In e en ions o Suppo Ca egi e s
Ca egi e s ace a signi ican challenge when ca ing o s oke pa ien s, which can lead o eelings o bu den bo h
physically and men ally. The wo se he heal h condi ion o s oke pa ien s, he mo e s ain is expe ienced by ca egi e s,
impac ing hei physical, emo ional, social, and inancial well-being. Be ween 30% and 68% o ca egi e s looking a e
s oke pa ien s epo expe iencing psychological s ain in he o m o anxie y and dep ession. P o iding
psychoeduca ion o ca egi e s can no ably alle ia e anxie y, se ing as a he apeu ic me hod o add ess psychosocial
issues commonly aced in hospi als and lessen ca egi e s' s ess and bu den. Psychoeduca ion, along wi h ca egi e
aining p og ams, aims o ease he demands on ca egi e s o s oke pa ien s, ensu ing ha he ca e p o ided emains
e ec i e and ha ca egi e s main ain hei heal h [30].
Families o s oke su i o s a e a a signi ican isk o expe iencing dep essi e symp oms, bu den, s ess, and a decline
in quali y o li e due o he esponsibili ies associa ed wi h ca egi ing [31]. P oblem-sol ing s a egies ha e p o en
e ec i e in assis ing ca egi e s in home se ings, ye hey a e o en no u ilized enough because hey equi e
conside able s a ime and can be challenging o ca egi e s. To add ess hese challenges, p og ams o s oke
ca egi e s need o o e low-cos , p ac ical solu ions ha can be in eg a ed in o s anda d clinical p ac ice [32]. Tailo ed,
indi idualized p oblem-sol ing and suppo ini ia i es a e mo e likely o p omo e changes in heal h beha iou s and
enhance sel -e icacy compa ed o gene ic p og ams [33]. Resea che s ha e consis en ly indica ed ha in e en ions
designed o help ca egi e s ackle issues a e he mos e ec i e in suppo ing ca egi e s a home [34].
S uc u ed home-based ehabili a ion is an e icien app oach ha seeks o enhance he in ol emen o pa ien s and
hei amilies in ecognizing hei needs and deli e ing essen ial educa ion [35]. I aims o p ese e and es o e pa ien s’
well-being and independence while minimizing he disabili y associa ed wi h s oke [36]. These se ices play a c ucial
ole in add essing he heal h equi emen s o indi iduals in need o ehabili a ion and a e ega ded as highly aluable
due o hei cos -e ec i eness, p ac icali y, com o o he clien , educ ion o equen hospi al admissions, and he
es ablishmen o a connec ion be ween he hospi al and he communi y [37].
Fo nume ous su i o s and hei ca egi e s, he pe cep ion o social suppo is linked o e ec i e coping s a egies
[38]. Indi iduals who eel hey ha e ample social suppo end o adjus be e o daily li e changes esul ing om new
disabili ies and e ol ing oles [39]. Pee s se e as a key sou ce o social suppo . Pee suppo g oups o e s oke
su i o s and ca egi e s aluable psychological and social suppo , dis inguished by sha ed expe iences ha os e
mu ual unde s anding and acili a e he exchange o emo ional, a i ma ional, and in o ma ional suppo [38]. Fo
s oke su i o s, o e ing suppo o pee s has been shown o b ing abou bene i s, as hose who p o ide suppo o en
ind enjoymen in he p ocess, expe ience pe sonal g ow h, and eel hey a e posi i ely impac ing ano he 's li e [40].
Nume ous esea ch s udies indica e ha s oke su i o s and hei ca egi e s o en do no ha e su icien knowledge
abou he communi y suppo esou ces a ailable o hem. P o iding imely and e ec i e educa ion and in o ma ion
will undoub edly help he ca egi e s [41]. The pa icipa ion o communi y heal h cen es in enhancing physio he apy
and p o iding emo ional suppo o ca egi e s can be bene icial [42].
8. Ca egi e Bu den in De eloping Coun ies
In Asian coun ies, including India, he esponsibili y o ca ing o s oke pa ien s can be challenging because abou one-
hi d o hem emain a home ins ead o being in ca e acili ies, as is common in de eloped coun ies. The adi ional
join amily sys em is p e alen in u al egions, whe e he e is plen y o oom, while in u ban a eas, many amily
membe s o en sha e c amped li ing spaces wi h limi ed in as uc u e [43].
