Survey on stroke rehabilitation in Europe (SUSTAIN-EU) to evaluate European stroke rehabilitation services

Authors

  • Guna Bērziņa Department of Rehabilitation, Riga Stradiņš University, Riga, Latvia
  • Katharina S. Sunnerhagen Rehabilitation Medicine, Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden; Rehabilitation Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden https://orcid.org/0000-0001-6826-2427
  • Ayse A. Küçükdeveci Ankara University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Turkey https://orcid.org/0000-0001-7255-7535
  • Mauro Zampolini Department of Rehabilitation, USL UMBRIA 2, Foligno, Italy https://orcid.org/0000-0001-8089-8583
  • Volodymyr Golyk Disability and Rehabilitation, Rehabilitation and Disability Unit, WHO Country Office in Ukraine; Ukrainian Society of Physical and Rehabilitation Medicine, Dnipro, Ukraine https://orcid.org/0000-0001-5106-6382
  • Yvona Angerova Department of Rehabilitation Medicine First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic https://orcid.org/0000-0002-9812-1614
  • Marco Franceschini Research Area in Neuromotor Rehabilitation and Rehabilitation Robotics, Department of Neuroscience, IRCCS San Raffaele Roma, Rome, Italy https://orcid.org/0000-0002-2131-1583
  • Daiana Popa Rehabilitation Hospital Felix Spa, Oradea, Romania
  • Catarina Aguiar Branco PRM Service – Hospital Feira – ULSEDV, Portugal and FMD University of Porto, Portugal https://orcid.org/0000-0001-5666-842X
  • Markos Sgantzos Medical School, University of Thessaly, Greece https://orcid.org/0000-0001-6337-4534
  • Paolo Boldrini Private Practice, Ferrara, Italy
  • Dominic Perennou Neurorehabilitation Department, Institute of Rehabilitation, Grenoble-Alpes University Hospital, Echirolles, France; Lab Psychology and NeuroCognition, University of Grenoble-Alpes, Grenoble, France https://orcid.org/0000-0003-2125-386X
  • Thierry Lejeune UCLouvain, Institut de Recherche Expérimentale et Clinique (IREC), Neuro Musculo Skeletal Lab (NMSK), Brussels, Belgium; Cliniques universitaires Saint-Luc, Service de médecine physique et réadaptation, Brussels, Belgium https://orcid.org/0000-0001-5741-7753
  • Xiaolei Hu Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden

DOI:

https://doi.org/10.2340/jrm.v58.44888

Keywords:

Europe, health services, stroke rehabilitation

Abstract

Objective: This study aimed to assess the organization and delivery of post-stroke rehabilitation services across Europe, focusing on the role of Physical and Rehabilitation Medicine physicians.

Design and Methods: A cross-sectional online survey was conducted by the ESPRM Working Group of Stroke Rehabilitation from 30 European countries. The survey followed the International Classification of Service Organization in Rehabilitation framework and covered stroke care levels, rehabilitation services, registries, and quality control. Descriptive statistics were used for analysis.

Results: With an 81% response rate, the study revealed both commonalities and disparities in service provision in 30 European countries. Stroke unit rehabilitation was available in 90% of countries, and inpatient services in 100%. However, early supported discharge (53%), community-based rehabilitation (63%), and telerehabilitation (57%) were less common. Countries joining ESPRM after 1991 had significantly lower rates of early supported discharge (−48%, p=0.01) and community-based care (−55%, p=0.02).

Conclusion: Despite widespread inpatient services, major gaps remain in community- and technology-supported rehabilitation. Addressing these disparities requires targeted policy changes, altered resource allocation, and enhanced training to ensure equitable and effective stroke recovery across Europe.

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References

Bennett DA, Krishnamurthi RV, Barker-Collo S, Forouzanfar MH, Naghavi M, Connor M, et al. The global burden of ischemic stroke: findings of the GBD 2010 study. Glob Heart 2014; 9: 107–112. DOI: https://doi.org/10.1016/j.gheart.2014.01.001

Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet 2014; 383: 245–254. DOI: https://doi.org/10.1016/S0140-6736(13)61953-4

Stevens, Emmett E, Wang Y, McKevitt C, Wolfe C. The burden of stroke in Europe. Report. Overview of stroke burden and care in each EU and SAFE member country. London: King’s College London for SAFE; 2017.

