Neurorehabilitation Clinical Pathways in Stroke: The Padova Model

Background: The rising prevalence of neurological disabilities underscores the need for neurorehabilitation units grounded in evidence-based medicine. However, a gap persists between available evidence and its consistent implementation in clinical practice. In this study, we present the experience of a single tertiary medical center and propose a structured, evidence-based framework for stroke neurorehabilitation aimed at standardizing care and improving functional outcomes. Methods: An iterative consensus process adapted from the modified Delphi Panel methodology was conducted. A multidisciplinary panel of clinicians and experts in stroke and neurorehabilitation reviewed evidence-based guidelines addressing upper limb rehabilitation, gait and balance, cognitive rehabilitation, speech and language therapy, and dysphagia. Guidelines were identified through systematic searches of databases, professional society websites, and reference lists, and appraised using the AGREE II instrument by three independent evaluators. Consensus was achieved through remote feedback rounds and structured in-person meetings between November 2023 and March 2024. Agreement was defined as ≥75% panel consensus. Results: Fifty-two guidelines were identified; eight were excluded due to low methodological quality (AGREE II score <6/7). Consensus was reached across all rehabilitation domains through one to three iterative rounds, depending on topic complexity. Agreement was achieved on all proposed assessment tools and intervention items for upper limb, gait and balance, cognitive, speech and language, and dysphagia rehabilitation. Based on consensus outputs, interventions were stratified according to two hierarchical dimensions: behavioral deficits and impairment severity (mild-moderate vs severe), informed by clinical and instrumental assessments and aligned with the International Classification of Functioning, Disability, and Health framework. Conclusions: Using a structured, multidisciplinary consensus approach, we developed evidence-based and context-sensitive neurorehabilitation clinical pathways supported by pragmatic stratification algorithms. This framework provides a reproducible model for translating guideline evidence into standardized inpatient neurorehabilitation practice, with the potential to optimize functional outcomes and quality of life in individuals with neurological disabilities.