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1047-1056
1052
A ecen s udy highligh s he s oke bu den among olde popula ions. The o e all age-adjus ed p e alence a es o
s okes in u al and u ban egions ange om 84 o 262 pe 100,000 and 334 o 424 pe 100,000, espec i ely, ac oss
a ious pa s o he coun y o e he las en yea s, which is compa able o a es obse ed in de eloped na ions [44]. In
India, he e is a signi ican lack o ehabili a ion acili ies wi hin he go e nmen heal hca e sec o . The ehabili a ion
se ices o e ed by he p i a e sec o a e cos ly and una o dable o many indi iduals. Mos s oke su i o s s op
engaging in physical he apy a e jus a ew weeks due o challenges wi h anspo a ion and expenses. Consequen ly,
many o hem end up being bed idden. As a esul , s oke su i o s end o adop a seden a y li es yle ha es ic s
hei abili y o pe o m daily ac i i ies, aises he isk o alls, and may lead o an inc eased likelihood o expe iencing
ano he s oke o de eloping ca dio ascula disease [45]. P e ious esea ch has shown ha s oke su i o s a e
capable o imp o emen and has documen ed he ad an ageous physiological, psychological, senso imo o , s eng h,
endu ance, and unc ional ou comes om a ious o ms o exe cise [46].
The inc easing global challenge posed by s okes, in bo h de eloped and de eloping coun ies, will esul in a g ea e
s ain on ca egi e s. Acco ding o esea ch indings, ac o s such as inancial wo ies, ex ended ca egi ing hou s, and
emo ional s ain all con ibu e o ca egi e s ess. To alle ia e ca egi e bu den and enhance pa ien eco e y, s oke
ehabili a ion se ices should also ocus on add essing ca egi e challenges h ough aining in p ac ical nu sing skills
and p o iding counselling sessions [47].
9. Gaps, Challenges, and Oppo uni ies
Many s udies ha e poin ed ou a conside able gap in amily ca egi e s' abili y o e ec i ely suppo and main ain he
heal h o s oke pa ien s [48]. Resea ch indica es ha ca egi e s equen ly eel unp epa ed o he esponsibili ies o
pos -discha ge ca e, la gely due o insu icien knowledge and skills. This challenge is compounded by he need o
ca egi e s o independen ly seek in o ma ion and assis ance, o en wi hou adequa e guidance o suppo [49]
The cos and accessibili y o s oke ehabili a ion se ices we e ound o be he p ima y ba ie s a he se ice le el.
Many indi iduals who could no a o d hese ehabili a ion se ices ended up s aying a home, whe e hey did no
ecei e adequa e ca e om hei amilies. When s oke su i o s do no ha e access o sui able ehabili a ion se ices,
he isk o pos -s oke complica ions and he se e i y o hei disabili ies inc ease, leading o a signi ican demand o
se ices ha a e bo h accessible and a o dable [50].
In esponse o hese challenges, digi al heal h inno a ions ha e signi ican ly ans o med he ield o ehabili a ion
medicine. Wea able echnologies, sma phone apps, heal h in o ma ion sys ems, eleheal h se ices, and mobile heal h
a e included in he b oad ange o digi al heal h.
Among hese inno a ions, eleheal h o s oke ca e has become inc easingly accessible, suppo ing bo h acu e
ea men and communi y-based se ices by acili a ing connec ions be ween heal hca e p o ide s and ca egi e s.
Tele-neu o ehabili a ion consul a ions, in pa icula , ha e p o en o be p ac ical and e ec i e o deli e ing
coo dina ed ca e o pa ien s in u al hospi als. Since in e ne connec i i y and sma phone owne ship a e widesp ead
in u al a eas, he use o sma phones o educa e pa ien s and hei amilies abou s oke and o e assis ance o
unc ional skills aining wi hou ha ing he di ec in ol emen o a he apis o ehabili a ion p o essional is becoming
mo e and mo e p e alen [49].
