Impact of Multidisciplinary Rehab Pathways on Post-Stroke Recovery Outcomes: A Case Study in a Regional Hospital Network

Thesis Abstract

The study investigates how multidisciplinary rehabilitation pathways influence post-stroke recovery outcomes within a regional hospital network, addressing the persistent gap between guideline recommendations and real-world practice that may impede timely, holistic recovery for stroke survivors. The aim is to evaluate whether integrated, team-based rehabilitation improves functional, psychosocial, and caregiver-related outcomes compared with conventional, discipline-specific approaches. Specific objectives are (1) to map current multidisciplinary rehabilitation pathways across three hospitals in the network; (2) to quantify functional recovery using the Fugl-Meyer Assessment (upper and lower extremity), Modified Rankin Scale, and Barthel Index at 3 and 6 months post-stroke; (3) to assess psychosocial well-being with the Hospital Anxiety and Depression Scale and Stroke Impact Scale; (4) to evaluate health service utilization, readmission rates, and length of stay; (5) to explore patient, caregiver, and clinician experiences to identify facilitators and barriers to pathway implementation; and (6) to determine the association between pathway intensity (number of disciplines involved, frequency of multidisciplinary meetings) and recovery trajectories. A mixed-methods design guides this study, integrating quantitative longitudinal analyses with qualitative insights anchored in the notion of collaborative care models and the biopsychosocial framework. The population comprises adult stroke survivors admitted to the regional hospital network over a 12-month recruitment window, with a planned sample of 320 participants to achieve adequate power for detecting clinically meaningful differences in functional outcomes. Inclusion criteria include first-ever ischemic or hemorrhagic stroke, initiation of rehabilitation within 14 days post-stroke, and capacity to provide informed consent or via a proxy. Exclusion criteria include pre-morbid disability precluding meaningful functional assessment and severe aphasia without adequate communication support. Quantitative data will be collected from patient medical records, standardized outcome measures at baseline (discharge), 3 months, and 6 months post-stroke, and health-system utilization data. Qualitative data will be gathered through semi-structured interviews with 40 patients, 20 caregivers, and 15 clinicians, plus focus groups with rehabilitation teams, using purposive sampling to capture diverse experiences. Quantitative analyses will employ linear mixed-effects models to examine trajectories of functional and psychosocial outcomes over time, controlling for baseline severity, age, sex, comorbidities, and stroke type. Multivariate regression will assess the relationship between pathway intensity and outcomes, while time-to-event analyses will compare readmission and length-of-stay metrics. Mediation analyses will explore whether improved psychosocial well-being mediates the effect of multidisciplinary pathways on functional recovery. The qualitative component will utilize thematic analysis, supported by NVivo, to identify patterns related to interprofessional communication, role clarity, patient engagement, and organizational culture. A convergent parallel design will synthesize quantitative and qualitative findings to provide a comprehensive interpretation of how multidisciplinary rehabilitation pathways influence recovery. The expected findings include superior functional gains (as indicated by higher Barthel Index and Fugl-Meyer scores) and reduced disability (lower Modified Rankin Scale) among participants engaged in multidisciplinary pathways, accompanied by improved mood, greater perceived impact on daily living, and reduced caregiver burden. It is anticipated that higher pathway intensity will correlate with more favorable outcomes, mediated by enhanced patient engagement and adherence to rehabilitation plans. Qualitative insights are expected to reveal facilitators such as structured interprofessional rounds, shared goals, standardized referral criteria, and robust patient education, alongside barriers including workforce constraints, information silos, and variability in pathway adoption across sites. The study contributes to knowledge by providing empirical evidence on the effectiveness of multidisciplinary rehabilitation pathways in real-world regional hospital settings, extending the applicability of collaborative care theories (e.g., the Chronic Care Model and Interdisciplinary Team Theory) to post-stroke recovery. It will offer actionable guidance for policy-makers and managers on designing and scaling integrated rehabilitation services, including criteria for pathway standardization, workforce planning, and information-sharing infrastructure. The main conclusion is that well-implemented multidisciplinary rehabilitation pathways can enhance functional and psychosocial outcomes for stroke survivors and reduce health-system utilization when complemented by active patient and caregiver engagement. Recommendations include establishing formalized multidisciplinary pathways with predefined roles, periodic outcome monitoring, investment in cross-training and interoperable information systems, and ongoing qualitative assessment to address contextual barriers and sustain practice improvements. Suggestions for further research include longitudinal evaluation beyond six months, cost-effectiveness analyses, and exploration of pathway adaptability in rural and peri-urban settings.