title: Stroke rehabilitation evidence and comorbidity: a systematic scoping review of randomized controlled trials.
abstract: Most strokes occur in the context of other medical diagnoses. Currently, stroke rehabilitation evidence reviews have not synthesized or presented evidence with a focus on comorbidities and correspondingly may not align with current patient population. The purpose of this review was to determine the extent and nature of randomized controlled trial stroke rehabilitation evidence that included patients with multimorbidity.
  
  
  
  A systematic scoping review was conducted. Electronic databases were searched using a combination of terms related to "stroke" and "rehabilitation." Selection criteria captured inpatient rehabilitation studies. Methods were modified to account for the amount of literature, classified by study design, and randomized controlled trials (RCTs) were abstracted.
  
  
  
  The database search yielded 10771 unique articles. Screening resulted in 428 included RCTs. Three studies explicitly included patients with a comorbid condition. Fifteen percent of articles did not specify additional conditions that were excluded. Impaired cognition was the most commonly excluded condition. Approximately 37% of articles excluded patients who had experienced a previous stroke. Twenty-four percent excluded patients one or more Charlson Index condition, and 83% excluded patients with at least one other medical condition.
  
  
  
  This review represents a first attempt to map literature on stroke rehabilitation related to co/multimorbidity and identify gaps in existing research. Existing evidence on stroke rehabilitation often excluded individuals with comorbidities. This is problematic as the evidence that is used to generate clinical guidelines may not match the patient typically seen in practice. The use of alternate research methods are therefore needed for studying the care of individuals with stroke and multimorbidity.
authors.affiliation: a Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute , Sinai Health Systems , Toronto , Canada.|b Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.|c Daphne Cockwell School of Nursing , Ryerson University , Toronto , Canada.
authors.forename: Michelle L A
authors.initials: MLA
authors.lastname: Nelson
authors.affiliation: a Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute , Sinai Health Systems , Toronto , Canada.|b Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.
authors.forename: Kaileah A
authors.initials: KA
authors.lastname: McKellar
authors.affiliation: a Bridgepoint Collaboratory, Lunenfeld-Tanenbaum Research Institute , Sinai Health Systems , Toronto , Canada.|b Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.
authors.forename: Juliana
authors.initials: J
authors.lastname: Yi
authors.affiliation: d Cardiac Care Network of Ontario , Toronto , Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Kelloway
authors.affiliation: e Toronto Rehabilitation Institute , University Health Network , Toronto , Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Munce
authors.affiliation: e Toronto Rehabilitation Institute , University Health Network , Toronto , Canada.|f Department of Physical Therapy , University of Toronto , Toronto , Canada.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Cott
authors.affiliation: g Institute of Clinical Evaluative Sciences , Toronto , Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Hall
authors.affiliation: h Département de médecine de famille , Universite de Sherbrooke , Sherbrooke , Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Fortin
authors.affiliation: i St. Joseph's Stroke Rehabilitation Program , Lawson Health Research Institute, Western University , London , Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
authors.affiliation: j Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.
authors.forename: Renee
authors.initials: R
authors.lastname: Lyons
mesh_terms: D015897:Comorbidity; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D000071939:Stroke Rehabilitation
keywords: Stroke; comorbidity; evidence based practice; multimorbidity; rehabilitation; scoping review