10. Conclusion
This e iew highligh s he c i ical connec ion be ween ca e well-being and s oke he apy. Al hough ehabili a ion
ea men s a e essen ial o enhancing pa ien ou comes, hey equen ly pu a signi ican inancial, emo ional, and
physical s ain on ca e s, especially in low-income en i onmen s. S ess and psychological s ain a e exace ba ed by a
lack o o mal aining, inadequa e p epa a ion, and a lack o sys emic suppo . Inno a i e app oaches ha show
p omise o lowe ing ca egi e s ess and p omo ing sus ainable ca e models include s uc u ed home-based
p og ams, p oblem-sol ing aining, pee suppo g oups, and elemedicine pla o ms. Finally, a success ul s oke
eco e y depends on empowe ing and suppo ing ca e s as ac i e pa icipan s in ca e, in addi ion o he pa ien 's
ehabili a ion jou ney. To ensu e ull, equi able, and success ul ou comes, ca egi e -inclusi e s a egies mus be
s eng hened.
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1053
Compliance wi h e hical s anda ds
Acknowledgmen s
The au ho g a e ully acknowledges he con ibu ions o esea che s and heal hca e p o essionals whose wo k in s oke
ehabili a ion and ca egi e suppo in o med his e iew. App ecia ion is also ex ended o academic men o s o hei
guidance du ing he p epa a ion o his manusc ip .
Disclosu e o con lic o in e es
The au ho s decla e no po en ial con lic s o in e es wi h espec o he esea ch, au ho ship, o publica ion o his
a icle.
Sou ce o Funding
This s udy did no ecei e any speci ic g an om unding agencies in he public, comme cial, o no - o -p o i sec o s.
No ma e ial o inancial suppo was p o ided by any o ganiza ion.
Decla a ion o O iginali y
This manusc ip is based on o iginal wo k and has no been published in pa o whole in any p in o elec onic media.
I is also no unde conside a ion elsewhe e, excep as an abs ac in con e ence p oceedings.
Au ho Con ibu ions
Con ibu o
Concep
S udy
Design
Da a
Collec ion
S a is ical
Analysis
Li e a u e
O e iew
Discussion
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Gene a ion
M s. Nee hu M
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D . Sindhu J
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Re e ences
[1] Kuma P, Naga P, Pa ma L. Quali y o Li e in Recen S oke Pa ien s and Bu den on Ca egi e s in Guja a s a e
o Wes e n India. J Pha m Res In [In e ne ]. 2021 Jul 13 [ci ed 2025 Jun 17];45–53. A ailable om:
h ps://jou naljp i.com/index.php/JPRI/a icle/ iew/2813
[2] GBD 2019 S oke Collabo a o s. Global, egional, and na ional bu den o s oke and i s isk ac o s, 1990-2019: a
sys ema ic analysis o he Global Bu den o Disease S udy 2019. Lance Neu ol. 2021 Oc ;20(10):795–820.
[3] Rela ionships be ween ca e bu den, esilience, and dep essi e symp oms among he main amily ca egi e s o
s oke pa ien s: A c oss-sec ional s udy - PubMed [In e ne ]. [ci ed 2025 Jun 18]. A ailable om:
h ps://pubmed.ncbi.nlm.nih.go /36203823/
[4] Hea Disease and S oke S a is ics—2017 Upda e: A Repo om he Ame ican Hea Associa ion | Ci cula ion
[In e ne ]. [ci ed 2025 Jun 18]. A ailable om:
h ps://www.ahajou nals.o g/doi/ ull/10.1161/CIR.0000000000000485
[5] Wins ein CJ, S ein J, A ena R, Ba es B, Che ney LR, C ame SC, e al. Guidelines o Adul S oke Rehabili a ion and
Reco e y: A Guideline o Heal hca e P o essionals om he Ame ican Hea Associa ion/Ame ican S oke
Associa ion. S oke. 2016 Jun;47(6): e98–169.
[6] (PDF) S ain and Bu den among Ca egi e s o S oke Su i o s in Punjab: A C oss-Sec ional S udy [In e ne ].
[ci ed 2025 Jun 18]. A ailable om:
h ps://www. esea chga e.ne /publica ion/375423003_S ain_and_Bu den_among_Ca egi e s_o _S oke_Su i
o s_in_Punjab_A_C oss-Sec ional_S udy
[7] Maggio MG, Co allo F, De F ancesco M, De Cola MC, De Luca R, Manuli A, e al. Unde s anding he amily bu den
and ca egi e ole in s oke ehabili a ion: insigh s om a e ospec i e s udy. Neu ol Sci [In e ne ]. 2024 No
[ci ed 2025 Jun 17];45(11):5347–53. A ailable om: h ps://link.sp inge .com/10.1007/s10072-024-07668-5
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1047-1056
1054
[8] Chak aba y J, Naik A. A Hospi al-Based S udy o Assess Ca egi e ’s Bu den among Ca egi e s o S oke
Su i o s. Med J D Pa il Vidyapee h [In e ne ]. 2024 Oc [ci ed 2025 Jun 17];17(Suppl 1): S115–20. A ailable
om: h ps://jou nals.lww.com/10.4103/mjd dypu.mjd dypu_1016_23
[9] Owolabi MO, Th i AG, Mahal A, Ishida M, Ma ins S, Johnson WD, e al. P ima y s oke p e en ion wo ldwide:
ansla ing e idence in o ac ion. Lance Public Heal h [In e ne ]. 2022 Jan 1 [ci ed 2025 Jun 19];7(1): e74–85.
