A Holistic Framework for Personalizing Rehabilitation in Post-Stroke Patients

Thesis Abstract

Stroke remains a leading cause of long-term disability worldwide, with heterogeneous recovery trajectories necessitating individualized rehabilitation strategies that address the multifaceted needs of patients. Despite advancements in stroke rehabilitation, there is a notable gap in comprehensive frameworks that integrate biological, psychological, social, and environmental factors to optimize personalized care. This study aims to develop and validate a holistic framework for tailoring rehabilitation interventions in post-stroke patients. The specific objectives include identifying key determinants influencing recovery, constructing an integrative model that captures these determinants, and evaluating the framework’s applicability in clinical settings. Employing a mixed-methods approach, the research adopts a sequential exploratory design. The qualitative phase involves in-depth interviews with 30 stroke survivors and 15 multidisciplinary rehabilitation professionals to explore contextual factors influencing individualized therapy. Thematic analysis is utilized to extract key themes underpinning personalization in rehabilitation. Building on qualitative insights, the quantitative phase encompasses a cross-sectional survey of 200 post-stroke patients recruited from five rehabilitation centers, representing diverse demographic and clinical profiles. Data collection incorporates validated instruments such as the Stroke Impact Scale, the Psychological Resilience Questionnaire, and the Social Support Appraisal Scale to quantify physical, psychological, and social domains. Quantitative data are analyzed through multiple regression analysis to identify significant predictors of functional recovery, and structural equation modeling (SEM) is employed to test the hypothesized interconnectedness of biological, psychological, social, and environmental factors within the proposed framework. Model fit indices such as CFI, TLI, RMSEA, and SRMR are used to evaluate the robustness of the conceptual model. The integration of qualitative themes with quantitative findings aims to produce a comprehensive, contextually grounded framework guiding personalized rehabilitation. The anticipated findings suggest that personalized rehabilitation outcomes are significantly influenced by an interplay of neurobiological recovery, psychological resilience, social support networks, and environmental factors, which together can be systematically integrated into a holistic framework. The model is expected to demonstrate good fit indices, confirming its validity and practical utility in clinical decision-making. This comprehensive approach addresses gaps in existing models by emphasizing tailored intervention strategies that consider patient-specific contexts, thereby promoting improved functional outcomes, increased patient satisfaction, and enhanced quality of life. The study contributes to the advancement of knowledge by providing a theoretically grounded and empirically validated model that informs clinical practice, policy formulation, and future research on personalized stroke rehabilitation. It underscores the necessity of multidisciplinary, patient-centered approaches in designing effective interventions, aligning with contemporary paradigms of holistic care. The main conclusion advocates for the implementation of the developed framework in rehabilitation settings, emphasizing that personalized rehabilitation requires an integrative model sensitive to the complex interactions influencing recovery. Recommendations include training rehabilitation practitioners in holistic assessment techniques, integrating psychosocial and environmental considerations into routine care, and further longitudinal studies to evaluate the framework's predictive capabilities over time. The research underscores the importance of adopting a multidisciplinary, patient-centered paradigm to redefine stroke rehabilitation, ultimately fostering maximal recovery potential and improved life quality for post-stroke patients.