Table 4. Studies of evaluations of programmes for stroke rehabilitation of young adults (n = 29).

Programme	Stroke Sample All ages* (n)	Stroke Sample Young Adults 18–45** (n)	Context	Mechanism		Outcome
				Resource	Response
Physical-related programme
Somatosensory training [70]	5	1	Attitudes, thoughts, and motivation.	Trains proprioception of upper and lower limbs.	Lack of sensation, early sensory re-education, regretted that sensation was not a priority in rehabilitation programme	Unable to deal with sensory issues. There is still a need for evidence-based and practice-appropriate clinical assessment tools and treatment strategies to be identified.
12-week land and water-based programme ([69]	1	1	Age, down syndrome, stroke type, training engagement, parent’s support, goal attaining scale.	Trains strength and balance, facilitates social interactions with similar aged peers.	Motivation, physical performance without help, better in socialising.	Improved cardiorespiratory fitness, strength, balance, and mobility. Indicators: oxygen uptake (VO2) peak, 8% increase, one-repetition maximum (51%), community balance and mobility scale (54%), comfortable walking speed (42%), six-minute walk test (28%), daily step count (21%). Improved social behaviour
Ambulatory monitoring using Accelerometery for Bilateral Lower Extremities (ABLE) [58]	16	3	Gender, age, type of stroke, days post-stroke, mobility, motor recovery, gait speed, balance, symmetry	Guides therapists to conduct appropriate changes to therapy, provides measures to monitor treatment outcomes, and serves as homework checker to ensure prescribed daily walking are conducted	Higher walking activity	Increased walking activity and walking bout durations. Significant association was found between the number of walking bouts to total walking time and laboratory gait speed and between laboratory gait speed and balance impairment. Increased in gait asymmetry during day-long measurement compared with the standard laboratory-based assessment
Combined aerobic exercise and task-specific training [93]	2	1	Adherence to protocol, suitable for subacute and chronic phase stroke patient	Combines two training, including aerobic exercise of 30 minutes of lower limb cycling and 30 minutes of upper limb task-specific training	The changeover from aerobic exercise to task-specific training interrupted the flow of the session and reduced recovery potential, the programme was too short	Upper limb motor function improved on Action Research Arm Test (ARAT) by 4 points and Wolf Motor Function Test (WMFT) 5 points, aerobic fitness improved 4.66ml/O2/kg/min and 6-minute walking distance 50-meter, increased strength and function in the upper limb, increased participation in daily activities, increased in activities of daily living categories, feeling fitter, increased in education of compensatory movements, and social interaction, provided hope and optimism that they could participate in meaningful activities they had not participated in since their stroke.
Ankle-Foot Orthosis (AFO) [61]	3	1	Weight, height, and comorbidities	Facilitates a long-term motor recovery	N/A	Gait endurance and velocity increased, motor recovery improved, general symmetry improved, muscle activity activate early, amplitude increased
Cardiorespiratory exercise [33]	17	4	Body mass, stroke types and location, comorbidities	Trains cardiorespiratory fitness with gait performance	N/A	Peak oxygen uptake (VO2peak) was 1.150.36L/ min, which was only 50% of the VO2peak reported in the literature for a healthy, age-matched group, maximal walking velocity (1.020.28m/s) and endurance (294.1120.2m) were also approximately 50% of an aged-matched healthy group, 6-minute walking endurance was strongly associated with self-selected walking velocity.
Gait analysis [78]	49	17	Walking ability, musculoskeletal condition	Provides spatio-temporal parameters	Gait analysis confidence level was improved	Changes in gait analysis (GA). GA significantly influences therapeutic planning surgical and non-surgical for chronic post-stroke patients with locomotor disability.
