In January 2025, the Rehab Care Alliance (RCA) was announced as the successful applicant to a Request for Proposal issued by Heart & Stroke (H&S) and funded by Ontario Health (CorHealth). In partnership with a provincial task group—including clinicians, researchers, administrators, people with lived experience, and representatives from H&S and Ontario Health (CorHealth)—the RCA provided leadership and project management to support a provincial initiative aimed at strengthening Community Stroke Rehabilitation (CSR) across Ontario.

The Problem

There is currently no consistent use of valid, standardized outcome measures across CSR programs in Ontario. This inconsistency limits the ability to assess patient progress and compare program performance across the province.

The Objective

To recommend an evidence-informed functional outcome measure that can be feasibly implemented by CSR programs to support consistent evaluation of meaningful patient change and cross program comparison.

The Process

Over the past year, the RCA led a rigorous, multi-stage initiative involving extensive knowledge synthesis and two Modified Delphi Processes to identify an outcome measure that can be used in CSR settings across Ontario, with further pilot testing of implementation before broader adoption.

The work unfolded in four phases:

Phase 1: Conceptualization

  • Formed a 24-member provincial task group with broad representation, including researchers, clinicians, people with lived experience, health system leaders, and CSR program managers/directors.
  • Developed and confirmed the scope and purpose statement.
  • Established outcome measure requirements aligned with the project purpose and scope.

Phase 2: First Modified Delphi Process to Establish Evaluation Criteria

  • Conducted multiple rounds of surveys, voting, and meetings to define and validate a set of evaluation criteria.
  • The resulting framework served as the foundation for evaluating outcome measures in the subsequent Modified Delphi process.

Phase 3: Knowledge Synthesis and Characterization of CSR Outcome Measures

  • Completed a comprehensive review of published literature.
  • Surveyed CSR programs province-wide to document current outcome measure use.
  • Conducted interviews with subject matter experts across Ontario and consulted international contributors.
  • Held focus groups with CSR clinicians and with people with lived experience who received community stroke rehabilitation within the past three years.

Phase 4: Second Modified Delphi Process to Select the Outcome Measure

  • Compiled and distributed a detailed resource package to support task group review and ratings.
  • Task group members evaluated 41 outcome measures using the criteria developed in Phase 2.
  • A ranking survey and final vote were conducted on the top three measures.
  • The Stroke Impact Scale (SIS) emerged as the preferred outcome measure.
  • The task group then discussed the final decision, implementation considerations, and next steps.

Overview of the Selected Outcome Measure: Stroke Impact Scale (SIS)

The Stroke Impact Scale is a patient-reported outcome measure designed to capture multidimensional functional outcomes after stroke. It includes eight domains:

  • Strength
  • Hand Function
  • Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL)
  • Mobility
  • Communication
  • Emotion
  • Memory and Thinking
  • Participation/Role Function

Each item is rated on a five-point Likert scale reflecting the level of difficulty experienced. Domain scores are expressed from 0–100.

An additional recovery item asks patients to rate—from 0–100—how much they feel they have recovered from their stroke.

Implementing the SIS will enable CSR programs to consistently capture functional change resulting from rehabilitation and to compare outcomes across programs. Reporting domain level (subscale) scores adds further value by supporting nuanced comparison across programs serving different populations (e.g., patients with predominant cognitive vs. mobility impairments).

Next Steps: Implementation Plan

In 2026/2027, the RCA will lead an implementation pilot with select CSR sites to determine optimal strategies and supports for SIS adoption and to assess feasibility. Lessons learned from the pilot will inform province-wide spread and scale of the SIS beginning in 2027/2028.

We extend our sincere thanks to all provincial partners – clinicians, researchers, administrators, people with lived experience – for their thoughtful contributions, dedication, and collaboration throughout this initiative. We also acknowledge the financial support of Heart & Stroke and Ontario Health (CorHealth) whose funding made this work possible. This work reflects a shared commitment to strengthening community stroke rehabilitation across Ontario, and the outcome would not have been possible without their collective expertise and engagement.