Thoshenthri Kandasamy, Rachel C Stockley, Jeroen M Hendriks, Shamala Thilarajah, Noorazah Azah Abd Aziz, Erin Godecke, Jie Jia, Margit Alt Murphy, Elizabeth A Lynch
ObjectiveTo evaluate how Centres of Clinical Excellence criteria align with routine clinical practice in international stroke rehabilitation centres and explore the factors influencing practices across diverse health systems.DesignMixed-methods study.SettingInternational stroke rehabilitation centres across diverse geographic and economic contexts.ParticipantsClinicians and service leaders representing 15 centres from 10 countries (two lower-middle-income, two upper-middle-income, and six high-income).InterventionEvaluation of how international stroke rehabilitation centres demonstrate performance that aligns with the multidimensional Centre of Clinical Excellence criteria, and exploration of the contextual factors influencing practices across diverse health systems.Main measuresSurvey responses and semi-structured interview data examining patient-centred care, interprofessional practice, workforce development, research, mentorship and organisational structures supporting clinical excellence.ResultsStrong alignment was observed for patient-centred outcomes, interprofessional teamwork, and staff education, supported by established clinical pathways and outcome measurement processes. High-income and metropolitan centres more frequently reported protected time, funding, and formal workforce development structures. Centres in low- and middle-income and regional settings relied more on informal processes due to resource constraints. Across all contexts, leadership development, mentorship, advocacy, research engagement, and continuity of care were inconsistently implemented and documented.ConclusionsCore domains of stroke rehabilitation are well established internationally; however, system-level supports that sustain evidence-based practice vary considerably. Embedding structured leadership, workforce development, research engagement, and advocacy mechanisms alongside routine care may strengthen sustainability, improve consistency of evidence-based practice, and reduce inequities in rehabilitation outcomes.