Non-pharmacological interventions for the improvement of post-stroke quality of life amongst older stroke survivors: a systematic review of systematic reviews (The SENATOR ONTOP series)

  • Carrie StewartEmail author
  • Selvarani Subbarayan
  • Pamela Paton
  • Elliot Gemmell
  • Iosief Abraha
  • Phyo Kyaw Myint
  • Denis O’Mahony
  • Antonio Cherubini
  • Alfonso J. Cruz-Jentoft
  • Roy L. Soiza

Key summary points


This systematic review aimed to determine if non-pharmacological interventions can impact upon older stroke survivors quality of life.


From 28 trials we identified limited evidence supporting a beneficial impact upon quality of life from additional physiotherapy and occupational therapy. Very limited evidence supported the use of a wide array of other non-pharmacological therapies.


Current evidence is limited by low study quality and small sample sizes and more trials specifically involving older stroke survivors are required.



The efficacy of non-pharmacological stroke rehabilitation approaches for older stroke survivors is largely unknown, particularly in relation to psychosocial outcomes such as quality of life. This systematic review examined the evidence for such interventions as part of the Optimal Evidence-Based Non-Drug Therapies in Older Persons (ONTOP) project conducted under an European Union funded project called the Software Engine for the Assessment and Optimisation of Drug and Non-Drug Therapies in Older Persons (SENATOR) [].


Thirteen experts in geriatric medicine, as part of a Delphi panel, agreed quality of life to be a critical outcome of stroke rehabilitation. A comprehensive search strategy was developed and databases were searched for eligible systematic reviews from which trials meeting our criteria were identified. Eligible papers were then double reviewed. Due to heterogeneity, narrative analysis was performed. Cochrane risk of bias and GRADE assessment tools were used to assess bias and quality of evidence.


We identified 28 trials, spanning ten types of intervention. Limited evidence supports the use of additional occupational therapy and physiotherapy, with very limited evidence supporting our recommendation to explore caregiver training, constraint-induced movement therapy, device-assisted physiotherapy, and self-management education further.


Limited evidence suggests a range of non-pharmacological interventions may improve the quality of life of older stroke survivors. However, evidence is limited by low study quality and the small number of studies targeting older stroke survivors. We recommend future studies explore such interventions exclusively in older adult populations and improve methodological and outcome reporting.


Older adults Ageing Stroke Rehabilitation Non-pharmacological therapies 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


This review was completed as part of a series of systematic reviews conducted as part of the SENATOR programme, a collaborative project funded by the European Union under the 7th Framework Programme (FP7/2007-2013) under grant agreement number 305930 ( The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

No informed consent was necessary for the study.

Supplementary material

41999_2019_180_MOESM1_ESM.pdf (367 kb)
Online Resource 1 PRISMA Checklist.pdf
41999_2019_180_MOESM2_ESM.pdf (355 kb)
Online Resource 2 Database Search Strategies.pdf
41999_2019_180_MOESM3_ESM.pdf (500 kb)
Online Resource 3 References of Studies Included in the Systematic Review.pdf
41999_2019_180_MOESM4_ESM.pdf (491 kb)
Online Resource 4 Description of All Included Interventions.pdf


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Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  1. 1.Department of Old Age MedicineAberdeen Royal InfirmaryAberdeenUK
  2. 2.Institute of Applied Health SciencesUniversity of AberdeenAberdeenUK
  3. 3.Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCAAnconaItaly
  4. 4.Department of Geriatric MedicineUniversity College CorkCorkIreland
  5. 5.Fundación para la Investigación Biomédica del Hospital Universitario Ramón y CajalMadridSpain

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