Abstract
BACKGROUND: Leisure participation is an important rehabilitation goal for survivors of stroke. Following stroke, there is a reduction in leisure participation; however, the focus of rehabilitation is typically on remediation of personal care activities and mobility. Furthermore, previous systematic reviews and current clinical practice guidelines provide inconsistent recommendations for rehabilitation interventions to improve leisure participation. This highlights the need for a comprehensive and targeted review of the literature to help inform clinical practice. OBJECTIVE: We propose a systematic review to synthesize data on the effectiveness of rehabilitation interventions to increase leisure participation in adult survivors of stroke, taking into account time since stroke and intervention context. METHODS: Searches will be conducted in MEDLINE, CINAHL, Embase, and CENTRAL. We will include randomized controlled trials and nonrandomized controlled trials that include adult survivors of stroke and test the effectiveness of rehabilitation interventions for leisure participation. Eligible interventions will be those that aim to improve leisure participation or where leisure participation is an outcome of interest. Two reviewers will independently screen full-text articles, and one reviewer will extract data, with a second reviewer providing confirmation. The Physiotherapy Evidence Database Scale will be used to assess the methodological quality of the studies. A random-effects meta-analysis will be performed, and a Cochran Q test will assess heterogeneity among studies. Outcome measures of leisure participation may include measures of amount, satisfaction and confidence, and performance. Secondary outcomes will include quality of life measures, adverse events, and resource use. RESULTS: Results will be discussed based on subgroup analyses where possible, including (1) time since stroke (early subacute, late subacute, and chronic), (2) delivery of the intervention (group or individualized), and (3) type of intervention (functional impairment, leisure education, and recreation participation). At the time of this protocol publication, the systematic review has progressed to data analysis, with publication of results expected in early 2026. CONCLUSIONS: The findings of this review will increase understanding of effective rehabilitation practices to increase leisure participation after stroke and may contribute to updates of existing clinical practice guidelines for stroke rehabilitation.