ANALISIS KEBIJAKAN DAN INTERVENSI PENYAKIT STROKE DI KOMUNITAS: SYSTEMATIC LITERATURE REVIEW

Syukriadi Syukriadi; Hardisman Hardisman

doi:10.30633/jsm.v8i2.30677

ANALISIS KEBIJAKAN DAN INTERVENSI PENYAKIT STROKE DI KOMUNITAS: SYSTEMATIC LITERATURE REVIEW

Syukriadi Syukriadi, Hardisman Hardisman

Abstract

Stroke merupakan penyebab utama kematian dan kecacatan global, dengan beban yang semakin meningkat di negara berpenghasilan rendah-menengah. Meskipun pedoman berbasis bukti telah tersedia, implementasi intervensi non-farmakologis dalam rehabilitasi pasca-stroke masih menghadapi tantangan signifikan, khususnya di tingkat komunitas. Tinjauan literatur sistematis ini bertujuan untuk mensintesis bukti terkini mengenai efektivitas intervensi non-farmakologis dalam rehabilitasi stroke dan menganalisis kesenjangan antara bukti ilmiah dengan implementasi kebijakan. Penelitian ini mengadopsi metode systematic literature review dengan protokol PRISMA 2020. Pencarian literatur dilakukan pada database Scopus, PubMed, ScienceDirect, Web of Science, dan Google Scholar untuk periode 2019–2025. Sebanyak 15 artikel memenuhi kriteria inklusi, terdiri dari systematic review, randomized controlled trials (RCT), dan analisis kebijakan. Analisis integratif juga dilakukan terhadap dokumen kebijakan nasional dan internasional. Bukti menunjukkan bahwa intervensi non-farmakologis seperti Modified Constraint-Induced Movement Therapy (mCIMT), rehabilitasi realitas virtual (VR), latihan intensitas tinggi, dan terapi robotik secara signifikan efektif dalam meningkatkan fungsi motorik, keseimbangan, kebugaran kardiorespirasi, dan kemampuan berjalan. Intervensi yang dimulai dalam 3 bulan pertama pasca-stroke dengan dosis tinggi (>20 jam) menunjukkan hasil fungsional terbaik. Pendekatan berpusat pada pasien, termasuk manajemen diri berbasis teori, dukungan pengasuh (dyadic interventions), dan dukungan sebaya, terbukti meningkatkan kualitas hidup, partisipasi sosial, self-efficacy, serta mengurangi beban pengasuh dan depresi. Namun, implementasinya terkendala oleh keterbatasan sumber daya, waktu, dan pengetahuan. Rehabilitasi pasca-stroke yang efektif memerlukan pendekatan yang personal, intensif, tepat waktu, dan holistik. Diperlukan kepemimpinan yang kuat, sistem kesehatan kolaboratif, dan integrasi prediksi pemulihan yang dipersonalisasi untuk mendukung implementasi praktik berbasis bukti di tingkat komunitas.

Kata Kunci: Rehabilitasi Stroke, Intervensi Non-Farmakologis, Tinjauan Sistematis, Analisis Kebijakan, Kesehatan Komunitas

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References

Baricich, A., Borg, M. B., Battaglia, M., Facciorusso, S., Spina, S., Invernizzi, M., ... & Santamato, A. (2024). High-intensity exercise training impact on cardiorespiratory fitness, gait ability, and balance in stroke survivors: a systematic review and meta-analysis. Journal of Clinical Medicine, 13(18), 5498.

Cantero-Tellez, R., Naughton, N., Algar, L., & Valdes, K. (2019). Outcome measurement of hand function following mirror therapy for stroke rehabilitation: A systematic review. Journal of Hand Therapy, 32(2), 277-291.

De Iaco, L., Veerbeek, J. M., Ket, J. C., & Kwakkel, G. (2024). Upper limb robots for recovery of motor arm function in patients with stroke: A systematic review and Meta-Analysis. Neurology, 103(2), e209495.

Doumen, S., Sorba, L., Feys, P., & Tedesco Triccas, L. (2023). Efficacy and dose of rehabilitation approaches for severe upper limb impairments and disability during early acute and subacute stroke: a systematic review. Physical Therapy, 103(4), pzad002.

Feigin, V. L., Brainin, M., Norrving, B., Martins, S., Sacco, R. L., Hacke, W., ... & Lindsay, P. (2022). World Stroke Organization (WSO): global stroke fact sheet 2022. International journal of stroke, 17(1), 18-29.