Rehabilitation programme (no assigned name given) [62]	1	1	Type of complication in stroke: Terson syndrome	Facilitates patient to effectively implement the necessary physical therapy, occupational therapy, speech therapy skills, and surgery.	N/A	Vision improved, patient successfully return to community and independence with all basic activities daily living
Upper limb rehabilitation [92]	3	1	Timing to start upper-limb rehabilitation	Failed to give early upper-limb intervention as in the community the rehabilitation emphasises more in lower-limb	If the programme started early, the participant felt that they could get more input on arms	Participants of the study felt depressed and loss of independence because of upper-limb impairment
Physical activity (PA) [103]	15	2	Individual factors: age, sex, race, years since stroke, Body Mass Index (BMI), Barthel index, ambulation, physical activity level, expectations, self-efficacy, self-regulation, social support	Encourages stroke survivors to complete activities of daily living, ambulate with or without an assistive device, perform tasks that required physical activity, and repeat practice of challenging tasks (physically active)	Gives a reward feeling of accomplishment, modifies task to compensate the difficulties (a sense of problem solving)	Regained strength, improved performance, strengthened one’s self efficacy
Functional electrical stimulation (FES) [65]	13	2	Gait velocity at setup, time since FES setup, home and social circumstances, time since stroke	Produces movement in muscles paralysed due to central nervous system lesions (e.g., lifting the foot during the swing phase of gait).	The quality and stamina of walking is much better and quicker	Improvements in walking, being involved in the family tradition, the positive feelings
Action for Rehabilitation in Neurological Injury (ARNI) [67]	30	4	Peer led and supported, group motivation, terminology (language), environment	Provides one-to-one time to address personal goals	Having opportunities to increase their individual capacity, feeling appreciated, regain independence, seek another activity, increase accessibility because the training was held at a community facility that did not require appointment	Feeling challenged, hard work, returning to activities and roles ceased since their stroke, participating more in community life
Psychological and well-being related programme
Dialogue-based intervention [72]	25	2	Language problems, group/individual intervention, physical limitations, fatigue, vision or hearing deficiencies, reduced memory, concentration difficulties	Uses work sheets, offers two meeting first meeting occurred as soon as possible after the stroke, usually within 4–8 weeks, and the last occurred approximately 6 months after the stroke (except for the aphasia group, in which the intervention had to be prolonged).	The work sheet was understandable but difficult to read and write, the content was very good, the intervention should last longer, the intervention should be personalised based on the need of participants since the age range was high	Having difficulties to read and write, using the workbook to start thinking, wanting a longer intervention, a mismatch between personal needs and the group topic discussion
Art health group programme [55]	11	2	Aphasia or underlying cognitive impairment	Provides an opportunity for stroke survivors to explore art in a supportive environment	Feeling of accomplishment, provide insight into physical capabilities, increased self-confidence and self-esteem, life-style benefit, change and instil hope, found something new to learn	Improved quality of life and well-being, included increased confidence, self-awareness, and social interaction which lead to improved self-efficacy of participants
Storytelling [40]	8	2	Age, gender, marital status, level of education, type of stroke, stroke severity, presence of sequelae, and number of days after the stroke event	Facilitates participants to share their story in detail about physical symptoms, emotional and social impact of their stroke experience and to discover their vision of hope and its role in life	N/A	Nurtures positive type of hope (active)
Positive mental training (PosMT) [87]	10	1	Level of depression, anxiety, suicidality, affective, and disability	Facilitates relaxation, manage anxiety, regain confidence, coping	Helps participants into a routine, deal with anxiety, sleep deprivation, stressed, panic attack, relaxed, and regain self confidence	Positive physical and psychological benefits, including improved relaxation, better sleep, reduced anxiety, gained positive outlook on the future, increased motivation, confidence, and ability to cope with rehabilitation
Self-awareness intervention [47]	1	1	Previous working experience, persisting awareness deficits, fluctuating emotional state, and motivation for treatment	Provides knowledge of the brain and brain injury, awareness of deficits and their everyday impact, self-evaluation of physical, cognitive and behavioural abilities, gives feedback, emotional support, provides counselling on how to do self-monitoring, identification of goals	Very interesting, gain useful insights and feedback on capability, learning through practical experience, individualising therapy	Participant was offered part-time paid work as a retail assistant (3 days per week, 5 hours per week) and had maintained this position at follow-ups conducted at 3, 6, and 9 months post intervention
Hospital-based peer support groups [63]	8–18 participants (varies across weeks range)	2	Laterality, dysphasia (communication problems), mobility, cognition difficulties, with young children, the group size	Provides a media to talk about particular problem	Want to know more about the effect on younger children when their parent has a stroke, feel more positive and encouraging, taught how to listen to others and respond to them	Gained helpful information and advice, built connections, and increased awareness of stroke
Arts in health [38]	21	3	Patients’ socio-demographic details, including socio-economic status (SES) using the Registrar General’s occupational codes, cognitive status using the abbreviated mental test	Slow pace of the reading sessions, reader/patient relationship, relief from anxiety	Easy to understand, thankful for willing to wait and not being in a rush in telling a story	The sense of being in control and the practical experience of communication, being able to talk freely, confiding things which they felt unable to share with friends and family, an entertaining distraction in a boring and anxiety provoking situation
