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Study Protocol
Revised

Life After Stroke and Supportive Stroke Pathways: Protocol For A Rapid Realist Review

[version 2; peer review: 2 approved, 1 approved with reservations]
Olive Lennon
https://orcid.org/0000-0001-7005-3616
1, Mary O'Neill2, Killian Walsh3, Frances Horgan
https://orcid.org/0000-0002-8773-9953
2
Olive Lennon
https://orcid.org/0000-0001-7005-3616
1, Mary O'Neill2, Killian Walsh3, Frances Horgan
https://orcid.org/0000-0002-8773-9953
2
PUBLISHED 25 Mar 2025
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS

Abstract

Background

Ever-growing numbers of individuals are surviving stroke and living with the consequences. Life after stroke is a key pillar in addressing the burden of stroke for the remaining lifespan for those with stroke. No consensus on how to best promote agency and fulfilment in life after stroke or the resources required to achieve this currently exists.

Methods

In this realist review protocol we outline the methods we will use to gain an understanding of supporting Life after Stroke through the development of programme theories. These will consist of context–mechanism–outcome configurations (CMOCs) and will acknowledge the resources required. The review will follow the RAMESES five-stage structured methodology to (1) define the scope of the review, and the development of initial programme theories for supporting life after stroke, (2) develop a comprehensive search strategy to identify relevant research, (3) review primary studies and extract data, (4) synthesise evidence (5) refine programme theories iteratively throughout the process using an Expert Panel and reference group, to including stroke researchers, health care professionals working in stroke care, people with lived experience of stroke and carers, and stroke support agencies.

Conclusion

This realist review aims to conceptualise supports for Life after Stroke. The CMOCs developed will help explain how generative causation within the life after stroke pathway works. The findings will help inform policy and practice and inform future realist evaluations of Life after Stroke support pathways.

Keywords

Life after stroke; Realist review; Programme theory; Supportive pathways

Corresponding author: Frances Horgan
Competing interests: No competing interests were disclosed.
Grant information: Health Research Board Ireland [APA-2022-019]. This work was also supported by the Irish Heart Foundation and the HSE National Stroke Clinical Programme.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright:  © 2025 Lennon O et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Lennon O, O'Neill M, Walsh K and Horgan F. Life After Stroke and Supportive Stroke Pathways: Protocol For A Rapid Realist Review [version 2; peer review: 2 approved, 1 approved with reservations]. HRB Open Res 2025, 8:10 (https://doi.org/10.12688/hrbopenres.14034.2) First published: 23 Jan 2025, 8:10 (https://doi.org/10.12688/hrbopenres.14034.1) Latest published: 14 Jul 2025, 8:10 (https://doi.org/10.12688/hrbopenres.14034.3)

Revised Amendments from Version 1

Our expert panel includes people with lived experience of stroke and carers and we have updated the abstract, the section detailing the expert panel and Table 1 to make this clearer. We have revised the review questions with a clearer reference to the population and context of life after stroke. There is a minor change to the legend for Figure 1. We have expanded on the approach to coding and thematic analysis in the data analysis section.

See the authors' detailed response to the review by Nicola Hancock

Introduction

Stroke is a leading cause of death and disability, affecting survivors physically, emotionally, cognitively and socially, and impacting their wider family and social networks1–5. In 2022 in Ireland, 5961 adults were admitted to acute hospitals following stroke, a year-on-year increase since 20196. Sixty-six per cent of individuals discharged home, had documented mild to moderate stroke-related disability. By 2035 there will be a 34% increase in stroke events in the EU, and by 2047, the projected rise in prevalent cases in the community is 27%7,8.

There is no consensus on what is meant by best care following discharge from specialist stroke services1. The Burden of Stroke in Europe Report describes life after stroke under four categories: health and activity issues, adjustment and wellbeing and information and support7,8. Multiple unmet needs after stroke have been described in the literature including body function and structure, activities, participation, environmental and personal domains8–10. Published Irish data on unmet needs identified mobility problems, emotional issues, fatigue, concentration difficulties, negative financial changes and low return-to-work rates after stroke11.

