Assessment of multidimensional functional recovery post-stroke: a systematic review of outcome measures and their psychometric properties.

Stroke is a leading cause of adult disability worldwide and results in complex impairments affecting motor, cognitive, functional and psychosocial domains. Despite progress in acute management, inconsistent adoption of standardized approaches and incomplete psychometric evidence coverage across functional domains limit the comparability of studies and the optimization of rehabilitation outcomes. To address this issue, a systematic review was conducted following PRISMA guidelines using PubMed, Scopus, Web of Science and the Cochrane Library for studies published between January 1990 and July 2025. Search terms included combinations of “stroke,” “cerebrovascular accident,” “outcome measures,” “assessment scales,” “motor function,” “cognition,” “activities of daily living,” “quality of life” and “rehabilitation.” Peer-reviewed studies evaluating psychometric properties of outcome measures in adult stroke populations were included and two reviewers extracted data on study features, validity and clinical relevance. Risk of bias was assessed using the COSMIN checklist. Of 2,847 identified studies 156 met inclusion criteria representing 89 outcome measures across motor function (n = 34), balance (n = 18), activities of daily living (n = 12), cognition (n = 15) and quality of life (n = 10). Motor assessments dominated the literature (62%) with the Fugl-Meyer Assessment showing the strongest psychometric evidence (Intraclass correlation coefficient (ICC) ≥ 0.90). The Berg Balance Scale showed high reliability (ICC = 0.83–0.97) and both the Barthel Index and Functional Independence Measure demonstrated excellent inter-rater reliability (ICC ≥ 0.94). Cognitive measures showed variable properties with the Montreal Cognitive Assessment outperforming the Mini-Mental State Examination (sensitivity 89% vs 63%) and patient-reported tools such as the Stroke Impact Scale showing promise but remaining underused. The review highlights heterogeneity in outcome selection and an overemphasis on motor recovery with limited focus on cognitive and participation aspects. Comprehensive ICF-based assessment frameworks and standardized core outcome sets are needed to improve research comparability clinical decision-making and stroke rehabilitation outcomes.