A ailable om: h ps://www. helance .com/jou nals/lanpub/a icle/PIIS2468-2667(21)00230-9/ ull ex
[10] Chima i o GL, Rhoda AJ. Scoping e iew o acu e s oke ca e managemen and ehabili a ion in low and middle-
income coun ies. BMC Heal h Se Res [In e ne ]. 2019 No 4 [ci ed 2025 Jun 19];19(1):789. A ailable om:
h ps://doi.o g/10.1186/s12913-019-4654-4
[11] Owolabi MO, Th i AG, Ma ins S, Johnson W, Pandian J, Abd-Allah F, e al. The s a e o s oke se ices ac oss he
globe: Repo o Wo ld S oke O ganiza ion-Wo ld Heal h O ganiza ion su eys. In J S oke O J In S oke Soc.
2021 Oc ;16(8):889–901.
[12] Wha o expec as you eco e om a s oke [In e ne ]. Mayo Clinic. [ci ed 2025 Jun 26]. A ailable om:
h ps://www.mayoclinic.o g/diseases-condi ions/s oke/in-dep h/s oke- ehabili a ion/a -20045172
[13] Amalia L, Qoni ah P. Clinical and epidemiological o e iew o hype acu e ischemic s oke pa ien s ea ed wi h
in a enous h ombolysis. Egyp J In e n Med [In e ne ]. 2025 Feb 19 [ci ed 2025 Jun 26];37(1):40. A ailable
om: h ps://doi.o g/10.1186/s43162-025-00419-8
[14] Cla ke DJ, Fo s e A. Imp o ing pos -s oke eco e y: he ole o he mul idisciplina y heal h ca e eam. J
Mul idiscip Heal hc [In e ne ]. 2015 Sep 22 [ci ed 2025 Jun 26]; 8:433–42. A ailable om:
h ps://www.ncbi.nlm.nih.go /pmc/a icles/PMC4590569/
[15] Was i SA, Su ya N, S ephan KM, Owolabi M. Heal hca e Se ings o Rehabili a ion A e S oke. In: Pla z T, edi o .
Clinical Pa hways in S oke Rehabili a ion: E idence-based Clinical P ac ice Recommenda ions [In e ne ]. Cham
(CH): Sp inge ; 2021 [ci ed 2025 Jul 7]. A ailable om: h p://www.ncbi.nlm.nih.go /books/NBK585579/
[16] S oke Rehabili a ion a Home | S oke [In e ne ]. [ci ed 2025 Jul 10]. A ailable om:
h ps://www.ahajou nals.o g/doi/10.1161/s okeaha.116.011309
[17] Ca e NRC (US) C on he R o HF in HH. In o mal Ca egi e s in he Uni ed S a es: P e alence, Ca egi e
Cha ac e is ics, and Abili y o P o ide Ca e. In: The Role o Human Fac o s in Home Heal h Ca e: Wo kshop
Summa y [In e ne ]. Na ional Academies P ess (US); 2010 [ci ed 2025 Jul 10]. A ailable om:
h ps://www.ncbi.nlm.nih.go /books/NBK210048/
[18] Toma T, Vyas M. The Role o Ca egi e s in S oke Pa ien s Reco e y: A Mixed Me hodology S udy Focusing on
Ca egi e Challenges and Pa ien Ou comes. In J Inno Sci Res Technol IJISRT [In e ne ]. 2024 Oc 17 [ci ed
2025 Jul 10];290–7. A ailable om: h ps://www.ijis .com/ he- ole-o -ca egi e s-in- he-s oke-pa ien s-
eco e y-a-mixed-me hodology-s udy- ocusing-on-ca egi e -challenges-and-pa ien -ou comes
[19] Tziaka E, Tsiaki i A, Vlo inou P, Ch is idi F, Tsip sios D, Aggelousis N, e al. A Holis ic App oach o Exp essing he
Bu den o Ca egi e s o S oke Su i o s: A Sys ema ic Re iew. Heal hc Basel Swi z. 2024 Feb 29;12(5):565.