A qualitative synthesis described the disruption to life experienced by people and their families and the need to adapt and rebuild a post-stroke life and identity12. Documented post-stroke experiences included autonomy, uncertainty, engagement, hope and social relations as key challenges for participation in life after stroke8,9,13.

The Stroke Action Plan for Europe (SAPE) (2018–2030) recognises Life after Stroke as one of seven key pillars to address the burden of stroke and long-term consequences1. The SAPE general principles for Life after Stroke and the World Stroke Organisation include a call for the recognition by society, of the worth and value of people with stroke-related disabilities14–17.

Our rapid realist review seeks to identify the mechanisms that promote agency and fulfilment in life after stroke and the resources required to achieve this. We will explore the contexts in which interventions have been successful, and will include the views and opinion of stakeholders in building programme level theories. This realist review will ask “what works for whom, why does it work and in what circumstances?”18.

Protocol

Study design

Realist synthesis is a theory driven approach and realist philosophy is based on ontological assumptions of a “real world”19. A realist lens conceptualises services and interventions that support Life after Stroke as a dynamic process19,20. Context-mechanism-outcome configurations (CMOCs) explain generative causation, what mechanisms are activated and how these interactions lead to different outcomes21,22. Our review will be conducted and reported according to the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES)22. The PRISMA-P checklist will be used23.

Methods

Stages of the realist review

Figure 1 outlines the five stages of the realist review in accordance with Pawson’s work24.

146ef13e-5178-457b-b9a4-d202a575ae37_figure1.gif

Figure 1. Five stages of the realist review according to Pawson24.

Defining the scope of the review

The aim of this realist review is to describe the mediators which enable a personally meaningful life after stroke. By determining the contexts, mechanisms and resources, the results will help guide clinicians, healthcare providers and peers to support people after stroke to regain a sense of identity, purpose, fulfilment and life satisfaction. The specific research questions being asked include:

What mediators or mechanisms enable interventions designed to support a personally meaningful life after stroke to result in the anticipated outcomes for people in their life after stroke?

What contextual factors and resources help facilitate achievement of a personally meaningful life after stroke following supportive interventions for people in their life after stroke?

The expert panel

An expert panel was convened including clinicians, researchers, a recognised international expert in the field, healthcare professionals working in stroke care, advocacy, stroke support workers from NGOs and people with lived experience of stroke and carers. Table 1 provides a breakdown of the members of the expert group. This group will have an important role, placing a spotlight on key literature, providing lived experience as someone who works in stroke care or has personal experience of stroke to aid the interpretation of data and complex concepts, in assessing the available evidence and in enhancing the credibility of the programme-level theories developed and their relevance clinically.

Table 1. The Expert Panel membership.

Membership
N=13		Gender breakdownSectorAdditional information
National Stroke Programme representation
(N=2)		Female: 2Health Service ExecutiveResponsibilities of the programme include development of the National Stroke Strategy
People with lived experience of stroke
(N=2)
Carers
(N=4)		Female: 1
Male: 1

Female:2
Male:2		Not applicable
National stroke charity representation (N=2)Female: 1
Male: 1		NGOAdvocacy director & Head of community support services
Physiotherapy (N=2)Female: 2Academic Clinical
Occupational therapy
(N=2)		Female: 1
Male: 1		Academic Clinical
Speech and language therapy
(N=1)		Female: 1Clinical
Psychology (N=1)Female: 1Clinical
Nursing
(N=1)		Female: 1AcademicInternational Expert

Early programme theory development

Potential explanations for how supports to achieve a personally meaningful Life after Stroke might work are first required. Describing candidate programme theories (CPTs) for a realist review is an important step, and will provide a scaffold on which the causal mechanisms can generate outcomes in specific contexts25. This step will begin with scoping the existing literature and describing early hypotheses about an intervention’s mechanism of action and expert-level insights26,27. A preliminary search of CINAHL and PubMed by title, abstract, keywords and subject headings was conducted in conjunction with a liaison librarian using search strings derived from the PICOC headings detailed in Table 2.

Table 2. PICOC Defined and Inclusion and Exclusion criteria.

