Abstract
Background and aims
During stroke recovery, patients frequently experience multiple interacting symptoms that limit rehabilitation participation. Symptom network analysis provides a data-driven approach to identify “core symptoms” that may sustain the symptom system and represent high-impact intervention targets. Identifying core symptoms may guide symptom-targeted rehabilitation strategies. We aimed to map the evidence on how core symptoms are identified using symptom network methods in stroke populations and summarize core symptoms reported.
Methods
Following the Joanna Briggs Institute scoping review methodology, we searched nine databases (MEDLINE, PubMed, EMBASE, Web of Science, ScienceDirect, CBM, CNKI, VIP, and Wanfang) from inception to August 26, 2025. Studies applying symptom network analysis to adults with stroke and reporting core symptoms using centrality metrics were included. We charted methodological features and synthesized reported core symptoms and rehabilitation-related applications.
Results
Eighteen studies (n=195–2185) were included. Core symptom identification commonly relied on validated symptom scales, symptom preprocessing, Gaussian graphical models with EBICglasso, and centrality indices, particularly expected influence and strength. Across multidimensional networks, the most consistently reported core symptoms were impaired self-care, reduced mobility, pain, fatigue, decreased attention, worry, and low confidence in rehabilitation. In single-domain networks, sadness and loneliness were most frequently identified. Several studies incorporated external variables (e.g., outcomes and disease characteristics), enabling exploration of symptom–outcome pathways.
Conclusions
Core symptoms during stroke recovery span physical, psychological, and cognitive domains and may represent high-impact targets to improve rehabilitation engagement and functional recovery. Future research should standardize core symptom identification and test whether targeting core symptoms improves symptom burden and rehabilitation outcomes.
Conflict of interest
Yunting Wu: nothing to disclose. Weige Sun: nothing to disclose. Fei Wu: nothing to disclose. Ran Zhang: nothing to disclose. Tong Wang: nothing to disclose. Minghui Liu: nothing to disclose. Yuying Wang: nothing to disclose. Weixin Cai: nothing to disclose.