Home›Neurology› Leisure rehabilitation improves participation in stroke survivors, but evidence is low certainty
Leisure rehabilitation improves participation in stroke survivors, but evidence is low certaintyRehabilitation Programs May Increase Leisure Activities for Stroke Survivors
The American journal of occupational therapy : official publication of the American Occupational Therapy AssociationPublished September 9, 2026Study authors: Alves-Stein Serena, Lannin Natasha A, Kramer Sharon, Wales Kylie, Jolliffe LauraPubMed ↗DOI ↗Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain
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Key Takeaway
Consider leisure rehabilitation for stroke survivors, but interpret results cautiously due to low evidence certainty.
This meta-analysis synthesized evidence on rehabilitation interventions aimed at improving leisure participation in adult stroke survivors living in the community. The primary outcome was leisure participation, with secondary outcomes including the number of leisure activities and regularity of participation. The comparator was standard control. The analysis included a small number of studies, and the certainty of evidence was rated low.
The pooled result showed that leisure participation was higher in the intervention groups at the end of the intervention compared with control, with a standardized mean difference of 0.80 (95% confidence interval 0.03 to 1.56). The number of leisure activities also increased, but regularity of participation showed no change. These findings suggest a potential benefit of leisure rehabilitation, but the wide confidence interval and low certainty warrant caution.
The authors noted several limitations: the small number of studies, high heterogeneity, and low certainty of evidence. They also indicated that it remains unclear whether any one intervention approach is more effective. Subgroup analysis suggested possible benefits when the intervention is provided earlier poststroke, but this was not a primary finding.
For clinical practice, leisure rehabilitation may improve leisure participation, but the quality of evidence is low. Clinicians should interpret these results with caution and consider individual patient factors when recommending leisure-based interventions. Further research with larger, more rigorous trials is needed to strengthen the evidence base.
How this fits prior evidence
This meta-analysis extends prior coverage on stroke rehabilitation by focusing on leisure participation, a domain not addressed in earlier reviews of vagus nerve stimulation, brain-computer interfaces, or mobile stroke units. While those interventions targeted motor or acute care outcomes, this analysis addresses a gap in community-based functional participation. The finding of improved leisure participation (SMD 0.80) is consistent with the positive but exploratory results seen in BCI-based interventions for motor scores. However, the low certainty and high heterogeneity mirror the early-stage evidence noted for wearable digital biomarkers.
Researchers looked at how different rehabilitation programs affect the daily lives of adults who have survived a stroke. They specifically looked at how much these programs helped patients engage in leisure activities, such as hobbies or social interests. The study compared these specialized programs against standard care.
The results showed that people in the rehabilitation groups participated in more leisure activities than those in the control groups. While the number of different activities increased, the regularity of how often they participated did not change. This suggests that while people may try more things, they do not necessarily do them more often.
It is important to note that the evidence for these findings is currently weak. This is because the study was based on a small number of reports that varied significantly. It is also not yet clear which specific type of rehabilitation is most effective. You should talk to a healthcare provider to see if these programs are right for your specific needs.
What this means for you:
Rehabilitation may increase the number of leisure activities for stroke survivors, but evidence quality is currently low.
Common questions
Can rehabilitation help stroke survivors enjoy more hobbies?
Yes, the study found that survivors in rehabilitation groups participated in more leisure activities than those receiving standard care. While the number of activities increased, the regularity of participation did not change. Because the evidence is based on a small number of studies, you should consult a doctor to discuss specific treatment plans.
What are the limitations of this finding?
The evidence for these results is considered low. This is because the study included a small number of reports and had high heterogeneity. Because of these factors, it is not yet known which specific rehabilitation approach is the most effective for stroke survivors.
Does the timing of rehabilitation matter for stroke survivors?
The data suggests there may be some benefits when rehabilitation is provided earlier after a stroke. However, because the overall quality of evidence is low, these results should be viewed as preliminary rather than a definitive rule for all patients.
ObjectiveTo investigate the effectiveness of rehabilitation interventions on increasing leisure participation in adult survivors of stroke.Data SourcesDatabases (Medline, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials) were searched from inception to September 2025.Study Selection and Data CollectionIncluded studies were randomized and nonrandomized controlled trials investigating leisure rehabilitation for community-living adults with stroke, which include a measure of leisure participation. Data extraction was performed using a predetermined data extraction form. The PEDro Scale was used to assess the risk of bias.FindingsA total of 6,813 records were retrieved, 46 were assessed at full-text review, and 8 studies were included. The meta-analysis included four studies, and another four studies were synthesized narratively. Leisure participation was higher in the intervention groups at the end of the intervention compared with the control (standardized mean difference = 0.80, 95% confidence interval 0.03 to 1.56). There was low certainty for this evidence due to the small number of studies and high heterogeneity. Subgroup analysis indicated possible benefits when intervention is provided earlier poststroke, and that leisure rehabilitation increases the number of leisure activities, but not the regularity of participation. It remains unclear whether any one intervention approach is more effective.Conclusions and RelevanceLeisure rehabilitation may improve leisure participation; however, the quality of evidence is low. Further well-designed trials are needed to address leisure participation following stroke, investigating the optimal timing of leisure rehabilitation and identifying the effective elements of the intervention.
