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Original Research Articles

The Effectiveness of Community-Based Interventions in Improving Activities of Daily Living and Quality of Life Outcomes in Persons Living with Stroke: a Systematic Review


Raymond Tosoc ,

University of the Philippines, Manila, PH
About Raymond
Raymond Tosoc is currently an Instructor and Community-based Rehabilitation (CBR) coordinator at the Lyceum of the Philippines University – Batangas. He received both his Bachelor’s and Master’s degree in Physical Therapy from the University of the Philippines, Manila. His interest about issues concerning community-based rehabilitation stems not only from his work and educational experience, but also from his membership in the CBR Special Interest Group of the Philippine Physical Therapy Association. He is also interested in topics related to neurological physical therapy and education.
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Rolando Lazaro

California State University, Sacramento, US
About Rolando
Rolando Lazaro PT, Ph.D., DPT, is a Professor in the Department of Physical Therapy, California State University Sacramento, United States of America. He is also a Visiting Professor at the University of the Philippines College of Allied Medical Professions, Manila, Philippines. Dr. Lazaro’s research interests include the development and validation of models of Community-Based Rehabilitation (CBR), and investigation of interventions aimed at improving balance and mobility in older adults. Dr. Lazaro is the lead editor of Umphred’s Neurological Rehabilitation, 7th ed, associate editor of the Goodman and Fuller’s Pathology: Implications for the Physical Therapist, 5th ed, and co-editor of the Goodman and Snyder’s Differential Diagnosis for Physical Therapists, 6th ed texts. In 2013, Dr. Lazaro was awarded a Fulbright Senior Scholarship to study community-based rehabilitation models in the Philippines. He was again awarded a Fulbright Senior Scholarship in 2020 to study urban community-based rehabilitation.
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Purpose: Despite the growth of literature regarding community-based interventions (CBI) in low- to middle-income and high-income countries, its effectiveness in improving outcomes related to activities of daily living (ADL) and quality of life (QOL) in people with stroke is inconclusive. This systematic review compared the effectiveness of community-based interventions with the usual or hospital-based treatments in improving ADL and QOL outcomes in this population.

Method: Four databases were systematically searched from inception until December 31, 2020, for relevant experimental studies from high-income and low- to middle-income countries that compared CBI with the usual/hospital rehabilitation on outcomes related to ADLs and QOL in clients with stroke.

Results: All the 10 experimental studies that were included came from high-income countries (Italy, United Kingdom, South Korea, Canada, and Australia), involving 1575 participants (806 males, 656 females, 113 not classified) with age range from 22-103 years. Seven articles measured ADL performance, and 10 measured QOL. Results indicated that CBI generally demonstrates improvement in ADL and QOL values similar to usual or hospital-based care. There was wide variability in the interventions described and the outcome measures used for both groups. Risk of bias assessment revealed issues with randomisation, blinding and follow-up. Stroke-specific baseline characteristics such as length of time since diagnosis and laterality varied considerably in all of the studies.

Conclusion and Limitations: CBI did not demonstrate significant difference in improving ADL and QOL outcomes for people with stroke compared to usual care, possibly due to the high quality of rehabilitation services existing in the countries where the studies took place. There is a need to use standardised outcome measures and interventions to ascertain these outcomes.
How to Cite: Tosoc, R. and Lazaro, R., 2022. The Effectiveness of Community-Based Interventions in Improving Activities of Daily Living and Quality of Life Outcomes in Persons Living with Stroke: a Systematic Review. Disability, CBR & Inclusive Development, 32(4), pp.63–97. DOI:
Published on 01 Feb 2022.


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