Objective methods for monitoring the effectiveness of rehabilitation in ischemic stroke patients

Background. Ischemic stroke remains a leading cause of adult disability. Effective rehabilitation requires standardized outcome assessment. The lack of consensus on a set of objective indicators complicates data interpretation and clinical guideline development.

Objective: To systematically analyze objective methods for monitoring the effectiveness of rehabilitation in ischemic stroke patients and to assess their validity, reproducibility, and practical applicability.

Material and methods. A systematic search was conducted in accordance with PRISMA 2020 guidelines. International (PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, IEEE Xplore) and Russian (eLibrary and CyberLeninka) databases were searched from January 2000 to December 2024 (last search: December 15, 2024). The analysis included studies of adult ischemic stroke patients undergoing rehabilitation with objective outcome assessment. Clinical-functional scales, instrumental biomechanical methods, neuroimaging and neurophysiological markers, biochemical biomarkers, and digital assessment methods were analyzed. The risk of bias was evaluated using RoB 2, ROBINS-I, and QUADAS-2 tools.

Results. The analysis of key systematic reviews, consensus documents, and representative primary studies yielded six cate­ gories of objective monitoring methods. Standardized clinical-functional scales (Fugl–Meyer Assessment, National Institutes of Health Stroke Scale, Barthel Index, Functional Independence Measure, Action Research Arm Test, and Berg Balance Scale) provide the most validated basis for monitoring rehabilitation effectiveness (quality of evidence: moderate-to-high). Instrumental biomechanical methods ensure high sensitivity to changes in movement quality; however, they are characterized by high protocol variability (quality of evidence: low-to-moderate). Neuroimaging, neurophysiological, and biochemical biomarkers show significant prognostic potential but remain primarily research tools (quality of evidence: low-to-moderate). Telerehabilitation and digital assessment methods enable objective monitoring in outpatient settings (quality of evidence: low).

Conclusion. The optimal approach to monitoring rehabilitation effectiveness in ischemic stroke patients involves using a standardized set of clinical outcomes as a mandatory minimum, with gradual addition of instrumental, neurophysiological, and biomarker methods. Further development of approaches to standardizing objective rehabilitation outcomes in such patients is needed.

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