Inclusion CriteriaExclusion Criteria
PAdult stroke or cerebrovascular accident or transient ischaemic attack.Other neurological conditions including traumatic brain injury. Paediatric stroke.
IInterventions designed to practically or psychologically support someone with stroke to have a personally meaningful life after stroke. Interventions may include self-management, peer support, communication, living well and healthily, goal setting and resilience building.Studies focussed on acute medical interventions, pharmacotherapy, rehabilitation of stroke impairments and disability.
CNot required but studies could include usual care or same or other interventions as comparator groups.
OAdapting to loss after stroke; re-establishing a self-identify and self-confidence; engaging in work (vocational or other), engaging in family and societal roles; managing psychological stress; purpose and fulfilment after stroke; wellbeing.Impairment and disability outcomes.
CFollowing discharge from acute hospital services across the remaining lifespan.Studies in acute hospital or in-patient rehabilitation settings.
Studies not in the English language.

This guided the first group of CPTs developed. Consultation between the researchers provided a first level refinement of these CPTs, often collapsing CPTs or separating them out where differing constructs were determined. These were then presented to the expert panel and further refined, taking account of their perspectives and experiences in relation to contexts, mechanisms and outcomes of supports for Life after Stroke. Here the panel were tasked with confirming, refuting or refining the CPTs23.

Development of a search strategy

The broad search terms derived from the CPTs are summarised in Table 3 and will be developed further with a liaison librarian, aligned to the RAMESES guidance22,23,28.

Table 3. Candidate Programme Theories.

Candidate programme theoryThemeEarly COMCs
1Supported self-management after strokeHaving agency and access to supportive resources when and as required from healthcare professionals and or family and or peers to manage life after stroke creates a space and a support system in which stroke survivors can feel comfortable to flourish and work towards their hopes and priorities to achieve a personally meaningful life after stroke.
2Goals and priorities and identifying needs after strokeWhen transitioning from active rehabilitation the conversation should move from shared rehabilitation goals to a more skilled conversation, in collaboration with services and therapists, that establishes their readiness for life after stroke, what is a priority for the person with stroke and their family, what is important to them and what they need to re-establish a sense of identity, promote adjustment to the new normal and allow active citizenship that may include engaging in work, vocational or other endeavours.
3Peer supportFor those who wish to engage with it, formal peer support with resources and training; or adequately resourced informal peer support or incidental peer support can all play an important role in adjustment to life after stroke by providing a safe space to talk, promoting self-compassion and perspectives of gratitude, decreasing isolation and increasing a sense of connectedness and fulfilment in the community.
4CommunicationOngoing communication that includes active listening and a skilled communication partner (or specific supports for those with language difficulty after stroke e.g. speech and language therapist facilitated), allows the person with stroke and their wider support network (or nominated supporter) to air their feelings and express complex emotions or trauma, to communicate their hopes for their future life, to seek the help they require and to re-engage in activities after their stroke that are meaningful for them.
5Psychological supportsPsychological supports, that can range from and include; professional support, to talk therapy, to active listening; can provide ‘headspace’ that helps people with stroke to work through complex emotions and internal thoughts, to develop a compassionate view of themselves, helps them to restore their locus of control and ability to seek help, leading to improved perceptions of well-being and self-esteem in their life after stroke.
6Living well after strokeIn individuals who have an understanding of risk factors for stroke (these can include medication adherence, physical activity, participation, healthy dietary habits, smoking cessation, safe substance use, alcohol and other emotional self-regulation and mood), self-evaluation of risk and self-directed choices should be supported by positive messaging and nudges for those who wish to change unhealthy lifestyle behaviours. Adequately resourced services, with supports for behaviour change, underpinned by behaviour change theory and techniques including monitoring and feedback, can positively impact cardiovascular health and wellness.

Multiple sources including electronic databases, organisational websites and grey literature will be searched and we will cross referencing citations in identified articles and suggested sources from the expert panel. The following databases CINAHL, EBSCOhost, MEDLINE, PubMed, EMBASE, Web of Science, Scopus, ScienceDirect Journals, and Google Scholar will be searched to identify the studies relevant to the review questions. The searches will include combinations of the keywords based on the population-intervention-comparison-outcome-context (PICOC) tool. This tool will help to describe the inclusion and exclusion criteria. An indicative search strategy for Ovid Medline is included (Table 4).

