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

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.