Implementation capacity, not treatment efficacy, is the primary barrier to delivering high-intensity stroke rehabilitation, international roundtable concludes

The 4th Stroke Recovery and Rehabilitation Roundtable, a consensus of 16 experts from 9 countries, concluded that implementation capacity — not treatment efficacy — is the primary barrier to delivering high-dose, high-intensity (HDHI) neurorehabilitation after stroke Synthesis (Branscheidt et al.1). The consensus states plainly that scale and delivery constraints “make home- and community-based hybrid pathways essential,” and identifies clinician time pressure, inflexible remuneration models, and weak system-level continuity as the key blockers to delivering evidence-based rehabilitation dose.

As an international expert consensus rather than a single trial, its authority rests on convergent expert judgement across health systems rather than one dataset; it does not itself specify how any individual health system should resource hybrid delivery, which remains a local commissioning and workforce question.

For services planning to scale post-stroke rehabilitation intensity without a matching expansion of acute bed capacity, the consensus supports home- and community-based hybrid delivery as a structural response — provided workforce and remuneration models are adapted to support it.