Gao, Q., Zhang, Y., Long, J., Pan, M., Wang, J., & Yang, F. (2023). Effect of different constraint-induced movement therapy protocols on recovery of stroke survivors with upper extremity dysfunction: a systematic review and network meta-analysis. International Journal of Rehabilitation Research, 46(2), 133-150.

GBD 2019 Stroke Collaborators. (2021). Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. Neurology, 20(10), 795

Gholipour, S., Akbarfahimi, N., Rezaie, L., Hosseinzadeh, S., & Bratty, A. J. (2025). Effectiveness of Motivational Interviewing for Improving Self-Efficacy in Stroke Patients: An Occupational Therapy Randomized Control Trial Study. Occupational Therapy In Health Care, 39(3), 667-684.

Hao, J., Yao, Z., Harp, K., Gwon, D. Y., Chen, Z., & Siu, K. C. (2023). Effects of virtual reality in the early-stage stroke rehabilitation: A systematic review and meta-analysis of randomized controlled trials. Physiotherapy theory and practice, 39(12), 2569-2588.

Hayward, K. S., Kramer, S. F., Dalton, E. J., Hughes, G. R., Brodtmann, A., Churilov, L., ... & Bernhardt, J. (2021). Timing and dose of upper limb motor intervention after stroke: a systematic review. Stroke, 52(11), 3706-3717.

Ibrahim, R. U., Abdullahi, A., Salihu, A. T., & Lawal, I. U. (2025). Intensity of task-specific training for functional ability post-stroke: Systematic review and meta-analysis. Clinical Rehabilitation, 39(9), 1133-1155.

Juckett, L. A., Wengerd, L. R., Faieta, J., & Griffin, C. E. (2020). Evidence-based practice implementation in stroke rehabilitation: a scoping review of barriers and facilitators. The American Journal of Occupational Therapy, 74(1), 7401205050p1-7401205050p14.

Liu, J., Wang, Z., Wang, C., & Zhang, Y. (2025). Interventional effects of modified constraint-induced movement therapy on upper limb function in patients who had a stroke: systematic review and meta-analysis. BMJ open, 15(5), e094309.

Lau, S. C., Judycki, S., Mix, M., DePaul, O., Tomazin, R., Hardi, A., ... & Baum, C. (2022). Theory-based self-management interventions for community-dwelling stroke survivors: a systematic review and meta-analysis. The American Journal of Occupational Therapy, 76(4), 7604205010.

Mead, G. E., Sposato, L. A., Sampaio Silva, G., Yperzeele, L., Wu, S., Kutlubaev, M., ... & Rabinstein, A. A. (2023). A systematic review and synthesis of global stroke guidelines on behalf of the World Stroke Organization. International Journal of Stroke, 18(5), 499-531.

Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., ... & American Heart Association Stroke Council. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50(12), e344-e418.

Pucciarelli, G., Lommi, M., Magwood, G. S., Simeone, S., Colaceci, S., Vellone, E., & Alvaro, R. (2021). Effectiveness of dyadic interventions to improve stroke patient–caregiver dyads’ outcomes after discharge: A systematic review and meta-analysis study. European Journal of Cardiovascular Nursing, 20(1), 14-33.

Stinear, C. M., Lang, C. E., Zeiler, S., & Byblow, W. D. (2020). Advances and challenges in stroke rehabilitation. The Lancet Neurology, 19(4), 348-360.

Van Wissen, K., & Blanchard, D. (2019). Circuit class therapy for improving mobility after stroke: A Cochrane review summary. International journal of nursing studies, 97, 130-131.

Wan, X., Chau, J. P. C., Mou, H., & Liu, X. (2021). Effects of peer support interventions on physical and psychosocial outcomes among stroke survivors: A systematic review and meta-analysis. International Journal of Nursing Studies, 121, 104001.

Wardlaw, J. M., Chabriat, H., de Leeuw, F. E., Debette, S., Dichgans, M., Doubal, F., ... & Lindgren, A. G. (2024). European stroke organisation (ESO) guideline on cerebral small vessel disease, part 2, lacunar ischaemic stroke. European Stroke Journal, 9(1), 5-68.

World Health Organization. (2022). Stronger collaboration for an equitable and resilient recovery towards the health-related Sustainable Development Goals, incentivizing collaboration: 2022 progress report on the Global Action Plan for Healthy Lives and Well-being for All. World Health Organization

Zhou, X., Du, M., & Hu, Y. (2022). The effect of self-management programs on post-stroke social participation: A systematic review and meta-analysis. Clinical Rehabilitation, 36(9), 1141-1152.

DOI: http://dx.doi.org/10.30633/jsm.v8i2.30677