Meta-synthesis of qualitative studies on home-based exercise rehabilitation experiences among stroke patients: a continuity of care perspective

Background: Home-based exercise rehabilitation plays a vital role in enhancing functional recovery among stroke patients; however, adherence remains low because of limited continuity of care, inadequate professional supervision, and discontinuities in the transition from home to community settings. Although previous studies have examined home-based rehabilitation experiences, they lack systematic integration from the perspective of care continuity, which hinders the development of a collaborative intervention framework across different care settings. Purpose: This study synthesizes the real-world experiences of stroke patients transitioning from hospital to home rehabilitation. It aims to elucidate how care continuity influences rehabilitation behaviors and to provide insights for optimizing nursing strategies. Method: A comprehensive search of six major databases (including PubMed, Embase, and CINAHL) was conducted. Ten qualitative studies were identified, appraised, and synthesized following the Joanna Briggs Institute (JBI) framework. Result: The synthesis included 263 stroke patients. Four major categories were identified: (1) deficiencies in discharge guidance and follow-up; (2) challenges in self-regulation and home-based motivation; (3) the facilitating role of family and community support; and (4) the influence of nursing and family support continuity. Existing services exhibit marked transitional discontinuities. Conclusion: The home rehabilitation experience is shaped by the interplay among care continuity, self-regulation, and support networks. We propose a closed-loop model encompassing guidance, monitoring, and motivation. This framework provides a practical approach to optimizing the hospital-community-home collaborative system, thereby promoting sustained adherence and improving long-term recovery outcomes. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023405581, PROSPERO CRD42023405581.