Norrving B, Barrick J, Davalos A, Dichgans M, Cordonnier C, Guekht A, et al. Action Plan for Stroke in Europe 2018–2030. Eur Stroke J 2018; 3: 309–336. DOI: https://doi.org/10.1177/2396987318808719

Wafa HA, Wolfe CDA, Emmett E, Roth GA, Johnson CO, Wang Y. Burden of stroke in Europe: thirty-year projections of incidence, prevalence, deaths, and disability-adjusted life years. Stroke 2020; 51: 2418–2427. DOI: https://doi.org/10.1161/STROKEAHA.120.029606

Selb M, Zampolini M, Barotsis N, Oral A, Stucki G, UEMS-PRM Section, et al. The standards and tools of the European Union of Medical Specialists Physical and Rehabilitation Medicine Section and Board for Rehabilitation Management and Care: an evidence brief for rehabilitation practitioners. Eur J Phys Rehabil Med 2024; 60: 729–736. DOI: https://doi.org/10.23736/S1973-9087.24.08653-2

Zampolini M, Selb M, Boldrini P, Branco CA, Golyk V, Hu X, et al. The Individual Rehabilitation Project as the core of person-centered rehabilitation: the Physical and Rehabilitation Medicine Section and Board of the European Union of Medical Specialists Framework for Rehabilitation in Europe. Eur J Phys Rehabil Med 2022; 58: 503–510. DOI: https://doi.org/10.23736/S1973-9087.22.07402-0

Solvang PK, Hanisch H, Reinhardt JD. The rehabilitation research matrix: producing knowledge at micro, meso, and macro levels. Disabil Rehabil 2017; 39: 1983–1989. DOI: https://doi.org/10.1080/09638288.2016.1212115

Gutenbrunner C, Nugraha B, Gimigliano F, Meyer T, Kiekens C. International Classification of Service Organization in Rehabilitation: an updated set of categories (ICSO-R 2.0). J Rehabil Med 2020; 52: jrm00004. DOI: https://doi.org/10.2340/16501977-2627

Meyer T, Gutenbrunner C, Kiekens C, Skempes D, Melvin JL, Schedler K, et al. ISPRM discussion paper: proposing a conceptual description of health-related rehabilitation services. J Rehabil Med 2014; 46: 1–6. DOI: https://doi.org/10.2340/16501977-1251

European Physical and Rehabilitation Medicine Bodies Alliance. White Book on Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 4. History of the specialty: where PRM comes from. Eur J Phys Rehabil Med 2018; 54: 186–197. DOI: https://doi.org/10.23736/S1973-9087.18.05147-X

United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects 2024. [cited 2024 November 25]; Available from: https://population.un.org/wpp/

MapChart. [cited 2025 May 1]. Available from: https://www.mapchart.net/index.html

World Bank Group. Countries and economies. 2025 [cited 2025 Jun 16]; Available from: https://data.worldbank.org/country

European Physical and Rehabilitation Medicine Bodies Alliance. White Book on Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 9. Education and continuous professional development: shaping the future of PRM. Eur J Phys Rehabil Med 2018; 54: 279–286. DOI: https://doi.org/10.23736/S1973-9087.18.05153-5

European Society of Cardiology. Incidence of stroke in Europe in 2021, by country (per 100,000 population). 2022; 2022.

Gimigliano F, Negrini S. The World Health Organization “Rehabilitation 2030: a call for action”. Eur J Phys Rehabil Med 2017; 53: 155–168. DOI: https://doi.org/10.23736/S1973-9087.17.04746-3

Lindsay MP, Norrving B, , Furie KL, Donnan G, Langhorne P, Davis S. Global stroke guidelines and action plan: a road map for quality stroke care. Stroke rehabilitation. Geneva: World Stroke Organization; 2019.

