The Personalization of Lifestyle Modification of Stroke Patients: A Scoping Review*

Abstract

Stroke remains one of the most pressing global health concerns of the twenty-first century, with approximately 13 million new cases reported worldwide each year. In Thailand, the burden of stroke has become increasingly severe, as reflected by rising incidence rates among newly diagnosed patients and a growing rate of hospital readmission, particularly among individuals with comorbid conditions such as hypertension, diabetes mellitus, and dyslipidemia. These trends place considerable strain on the healthcare system and underscore the urgent need for effective secondary prevention strategies. Preventing stroke recurrence is therefore of critical clinical and public health importance, and lifestyle modification—encompassing medication adherence, healthy dietary practices,smoking cessation, and regular physical activity—plays a central role in reducing the risk of recurrence and long-term complications.

In recent years, the concept of lifestyle modification has been increasingly integrated into the management of chronic non- communicable diseases (NCDs) as part of a broader movement toward lifestyle medicine, aimed at promoting effective and sustainable self-management. Rather than applying a uniform approach to all patients, this framework emphasizes individualized lifestyle modification tailored to each patient's unique physical condition, psychosocial circumstances, and cultural context. Core components of this individualized approach include dietary intake, physical activity, sleep quality, stress management, smoking cessation, and social engagement. Despite the growing recognition of this model internationally, its application among stroke populations—particularly within the Thai healthcare context—remains underexplored. This scoping review aimed to examine the existing evidence on individualized lifestyle modification among stroke patients in order to inform the future development of a person-centered lifestyle-promotion model suitable for clinical implementation.

This study was conducted over 12 months, from March 2024 to February 2025. A comprehensive literature search was performed across three major databases—PubMed, Scopus, and ScienceDirect—covering publications from 2014 to 2024. The inclusion criteria were: (1) original articles and review articles (systematic reviews, meta-analysis, narrative reviews) involving stroke patients aged 18 years or older, and (2) original articles with content explicitly addressing health behavior modification. Articles for which the full text could not be accessed were excluded from the review. Study selection was conducted independently by two reviewers to minimize selection bias,with a third reviewer consulted to resolve any discrepancies or disagreements. Data were analyzed using content analysis and descriptive synthesis, supplemented by basic descriptive statistics to characterize the included studies. Methodological quality and reporting rigor were appraised using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework.

Analysis of the 17 studies comprising 5 original articles, 4 systematic reviews, and 8 narrative reviews revealed that dietary control and physical activity were the two components accorded the highest priority in health behavior modification following stroke. With respect to dietary recommendations, ensuring adequate daily caloric intake and adherence to a Mediterranean-style dietary pattern—rich in vegetables, fruits, whole grains, lean protein, and unsaturated fats—were most frequently recommended across the reviewed literature. For patients with comorbidities such as hypertension or diabetes, reduced sodium and sugar intake was consistently advised to support blood pressure and glycemic control. In addition, patients presenting with dysphagia required specialized nutritional care and swallowing assessment to prevent aspiration and the subsequent development of aspiration pneumonia, a common and serious complication in this population. Physical mobility emerged as another critical issue, given that a substantial proportion of stroke survivors experience motor impairment and mobility limitations. Prolonged immobility, particularly among bedridden patients, was found to contribute to muscle atrophy, joint contractures, and pressure injuries. Encouraging patients to engage in activities of daily living, alongside physical exercise appropriately tailored to individual functional capacity,was shown to support motor rehabilitation,prevent secondary complications, and enhance overall quality of life.

In conclusion, this review highlights that dietary control and physical activity constitute the core pillars of post-stroke rehabilitation, contributing meaningfully to reducing complications and preventing stroke recurrence—particularly among working-age patients who must return to meaningful and independent daily functioning. Nevertheless, research on lifestyle medicine within the Thai context remains relatively limited, particularly regarding healthcare infrastructure, digital health technology, and health workforce capacity. As a result, the implementation of lifestyle-based interventions in rural areas and among vulnerable populations remains inconsistent and inequitable.Future research is therefore warranted to explore the lived experiences of Thai stroke patients in modifying health behaviors within authentic social and healthcare system contexts. From a nursing perspective, such research would substantially strengthen nurses' competency in counseling patients on lifestyle modification, particularly by integrating health promotion principles into routine nursing care processes. It would foster stronger interprofessional collaboration across the care continuum.Furthermore, nursing education curricula should place greater emphasis on developing competencies related to self-management support, effective therapeutic communication, and culturally sensitive health education to prepare future nurses to meet the evolving needs of this patient population.

Keywords: Lifestyle modification, Personalization, Stroke

Author Contributions:
TR: Conceptualization, Method and design, Literature review, Article appraisal, Drafting,reviewing, and editing the manuscript, Final approval of the submitted version, Corresponding with editor-in-chief
WJ: Conceptualization, Method and design, Literature review, Article appraisal, Reviewing and editing the manuscript, Final approval of the submitted version