Addressing the Evidence Gap in Stroke Rehabilitation for Patient Complexity: A Preliminary Research Agenda

Evidence suggests that a stroke occurs in isolation (no comorbid conditions) in less than 6% of patients. Multimorbidity, compounded by psychosocial issues, makes treatment and recovery for stroke increasingly complex. Recent research and health policy documents called for a better understanding of the needs of this patient population, and for the development and testing of models of care that meet their needs. A research agenda specific to complexity is required. The primary objective of the Think Tank was to identify and prioritize research questions that meet the information needs of stakeholders, and to develop a research agenda specific to stroke rehabilitation and patient complexity. A modified Delphi and world cafe approach underpinned the Think Tank meeting; approaches well recognized to foster interaction, dialogue, and collaboration between stakeholder. Forty-three researchers, clinicians and policy makers attended a two-day meeting. Initial question generating activities resulted in 120 potential research questions. Sixteen high-priority research questions were identified, focusing on predetermined complexity characteristics—multimorbidity, social determinants, patient characteristics, social supports and system factors. The final questions are presented as a prioritized research framework. An emergent result of this activity is the development of a Complexity and Stroke Rehabilitation research network. The research agenda reflects topics of importance to stakeholders working with stroke patients with increasingly complex care needs. This robust process resulted in a preliminary research agenda that could provide policy makers with the evidence needed to make improvements towards better-organized services, better coordination between settings, improved patient outcomes and lower system costs.