Table 4. Indicative Search Strategy.

No.QueryRun ViaResults
1(TI=(stroke or cardiovas* or "cerebral infarc*" or cerebral or "acquired brain injur*" or infract* or
intracereb* or "cerebrovascular accident*" or "CVA" or "cerebrovascular insult" or "CVI" or "brain
attack")) OR AB=(stroke or cardiovas* or "cerebral infarc*" or cerebral or "acquired brain injur*" or
infract* or intracereb* or "cerebrovascular accident*" or "CVA" or "cerebrovascular insult" or "CVI"
or "brain attack")		Web of Science1,269,283
2(TI=("integrated care" or "ICS" or "mulit-disciplinary care" or "multidisciplinary care" or "coordinated
care" or "co-ordinated care" or "fragmentation of care" or "continuity of care" or "transition
of care" or "integrated health" or "comprehensive care" or "seamless care" or "transmural
care" or "collaborative care" or "team based care" or "team-based-care" or "MDT" or ((team or
multidisciplinary or "multi disciplinary") NEAR/2 care) )) OR AB=("integrated care" or "ICS" or
"mulit-disciplinary care" or "multidisciplinary care" or "coordinated care" or "co-ordinated care"
or "fragmentation of care" or "continuity of care" or "transition of care" or "integrated health" or
"comprehensive care" or "seamless care" or "transmural care" or "collaborative care" or "team
based care" or "team-based-care" or "MDT" or ((team or multidisciplinary or "multi disciplinary")
NEAR/2 care ))		Web of Science89,274
3(TI=("care planning" or "social support*" or "need* assessment*" or "access to care" or "service sign* post*" or "recreational activit*" or "recreational hobb*" or "social support" or "self management" or "recreational hobb*")) OR AB=("care planning" or "social support*" or "need* assessment*" or "access to care" or "service sign* post*" or "recreational activit*" or "recreational hobb*" or "social support" or "self management" or "recreational hobb*")Web of Science133,521
4(TI=((peer NEAR/2 social) or (care NEAR/2 transition) or (pathway* NEAR/2 care) or (support* NEAR/2 group*) or (service NEAR/2 sign*) or ((physical or psychological) NEAR/2 support*)) OR AB=((peer NEAR/2 social) or (care NEAR/2 transition) or (pathway* NEAR/2 care) or (support* NEAR/2 group*) or (service NEAR/2 sign*) or ((physical or psychological) NEAR/2 support*)))Web of Science90,290
5(TI=("universal access*" or 'primary screening' or ((multisectoral or multi-sectoral) NEAR/2 "public health intervention*") or "patient focused care" or "chain of care" or ((individual or societ*) NEAR/2 prevention*) or "evaluation of outcome*" or "primary prevention initiative*" or (target NEAR/2 "whole population*") or "self management*" or "health* lifetime change*" or "personalized assessment*" or "universal access" or "national strateg*" or "public health campaign*" or ((legislation* or national) NEAR/2 strateg*) or "early supported discharge" or (early NEAR/2 "supported discharge") or "specialist knowledge" or (skilled N2 "stroke personnel") or "evidence based pathway*" or "national stroke plan*" or "coordinated care" or "co ordinated care" or "co-ordinated care" or ((optimised or optimized or equal) N3 "access care") or (onset N2 treatment*) or "thrombolysis" or "specialist advice" or "continuum of care" or "specialist rehabilitation" or "early supported discharge" or (ongoing NEAR/3 intensive NEAR/2 intervention*) or "lifestyle support*" or "physical fitness program*" or (review NEAR/2 need*) or (adopting NEAR/2 "local condition*") or "patient centered care" or "patient centred care" or (national NEAR/3 "stroke care") or "enhanced self management*" or "enhanced self-management" or "assistance system*" or "secondary prevention" or (secondary NEAR/2 prevention) )) OR AB=("universal access*" or 'primary screening' or ((multisectoral or multi-sectoral) NEAR/2 "public health intervention*") or "patient focused care" or "chain of care" or ((individual or societ*) NEAR/2 prevention*) or "evaluation of outcome*" or "primary prevention initiative*" or (target NEAR/2 "whole population*") or "self management*" or "health* lifetime change*" or "personalized assessment*" or "universal access" or "national strateg*" or "public health campaign*" or ((legislation* or national) NEAR/2 strateg*) or "early supported discharge" or (early NEAR/2 "supported discharge") or "specialist knowledge" or (skilled N2 "stroke personnel") or "evidence based pathway*" or "national stroke plan*" or "coordinated care" or "co ordinated care" or "co-ordinated care" or ((optimised or optimized or equal) N3 "access care") or (onset N2 treatment*) or "thrombolysis" or "specialist advice" or "continuum of care" or "specialist rehabilitation" or "early supported discharge" or (ongoing NEAR/3 intensive NEAR/2 intervention*) or "lifestyle support*" or "physical fitness program*" or (review NEAR/2 need*) or (adopting NEAR/2 "local condition*") or "patient centered care" or "patient centred care" or (national NEAR/3 "stroke care") or "enhanced self management*" or "enhanced self-management" or "assistance system*" or "secondary prevention" or (secondary NEAR/2 prevention) )Web of Science235,698
6TI=(therap* or ("mental health" NEAR/2 (support* or therap* or service*)) or counselling or rehabilitation or (wellbeing NEAR/2 support) or "behavioral therapy" or "behavioural therapy" or "residential care" or "crisis intervention*" or "individual care plan*" or "social worker*" or "mental health treatment*" or "wellbeing support*" or "well-being support*" or "psychiatric support*" or "emotional support*" or ("self-efficacy" NEAR/2 support) or therap* or (("self-efficacy" or autonomy) N2 support))Web of Science1,279,103
7AB=(therap* or ("mental health" NEAR/2 (support* or therap* or service*)) or counselling or rehabilitation or (wellbeing NEAR/2 support) or "behavioral therapy" or "behavioural therapy" or "residential care" or "crisis intervention*" or "individual care plan*" or "social worker*" or "mental health treatment*" or "wellbeing support*" or "well-being support*" or "psychiatric support*" or "emotional support*" or ("self-efficacy" NEAR/2 support) or therap* or (("self-efficacy" or autonomy) N2 support))Web of Science3,004,968
8#2 OR #3 OR #4 OR #5 OR #6 OR #7Web of Science4,125,431
9(TI=(recovery or cognit* or neuropsych* or "mild cognitive impairment*" or "vascular mild cognitive impairment*" or attention or attention* or "information process*" or memory or recall or executive or dysexecutive or memory or "executive function*" or "attention*")) OR AB=(recovery or cognit* or neuropsych* or "mild cognitive impairment*" or "vascular mild cognitive impairment*" or attention or attention* or "information process*" or memory or recall or executive or dysexecutive)Web of Science3,719,350
10TI=(negativity or (negative NEAR/2 (feeling* or emotion* or thought* or "mental state*")) or depression or depressive or melancholy or unhappiness or sorrow or woe or "poor mental state*" or "wellbeing" or "well-being" or melancholy or sadness or unhappiness )Web of Science308,614
11AB=(negativity or (negative NEAR/2 (feeling* or emotion* or thought* or "mental state*")) or depression or depressive or melancholy or unhappiness or sorrow or woe or "poor mental state*" or "wellbeing" or "well-being" or melancholy or sadness or unhappiness )Web of Science700,256
12TI=(work* or occupat* or "paid employment*" or employ* or vocation* or parent* or caregiv* or carer* or caring or mother* or father* or relationship* or relation or relations or caregiv* or leisure* or sport* or ("life participation" NEAR/3 (participation or engagement* or role)))Web of Science2,849,953
13AB=(work* or occupat* or "paid employment*" or employ* or vocation* or parent* or caregiv* or carer* or caring or mother* or father* or relationship* or relation or relations or caregiv* or leisure* or sport* or ("life participation" NEAR/3 (participation or engagement* or role)))Web of Science11,930,236
14#9 OR #10 OR #11 OR #12 OR #13Web of Science16,421,368
15((TI=("long term" or "longterm" or "long-term")) OR AB=("long term" or "longterm" or "long-term"))Web of Science1,436,868
16#1 AND #8 AND 14 AND 15Web of Science9,576
17(TI=("middle age" OR "young adult" OR "working age" OR "working adult*")) OR AB=("middle age" OR "young adult" OR "working age" OR "working adult*")Web of Science57,013
18#16 AND #17Web of Science61
19(TI=("middle age" OR "young adult" OR "working age" OR "working adult*")) OR AB=("middle age" OR "young adult" OR "working age" OR "working adult*")Web of Science59,547
20#16 AND #20Web of Science70
21#20 AND #16 and 2013 or 2014 or 2015 or 2016 or 2023 or 2022 or 2021 or 2020 or 2019 or 2017 or 2018 (Publication Years) and English (Languages)Web of Science54

Evidence selection and appraisal

Papers will be included based on their relevance to the research question and IPTs19. We will assess the relevance and rigor of included works as we test the IPTs29.

Data extraction

Data extraction will be a three-step process, initial title and abstract screening using the inclusion and exclusion criteria (Table 2); followed by full-text review and appraisal. All authors will screen documents for initial relevance. Any conflicts will be discussed by all authors. A bespoke data extraction form will be used to extract and review information for programme theory refinement to include context, mechanisms, outcomes and resources relating to the research questions.

Data analysis

Following data extraction, the selected papers will be imported into the qualitative software NVivo [91] version 14 (Mac), to facilitate coding and thematic data analysis to identify CMOCs. We will use the Braun and Clarke (29) thematic analysis framework to analyse the findings from each selected paper; (1) familiarity with the information, (2) generate codes, search for themes, (3) review the themes, (4) define and (5) names the themes and (6) produce the findings. Results and discussion sections will be coded in order to identify context, mechanism, outcome configurations in the findings.

The expert panel will help to improve the final theoretical framework and we will revisit any stage of the process to ensure that we have enough data and reach a state of ‘theory’.

Refinement of Initial Programme Theories (IPTs)

The first draft IPTs will be presented to the expert panel for feedback to ensure appropriate interpretation of results. The expert panel will ensure that the refined IPTs are robust, contextually appropriate and reflect the complexities associated with the implementation of the intervention and relevant outcomes25.

Dissemination of findings

Dissemination will be consistent with the RAMESES guidelines22,28. The findings will be published in a peer-reviewed journal, presented at relevant conferences and stakeholder events. The protocol will be registered with PROSPERO.

Discussion

Realist inquiry facilitates an understanding of the extent to which an intervention works, for whom, in what context, why and how. This methodology has previously proven useful in research relating to stroke care in the context of early supported discharge30, neuropsychology rehabilitation31 and in evaluating outpatient rehabilitation and community support services post stroke32. This protocol adds to the growing number of publications in stroke care. It provides details for a realist review that will enable a better understanding of the specific contexts in which certain mechanisms are activated to enable long-term support to achieve a personally meaningful life after stroke, targeting both the visible and often hidden forces that generate the outcomes of interest32,33.

Life after stroke has only been regarded as a separate entity in recent years. Few of the current adult UK guidelines specifically address longer term stroke management34, reflecting the paucity of evidence in this area and the limited programme theory available to support the required complex interventions. The realist review proposed in this protocol, rather than judging the effectiveness of an intervention, is concerned with answering how supports provided for Life after Stroke work, who they work for and in what circumstances.

Realist programme theories that can coherently explains how supports are expected to work in Life after Stroke will provide researchers, policy makers and service funders/providers with new insights and robustly generated programme theories that can be developed, implementation or evaluated in existing stroke care pathways. Key to the knowledge gain associated with this methodologic approach is the inclusion of reference panels comprising healthcare professional and experience-based experts in the development of the research questions, the search strategy and in the refinement of the review’s findings to both an Irish and a personal context.

Ethics and consent

Ethical approval and consent were not required.

Data availability

Underlying data

No data are associated with this protocol.

Extended data

Open Science Framework: CLASP project - Life after stroke and supportive stroke pathways: Protocol for a rapid realist review. https://doi.org/10.17605/OSF.IO/UJC5X35.