Owolabi MO, Thrift AG, Martins S, Johnson W, Pandian J, Abd-Allah F, et al. The state of stroke services across the globe: report of World Stroke Organization-World Health Organization surveys. Int J Stroke 2021; 16: 889–901. DOI: https://doi.org/10.1177/17474930211019568

Kucukdeveci AA, Stibrant Sunnerhagen K, Golyk V, Delarque A, Ivanova G, Zampolini M, et al. Evidence-based position paper on Physical and Rehabilitation Medicine professional practice for persons with stroke. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2018; 54: 957–970. DOI: https://doi.org/10.23736/S1973-9087.18.05501-6

Langhorne P, Baylan S. Early supported discharge services for people with acute stroke. Cochrane Database Syst Rev 2017; 10.1002/14651858.CD000443.pub4. DOI: https://doi.org/10.1002/14651858.CD000443.pub4

Zampolini M, Oral A, Barotsis N, Aguiar Branco C, Burger H, Capodaglio P, et al. Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2024; 60: 165–181. DOI: https://doi.org/10.23736/S1973-9087.24.08396-5

Rehabilitation indicator menu: a tool accompanying the Framework for Rehabilitation Monitoring and Evaluation (FRAME), second edition. Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO; 2023.

Stroke Unit Trialists C. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev 2013; 10.1002/14651858.CD000197.pub3: CD000197.

Stroke Unit Trialists C. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev 2002; 10.1002/14651858.CD000197: CD000197.

Ward AB, Gutenbrunner C, Damjan H, Giustini A, Delarque A. European Union of Medical Specialists (UEMS) section of Physical & Rehabilitation Medicine: a position paper on physical and rehabilitation medicine in acute settings. J Rehabil Med 2010; 42: 417–424. DOI: https://doi.org/10.2340/16501977-0565

Intercollegiate Stroke Working Party National clinical guideline for stroke. 5th. London:: Royal College of Physicians; 2016.

European Physical and Rehabilitation Medicine Bodies Alliance. White Book on Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 8. The PRM specialty in the healthcare system and society. Eur J Phys Rehabil Med 2018; 54: 261–278. DOI: https://doi.org/10.23736/S1973-9087.18.05152-3

Gutenbrunner C, Blumenthal M, Geng V, Egen C. Rehabilitation services provision and payment. Am J Phys Med Rehabil 2017; 96: S35–S40. DOI: https://doi.org/10.1097/PHM.0000000000000668

Mayo NE. Stroke rehabilitation at home: lessons learned and ways forward. Stroke 2016; 47: 1685-1691. DOI: https://doi.org/10.1161/STROKEAHA.116.011309

World Health Organization U, International Labour Organization & International Disability Development Consortium. Community-based rehabilitation: CBR guidelines. Geneva: World Health Organization; 2010.

Gutenbrunner C, Bickenbach J, Melvin J, Lains J, Nugraha B. Strengthening health-related rehabilitation services at national levels. J Rehabil Med 2018; 50: 317–325. DOI: https://doi.org/10.2340/16501977-2217

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Published

2026-08-17

How to Cite

Bērziņa, G., S. Sunnerhagen, K., A. Küçükdeveci, A., Zampolini, M., Golyk, V., Angerova, Y., … Hu, X. (2026). Survey on stroke rehabilitation in Europe (SUSTAIN-EU) to evaluate European stroke rehabilitation services. Journal of Rehabilitation Medicine, 58, jrm44888. https://doi.org/10.2340/jrm.v58.44888

Issue

Vol. 58 (2026)

Section

Original Report

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Copyright (c) 2026 Guna Bērziņa, Katharina S. Sunnerhagen, Ayse A. Küçükdeveci, Mauro Zampolini, Volodymyr Golyk, Yvona Angerova, Marco Franceschini, Daiana Popa, Catarina Aguiar Branco, Markos Sgantzos, Paolo Boldrini, Dominic Perennou, Thierry Lejeune, Xiaolei Hu

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