title: Are rehabilitation and/or care co-ordination interventions delivered in the community effective in reducing depression, facilitating participation and improving quality of life after stroke?
abstract: OBJECTIVE
  To conduct a systematic review to explore the effectiveness of community-based rehabilitation interventions delivered by allied health professionals and/or nursing staff in reducing depression, facilitating participation and improving health-related quality of life (HRQoL) post-inpatient stroke rehabilitation.
  
  
  METHODS
  A search was conducted in the databases of MEDLINE, PEDro, CINAHL and the Cochrane Library. Publications were classified into categories based on the type of the interventions. Best evidence synthesis and meta-analysis were utilised to determine the level of evidence.
  
  
  RESULTS
  Fifty-four studies were included in the review, and divided into nine broad intervention categories. Meta-analysis demonstrated significant reduction in depression with exercise interventions (n = 137; effect estimate SMD: -2.03, 95%CI: -3.22, -0.85). Community-based interventions targeting participation and leisure domains showed moderate evidence for improvement in global participation measures and HRQoL. Comprehensive rehabilitation demonstrated limited evidence for depression and participation, and strong evidence for HRQoL.
  
  
  CONCLUSIONS
  There is limited to moderate evidence supporting some rehabilitation interventions in affecting the outcomes of depression, participation and HRQoL post-stroke. Heterogeneity of the studies made evidence synthesis difficult. Further consideration needs to be given to the type and timing of outcome measures selected to represent the domains of participation and HRQoL.
authors.affiliation: Physiotherapy Department, St.Vincent's Hospital Melbourne, Ground Floor Bolte Wing, P.O. Box 2900, Fitzroy, Melbourne 3065, Australia. christine.graven@svhm.org.au
authors.forename: Christine
authors.initials: C
authors.lastname: Graven
authors.forename: Kim
authors.initials: K
authors.lastname: Brock
authors.forename: Keith
authors.initials: K
authors.lastname: Hill
authors.forename: Lynette
authors.initials: L
authors.lastname: Joubert
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003863:Depression / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D006801:Humans; D011788:Quality of Life; D012944:Social Support; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation