{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:11:41Z","timestamp":1789841501654,"version":"4.0.1"},"reference-count":47,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:00:00Z","timestamp":1787356800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"UK Stroke Forum","award":["Funding The authors disclose receipt of the follow"],"award-info":[{"award-number":["Funding The authors disclose receipt of the follow"]}]},{"name":"P&K P\u00fchringer Stiftung"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Convergent evidence indicates that high-dose, high-intensity rehabilitation (HDHI) improves outcomes beyond usual care after stroke, yet implementation remains limited. While questions of optimal dose, timing, and delivery format continue to be refined, the biological plausibility and clinical rationale for HDHI are well established. The fourth Stroke Recovery and Rehabilitation Roundtable convened to identify principal barriers to wider HDHI uptake and derive actionable solutions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Sixteen international experts from nine countries used a structured consensus process, including surveys, barrier ranking, targeted evidence reviews, and a 2-day in-person meeting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Four interrelated barriers were identified: (1) a conceptual knowledge gap persists regarding HDHI\u2019s targets, mechanisms, and effects; (2) scale and delivery constraints prevent the required dose from being delivered by current conventional care models, making home- and community-based hybrid pathways essential; (3) resistance to change despite the evidence because it places strain on clinicians given their time constraints, inflexible remuneration, and low levels of administrative support; and (4) insufficient system-level enablers to provide longitudinal continuity, patient coordination, and readily accessible technology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Recommendations:<\/jats:title>\n                    <jats:p>The primary limitation to HDHI is implementation capacity, not biological plausibility, or lack of evidence. Implementation research should now proceed in parallel with ongoing efficacy refinement. Priorities include building mechanistic and evidentiary literacy, clarifying professional roles, enabling home-based delivery, aligning reimbursement with long-term economic evaluation, and developing the infrastructure and protocols for scalable longitudinal care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17474930261483951","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T12:11:26Z","timestamp":1787400686000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The future of high-dose, high-intensity neurorehabilitation: Consensus-based core recommendations from the fourth Stroke Recovery and Rehabilitation Roundtable"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4008-6916","authenticated-orcid":false,"given":"Meret","family":"Branscheidt","sequence":"first","affiliation":[{"name":"Cereneo Center for Neurology and Rehabilitation AG, Weggis, Switzerland"},{"name":"Department of Health Sciences and Technology, ETH Z\u00fcrich, Z\u00fcrich, Switzerland"},{"name":"Recovery and Neurophysiology Lab (ReNeu), Lake Lucerne Institute AG, Vitznau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6808-0256","authenticated-orcid":false,"given":"Wala J","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"Cereneo Center for Neurology and Rehabilitation AG, Weggis, Switzerland"},{"name":"Department of Health Sciences and Technology, ETH Z\u00fcrich, Z\u00fcrich, Switzerland"},{"name":"Recovery and Neurophysiology Lab (ReNeu), Lake Lucerne Institute AG, Vitznau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6428-409X","authenticated-orcid":false,"given":"Christoph","family":"Bauer","sequence":"additional","affiliation":[{"name":"Therapy Science Lab, Lake Lucerne Institute AG, Vitznau, Switzerland"},{"name":"Department of Health Sciences, University of Jyv\u00e4skyl\u00e4, Jyv\u00e4skyl\u00e4, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C","family":"Cort\u00e9s","sequence":"additional","affiliation":[{"name":"Division of Neurorehabilitation, Dubai Health, Dubai, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. James","family":"Cotton","sequence":"additional","affiliation":[{"name":"Intelligent Sensing and Rehabilitation Lab, Regenstein Center for Bionic Medicine, Shirley Ryan AbilityLab, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven C","family":"Cramer","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles, CA, USA"},{"name":"California Rehabilitation Institute, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5797-7064","authenticated-orcid":false,"given":"Sebastian","family":"Gallegos-Berrios","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Chile, Santiago, Chile"},{"name":"School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4041-4043","authenticated-orcid":false,"given":"Gert","family":"Kwakkel","sequence":"additional","affiliation":[{"name":"Department Rehabilitation Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0760-7054","authenticated-orcid":false,"given":"Olivier","family":"Lambercy","sequence":"additional","affiliation":[{"name":"Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Z\u00fcrich, Z\u00fcrich, Switzerland"},{"name":"Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0259-2209","authenticated-orcid":false,"given":"Kate","family":"Laver","sequence":"additional","affiliation":[{"name":"Caring Futures Institute, Flinders University, Adelaide, SA, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-8276","authenticated-orcid":false,"given":"Alessandro","family":"Picelli","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6178-0691","authenticated-orcid":false,"given":"Nancy M","family":"Salbach","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada"},{"name":"KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0828-6977","authenticated-orcid":false,"given":"John M","family":"Solomon","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2644-7957","authenticated-orcid":false,"given":"Robert","family":"Teasell","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada"},{"name":"Parkwood Institute, Lawson Research Institute, London, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamaya","family":"Van Criekinge","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Movement Sciences, Maastricht Universitair Medisch Centrum, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Weerdesteyn","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4316-1846","authenticated-orcid":false,"given":"John W","family":"Krakauer","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands"},{"name":"Champalimaud Integrated Brain Research and Repair Programme, Champalimaud Foundation, Lisbon, Portugal"},{"name":"Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA"},{"name":"The Santa Fe Institute, NM, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,22]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.123.010026"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/02692155231172295"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.122.041098"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930231215005"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/esj\/aakaf026"},{"key":"e_1_3_3_7_2","article-title":"Stroke survivors\u2019 and informal caregivers\u2019 experiences of primary care and community healthcare services\u2014a systematic review and meta-ethnography","volume":"13","author":"Pindus DM","year":"2018","unstructured":"Pindus DM, Mullis R, Lim L, et al. Stroke survivors\u2019 and informal caregivers\u2019 experiences of primary care and community healthcare services\u2014a systematic review and meta-ethnography. PLoS ONE 2018; 13: e0192533.","journal-title":"PLoS ONE"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzz159"},{"key":"e_1_3_3_9_2","unstructured":"Thomas T. Physiotherapy care in decline because of poor NHS facilities poll shows. The Guardian 27 October 2025. https:\/\/www.theguardian.com\/society\/2025\/oct\/27\/physiotherapy-care-in-decline-because-of-poor-nhs-facilities-poll-shows (accessed 1 November 2025)."},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzaf111"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2012.656790"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2018.04.012"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.043650"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873251338142"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.029245"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2018-319954"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2026676118"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.004695"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2021-326948"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/1545968315624784"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/1545968316675432"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/15459683241304352"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/1545968315624783"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/1545968317753074"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/pzaf005"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","unstructured":"Byblow WD Shanks MJ Scrivener B et al. The Enhancing Spontaneous Recovery After Stroke Study (ESPRESSo): a randomised controlled trial. medRxiv 2025. DOI: 10.1101\/2025.11.19.25340598.","DOI":"10.1101\/2025.11.19.25340598"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2017.07.011"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.040736"},{"key":"e_1_3_3_29_2","unstructured":"Office of the Auditor General of Ontario. Value-for-money audit: cardiac disease and stroke treatment. Report Office of the Auditor General of Ontario December 2021."},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/HMR.0000000000000086"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-025-01450-7"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","unstructured":"Cotton RJ Seamon BA Segal RL et al. A causal framework for precision rehabilitation. arXiv 2024. DOI: 10.48550\/arXiv.2411.03919.","DOI":"10.48550\/arXiv.2411.03919"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2018.09.112"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00475-X"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1097\/WCO.0000000000000025"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00148.2021"},{"key":"e_1_3_3_37_2","unstructured":"Neuromatch. Home neuromatch.io (accessed 3 March 2026)."},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1177\/15459683221100492"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2019.1604"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.2196\/69335"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.2196\/47172"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269215514565395"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60325-5"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.08.164"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-29"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","unstructured":"Arbuckle SA Knill AS Rozanski G et al. A resource efficient high-dose neurorehabilitation program for chronic stroke at home. medRxiv 2024. DOI: 10.1101\/2024.10.08.24313178.","DOI":"10.1101\/2024.10.08.24313178"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)05550-7"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1186\/1475-2875-11-399"}],"container-title":["International Journal of Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17474930261483951","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17474930261483951","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17474930261483951","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T17:50:09Z","timestamp":1789840209000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17474930261483951"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,22]]},"references-count":47,"alternative-id":["10.1177\/17474930261483951"],"URL":"https:\/\/doi.org\/10.1177\/17474930261483951","relation":{},"ISSN":["1747-4930","1747-4949"],"issn-type":[{"value":"1747-4930","type":"print"},{"value":"1747-4949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,22]]},"article-number":"17474930261483951"}}