Reconstructing an occupational identity [89]	6	2	Number of strokes, hospital length of stay, participation in inpatient rehabilitation, outpatient rehabilitation, living situation, working prior to stroke, leisure occupations prior to stroke, ethnicity	Reflecting the impact on their identity through leisure occupations, trying to make sense of symptoms, communication difficulties, discharged from services bringing a confrontation with the reality of the stroke, reframe thinking, re-evaluating priorities, managing emotions	N/A	Feeling destroyed, putting the symptoms down to being tired, hot or unwell, resisting friends’ urges to go to hospital, hindering connecting with the reality of the stroke, not realising having the challenges, a sudden sense of isolation at discharge, being grateful that they could return to previous occupation, accepting that the stroke had occurred and looking towards a new future reality, being judged by people when having social interactions
Enriched environment [81]	10	1	age, gender, first ever stroke, length of stay in rehabilitation, discharge destination, mobility restrictions	enhances social interaction, increases activity levels at patient’s bedside and the experience of access to activities from a participant’s home settings facilitated adaptation to the unfamiliar hospital environment, set daily routines on the ward	Compromised personal preferences towards accessing the communal enriched environment	Feeling constrained and unable to move around the ward at their leisure, feelings of boredom staying at bedside
Volunteering [57]	14	1	Level of engagement, according to the following factors: length of time of involvement; regularity of activity; range of activities; number of activities; role within the activities and effects within the activity for the organisations involved, fatigue, other life priorities; time since the stroke; skills possessed prior to having aphasia and those limited by aphasia; concentration, emotions, memory; personality characteristics	Participation in the activity, enabling them to fulfil their self-expectations and live their lives in a personally meaningful way, delivering public presentations, engaging in group discussions, managing conversations, assistance and support given for people with disabilities, activities or services offered	More confident, speak better, give opinion, can relate to someone else	Feeling more confident, enduring personality traits, improvements in communication, family member’s support, having empathy with others living with a similar disability, aphasia ’made real’ for staff
Secondary prevention advice [44]	25	2	Ability to comprehend information, language used by clinicians to give explanation	Fails to identify the appropriate moment in delivering information, fail to use universal language that can be understood by laypersons	Information given was irrelevant, participant cannot understand the Latin words which were used by doctors	Rejection of information, confusion and misunderstanding
Self-management of risk factors [101]	100	1	Age, gender, race/ethnicity, education, insurance, mean systolic and diastolic blood pressure, medication adherence, know target of blood pressure (BP), ownership of mobile phone, the use of internet to access health information, ownership of home monitors to measure BP or taking their BP at a pharmacy, motivation to learn to take their BP, lack of financial resources	The use of some form of health information technology in supporting risk factor control, such as appointment reminders, instructions from a health professional in the correct procedures for monitoring BP	N/A	Raised awareness of risk, motivated to make changes, searching for information about risk factors on the internet, setting an alarm on their mobile phone as a reminder to take pills, text messages for appointment reminders, home BP monitoring, and using internet sites to track BP over time.
Early supported discharge (ESD) [86]	22	1	Employment status, type of stroke, days in hospital, visits from ESD team, future ESD visits or phone calls planned, participating in community-based rehab	Individual assessment, team visit, evaluation of patients’ needs and outline a rehabilitation plan	Home as calm, participant did not feel that the plan covered rehabilitation needs. Participant felt that the services were more suited for retired and older patients.	There was a mismatch between the needs of young adult participants and service offered by ESD
Neuropharmacological related intervention
Methylphenidate and bromocriptine [31]	3	1	Drug dose, stroke severity level, other drug uses	Improve neuro function	Participant reported minimal memory and word-finding deficits and mild personality changes	Associated with an excellent functional gain: 50 Functional Independence Measure (FIM) points in 37 days. Patient returned to work.
Integrated programme
Combined physical and mental practice [59]	1	1	The location for the therapy session, the occupational therapist, patient motivation, stroke severity	Provides physical and mental practices	The patient complained of minor fatigue, increased frustration with more challenging tasks and boredom	Patient showed increases in measures of functional performance and self-perception of performance, despite persistent Ideomotor Apraxia (IMA).
Stroke Rehabilitation Enhancing and Guiding Transition Home (STRENGTH) [71]	7	1	N/A	Provides opportunities for therapist, client, and carers to experience the challenges of everyday activities within the home and immediate community environment	Have a better idea when participant experiencing transitions	STRENGTH allowed participants to see positive outcomes in relation to their physical, cognitive and communication abilities, promote adaption. However, due to creating false environment during STRENGTH, participant may not be ready with the dynamic situations of real environment
Asitaba programme [68]	2	1	Underlying problem based on technical consultation and vocational evaluation form	Supported by the work support agencies and hospital that provide evaluation. Emphasises on participant’s learning ability to recognised tiredness, how it could be controlled and explain disabilities	Participant commented that his anxiety and distress toward re-employment was diminishing following the Asitaba programme.	Participant started seeking jobs by himself, which was the initial objective. Participant has re-entered the workforce and is actively working as a clerk.

*Only adults with stroke. Other study participants such as carers and staff were not included in the total number.

** The number of young adults (18–45) included in the All age adult sample.