[20] Young ME, Lu z BJ, C easy KR, Cox KJ, Ma z C. A comp ehensi e assessmen o amily ca egi e s o s oke
su i o s du ing inpa ien ehabili a ion. Disabil Rehabil. 2014;36(22):1892–902.
[21] Damaiyan i M, Ami H, Cahyani DD, Alhidaya NS, A ian i N, Rahmia i C, e al. Imp o ing ca egi e p epa edness
in he ca e ansi ion o s oke pa ien s: a scoping e iew. J Med Li e. 2023 Dec;16(12):1723–31.
[22] Bha acha jee M, Vai ale J, Gawali K, Dalal PM. Fac o s a ec ing bu den on ca egi e s o s oke su i o s:
Popula ion-based s udy in Mumbai (India). Ann Indian Acad Neu ol [In e ne ]. 2012 [ci ed 2025 Jul
11];15(2):113–9. A ailable om: h ps://www.ncbi.nlm.nih.go /pmc/a icles/PMC3345587/
[23] Zhao J, Zeng Z, Yu J, Xu J, Chen P, Chen Y, e al. E ec o main amily ca egi e ’s anxie y and dep ession on mo ali y
o pa ien s wi h mode a e-se e e s oke. Sci Rep [In e ne ]. 2021 Feb 2 [ci ed 2025 Jul 11];11(1):2747. A ailable
om: h ps://www.na u e.com/a icles/s41598-021-81596-8
[24] F on ie s Ca egi e bu den and i s associa ed ac o s among p ima y ca egi e s o s oke su i o s a Amha a
egional s a e e ia y hospi als: a mul icen e s udy [In e ne ]. [ci ed 2025 Jul 12]. A ailable om:
h ps://www. on ie sin.o g/jou nals/s oke/a icles/10.3389/ s o.2023.1226140/ ull
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1047-1056
1055
[25] Kal a L, E ans A, Pe ez I, Melbou n A, Pa el A, Knapp M, e al. T aining ca e s o s oke pa ien s: andomised
con olled ial. BMJ [In e ne ]. 2004 May 8 [ci ed 2025 Jul 13];328(7448):1099. A ailable om:
h ps://www.ncbi.nlm.nih.go /pmc/a icles/PMC406319/
[26] Li X, He Y, Wang D, Rezaei MJ. S oke ehabili a ion: om diagnosis o he apy. F on Neu ol [In e ne ]. 2024 Aug
13 [ci ed 2025 Jun 19];15. A ailable om:
h ps://www. on ie sin.o g/jou nals/neu ology/a icles/10.3389/ neu .2024.1402729/ ull
[27] Vloo huis JD, Mulde M, Vee beek JM, Konijnenbel M, Visse ‐Meily JM, Ke JC, e al. Ca egi e ‐media ed exe cises
o imp o ing ou comes a e s oke. Coch ane Da abase Sys Re [In e ne ]. 2016 Dec 21 [ci ed 2025 Jul
13];2016(12):CD011058. A ailable om: h ps://www.ncbi.nlm.nih.go /pmc/a icles/PMC6463929/
[28] Islam M, Khandake N, Rahman MdS, Sul ana A, Yasmin K, Dewan PD, e al. E icacy o Ca egi e s T aining in
Rehabili a ion o S oke Su i o s in Bangladesh: A Quasi-expe imen al S udy. Cu eus [In e ne ]. [ci ed 2025 Jul
13];15(1): e33812. A ailable om: h ps://www.ncbi.nlm.nih.go /pmc/a icles/PMC9929611/
[29] And ews G. Empowe ing pa ien s and ca egi e s h ough s oke educa ion. 2024 [ci ed 2025 Jul 13]; A ailable
om: h ps://mospace.umsys em.edu/xmlui/handle/10355/106523
[30] (PDF) Psychoeduca ional In e en ion o Family Ca egi e Bu den in S oke Pa ien s Ca e [In e ne ]. [ci ed
2025 Jul 13]. A ailable om:
h ps://www. esea chga e.ne /publica ion/362809100_Psychoeduca ional_In e en ion_ o _Family_Ca egi e
_Bu den_in_S oke_Pa ien s_Ca e
[31] Haley WE, Ro h DL, Ho a e M, Clay OJ. Long- e m impac o s oke on amily ca egi e well-being: a popula ion-
based case-con ol s udy. Neu ology. 2015 Ma 31;84(13):1323–9.