The project contains the following underlying data:

  • Extended File 1: PRISMA-P – complete checklist of items in reporting scoping reviews

  • Extended File 2: Search Terms – complete list of search terms used in all databases

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgements

The authors are grateful to our Public and Patient Involvement (PPI) partners who worked with us on the grant application, this research methodology and who participated as Expert Panel members in developing candidate programme theories to inform this review.

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Lennon O, O'Neill M, Walsh K and Horgan F. Life After Stroke and Supportive Stroke Pathways: Protocol For A Rapid Realist Review [version 2; peer review: 2 approved, 1 approved with reservations]. HRB Open Res 2025, 8:10 (https://doi.org/10.12688/hrbopenres.14034.2)
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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
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Reviewer Report 10 Apr 2025
Diane Trusson, University of Nottingham, Nottingham, UK 
Approved
VIEWS 1
https://doi.org/10.21956/hrbopenres.15524.r46546
Thank you for the opportunity to review this manuscript. It is good to see this very important, yet under-researched,  topic within stroke research being addressed. It seems that the manuscript is much stronger as a result of the revisions made ... Continue reading
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Trusson D. Reviewer Report For: Life After Stroke and Supportive Stroke Pathways: Protocol For A Rapid Realist Review [version 2; peer review: 2 approved, 1 approved with reservations]. HRB Open Res 2025, 8:10 (https://doi.org/10.21956/hrbopenres.15524.r46546)
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Rita Chiaramonte, University of Catania, Catania, Italy 
Approved with Reservations
VIEWS 8
https://doi.org/10.21956/hrbopenres.15524.r46543
The study aims to identify consensus on best practices for care following discharge from specialist stroke services.

Title:

The current title is unclear. Please revise it to more explicitly reflect the aim and methodology ... Continue reading
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Chiaramonte R. Reviewer Report For: Life After Stroke and Supportive Stroke Pathways: Protocol For A Rapid Realist Review [version 2; peer review: 2 approved, 1 approved with reservations]. HRB Open Res 2025, 8:10 (https://doi.org/10.21956/hrbopenres.15524.r46543)
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Nicola Hancock, University of East Anglia, Norwich, UK 
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https://doi.org/10.21956/hrbopenres.15524.r46508
No ... Continue reading
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Hancock N. Reviewer Report For: Life After Stroke and Supportive Stroke Pathways: Protocol For A Rapid Realist Review [version 2; peer review: 2 approved, 1 approved with reservations]. HRB Open Res 2025, 8:10 (https://doi.org/10.21956/hrbopenres.15524.r46508)
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Reviewer Report 17 Mar 2025
Nicola Hancock, University of East Anglia, Norwich, UK 
Approved
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https://doi.org/10.21956/hrbopenres.15406.r45178
Thank you for the opportunity to review this protocol for a rapid realist review that aims to conceptualise support for Life After Stroke- this is an under-researched part of the stroke pathway and, according to my interpretation of the protocol,  ... Continue reading
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HOW TO CITE THIS REPORT
Hancock N. Reviewer Report For: Life After Stroke and Supportive Stroke Pathways: Protocol For A Rapid Realist Review [version 2; peer review: 2 approved, 1 approved with reservations]. HRB Open Res 2025, 8:10 (https://doi.org/10.21956/hrbopenres.15406.r45178)
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https://hrbopenresearch.org/articles/8-10/v1#referee-response-45178
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  • Author Response 25 Mar 2025
    Frances Horgan, School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
    25 Mar 2025
    Author Response
    Dear Professor Hancock,

    Thank you for your very positive feedback and suggested changes to our protocol. We have addressed and made all of these changes as follows. 

    - ... Continue reading
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  • Author Response 25 Mar 2025
    Frances Horgan, School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
    25 Mar 2025
    Author Response
    Dear Professor Hancock,

    Thank you for your very positive feedback and suggested changes to our protocol. We have addressed and made all of these changes as follows. 

    - ... Continue reading
    Report a concern

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Alongside their report, reviewers assign a status to the article:

Approved
The paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations
A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved
Fundamental flaws in the paper seriously undermine the findings and conclusions

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Version 1
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  1. Nicola Hancock, University of East Anglia, Norwich, UK
  2. Rita Chiaramonte, University of Catania, Catania, Italy
  3. Diane Trusson, University of Nottingham, Nottingham, UK

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Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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