[32] Lui MH, Ross FM, Thompson DR. Suppo ing amily ca egi e s in s oke ca e: a e iew o he e idence o p oblem
sol ing. In: Da abase o Abs ac s o Re iews o E ec s (DARE): Quali y-assessed Re iews [In e ne ] [In e ne ].
Cen e o Re iews and Dissemina ion (UK); 2005 [ci ed 2025 Jul 17]. A ailable om:
h ps://www.ncbi.nlm.nih.go /books/NBK71549/
[33] Bakas T, Cla k PC, Kelly-Hayes M, King RB, Lu z BJ, Mille EL, e al. E idence o s oke amily ca egi e and dyad
in e en ions: a s a emen o heal hca e p o essionals om he Ame ican Hea Associa ion and Ame ican
S oke Associa ion. S oke. 2014 Sep;45(9):2836–52.
[34] Cheng HY, Chai SY, Chau JPC. The e ec i eness o psychosocial in e en ions o s oke amily ca egi e s and
s oke su i o s: A sys ema ic e iew and me a-analysis. Pa ien Educ Couns [In e ne ]. 2014 Ap 1 [ci ed 2025
Jul 17];95(1):30–44. A ailable om: h ps://www.sciencedi ec .com/science/a icle/pii/S0738399114000135
[35] Pou shi ani A, Saieedi JA, Nekozad N, Zandi M. The impac o home ca e based on he Con inuous Ca e Model by
amily ca egi e s on ac i i ies o daily li ing o s oke pa ien s. Ad Nu s Midwi e y [In e ne ]. 2018 [ci ed 2025
Jul 17];27(1):39–52. A ailable om: h ps://jou nals.sbmu.ac.i /index.php/anm/a icle/ iew/15767
[36] Dehghan Naye i N, Mohammadi S, Ped am Razi S, A azi TM, Kazemnejad A. E ec i eness o amily empowe men
p og am on le el o adhe ence o ea men egimens in s oke pa ien s; a andomized con olled ial. E id
Based Ca e [In e ne ]. 2015 Ap 1 [ci ed 2025 Jul 17];5(1):57–66. A ailable om:
h ps://ebcj.mums.ac.i /a icle_4072.h ml
[37] Ja a i J, Ke mansa a i F, Yaghoubinia F. The E ec o Home-Based Rehabili a ion on Adhe ence o T ea men and
Quali y o Li e o Indi iduals A e S oke [In e ne ]. Medical - Su gical Nu sing Jou nal; 2020 [ci ed 2025 Jul
17]. Repo No.: 9. A ailable om: h ps://b ie lands.com/a icles/msnj-107716#abs ac
[38] Mo is R, Mo is P. Pa icipan s’ expe iences o hospi al-based pee suppo g oups o s oke pa ien s and
ca e s. Disabil Rehabil [In e ne ]. 2012 Feb 1 [ci ed 2025 Jul 17];34(4):347–54. A ailable om:
h ps://doi.o g/10.3109/09638288.2011.607215
[39] Coping wi h he Challenges o Reco e y om S oke - Amanda M. Ch’Ng, Da ina F ench, Neil Mclean, 2008
[In e ne ]. [ci ed 2025 Jul 17]. A ailable om:
h ps://jou nals.sagepub.com/doi/abs/10.1177/1359105308095967
[40] Kessle D, Egan M, Kubina LA. Pee suppo o s oke su i o s: a case s udy. BMC Heal h Se Res [In e ne ].
2014 Jun 16 [ci ed 2025 Jul 17];14(1):256. A ailable om: h ps://doi.o g/10.1186/1472-6963-14-256
[41] R K. Family Needs o Ca egi e s o S oke Su i o s. Ad P ac Nu s [In e ne ]. 2016 [ci ed 2025 Jul 17];01(03).
A ailable om: h ps://www.omicsonline.o g/open-access/ amily-needs-o -ca egi e s-o -s oke-su i o s-
APN-1000120.php?aid=77371
