Trend in research and hotspot on exercise therapy at home for stroke patients: a bibliometric analysis

The information utilized in this study for the bibliometric analysis was obtained from SCOPUS database, given its status as the preeminent repository of such data. SCOPUS, owned by Elsevier BV Company in the USA, is the largest database of scientific peer-reviewed literature, with over 22,000 titles from international publishers.¹² This research was conducted between June 2013 and June 2023. The search strategy was as follows: “exercise therapy” OR “rehabilitation” OR “physical exercise” OR “exercise” AND “home” OR “Home-based” OR “home-dwelling” AND “stroke” OR “Cerebrovascular Accidents” OR “CVA (Cerebrovascular Accident)” OR “Brain Vascular Accident” OR “Acute Cerebrovascular Accident” OR “Stroke patient.” Articles were the primary form of literature selected for this investigation. Select “English” as the language category; non-English publications were excluded. The documents that were chosen were downloaded on 5 March 2024.

To ensure the accuracy and reliability of the data, the dataset was cleaned before proceeding. This process involved removing duplicate records and verifying the relevancy of the articles. After this cleaning process, a final selection of 1493 articles was made. The process of screening is illustrated in Figure 1.

Figure 1.

Flow chart of how the articles in this study were chosen.

VOSviewer version 1.6.20, a software tool for constructing and visualizing bibliometric networks, was utilized for bibliometric and visual analysis in this study.¹³ Significant quantities of bibliographic data are transformed into visual representations by the software.¹⁴ VOSviewer uses a similarity visualization mapping technique to create more structured bibliometric maps than other typical multidimensional scaling methods. VOSviewer uses a similarity matrix to position things close together if they are very similar and far apart if they are dissimilar on a 2-dimensional map. VOSviewer stands out from other mapping programs by focusing on creating graphical representations of bibliometric maps that are easily understandable.¹⁵

We visualized the network using VOSviewer, which also performed co-occurrence analyses of researchers, institutions, countries, keywords, and journals. Co-occurrence and co-citation analysis are the 2 most prevalent methodologies. Co-occurrence analysis enables academics to find the prominent subjects and patterns in a field of study. If 2 words regularly appear together in an article, it suggests a stronger association between them compared to other word pairings.¹² Complete records and references were included in the exported literature from SCOPUS in CSV (CommaSeparated Values) format, which allows structured bibliographic data to be stored in a tabular form suitable for bibliometric analysis. Subsequently, the literature was imported into VOSviewer for the purpose of conducting bibliometric analysis. Additionally, the data were imported into Microsoft Excel and analyzed using both quantitative and qualitative analyses.

Bibliographic data were sought and obtained from SCOPUS. The data were publicly accessible. The data extraction process did not require any interaction with human participants or animals. No ethical difficulties arose from using these data; therefore, no clearance from an ethics commission was necessary.

Using our search method, we discovered and included 1493 publications on exercise therapy at home for stroke patients from SCOPUS. These articles originated from a total of 517 distinct sources, with an average publication rate of 8.75 articles per year and an average citation count of 15.13 (h-index 62). According to the data, 2786 keywords attributed to 26 distinct authors have been cited. This demonstrates that how strong the exercise therapy at home for stroke patients’ field of study is and how it connects with other disciplines. Furthermore, these demonstrate that how this study is a developing discipline and how it maintains or fosters interactions with other subjects.

The annual number of publications on home-based exercise therapy for stroke patients increased from 83 in 2013 to 192 in 2023, as seen in Figure 2. Since 2013, the average number of citations per year per published item peaked at 3.14 for the 109 articles published in 2017, 2.91 for the 114 articles published in 2015, and 2.73 for the 140 articles published in 2019. The citation peaks were a result of 3 articles that were widely referenced; Dodakian, McKenzie, Le, See, Pearson-Fuhrhop, Burke Quinlan, Zhou, Augsberger, Tran, Friedman, Reinkensmeyer and Cramer¹⁶ entitle “A Home-Based Telerehabilitation Program for Patients With Stroke”; Hammel, Magasi, Heinemann, Gray, Stark, Kisala, Carlozzi, Tulsky, Garcia and Hahn¹⁷ entitle “Environmental barriers and supports to everyday participation: A qualitative insider perspective from people with disabilities”; and Cramer, Dodakian, Le, See, Augsburger, McKenzie, Zhou, Chiu, Heckhausen, Cassidy, Scacchi, Smith, Barrett, Knutson, Edwards, Putrino, Agrawal, Ngo, Roth, Tirschwell, Woodbury, Zafonte, Zhao, Spilker, Wolf, Broderick and Janis¹⁸ entitle “Efficacy of Home-Based Telerehabilitation vs In-Clinic Therapy for Adults after Stroke: A Randomized Clinical Trial.”

Figure 2.

The annual publication output between 2013 and 2023.

The search results indicated that 1493 publications originated from 83 countries/regions and 160 institutions. The country with the most published articles was United States (454, or 23.8%) (see Table 1), followed by the United Kingdom (181, or 9.5%), Australia (118, or 6.2%), Canada (114, or 6%), and Netherland (87, or 4.6%). Despite it ranks eighth in terms of total articles, Italy attains the highest average citation per item (ACI) at 19.5. This demonstrates the exceptional caliber of Italian research concerning at-home exercise therapy for stroke patients and its extensive acclaim among scholars.

The VOSviewer analysis presents Figure 3A, which illustrates a time overlay map showcasing the cooperation networks of various countries. The lines connecting nodes depict country connections, with node size indicating the number of publications from various countries. Node color reflects time changes. Early research on home exercise therapy for stroke patients saw significant publications, led by Germany, Norway, Slovenia, and Turkey. As shown in Figure 3B, the United States exhibited the highest total link strength (TLS) (142), signifying its profoundest level of collaboration with other nations. United Kingdom behind with 128, followed by Australia (81), the Netherlands (68), and Canada (47) in terms of cooperation intensity.

Figure 3.

The network of coauthorship among countries/regions (international collaboration).

The top 10 institutions came from the United States (5/10), Canada and Sweden (2/10), and Australia (1/10). The most productive institution is the University of Toronto (1.74%), followed by Karolinska Institutet (1.63%), Massachusetts General Hospital (1.46%), and Harvard Medical School (1.41%) (see Figure 4).

Figure 4.

The 10 institutions with the greatest number of research outcomes in this field.

The search results indicate that there are 1493 papers on exercise therapy at home for stroke patients, authored by 7566 individuals. Table 2 lists the top 10 most productive writers (all authors of each publication were scored equally) in exercise treatment at home for stroke patients’ study. Cramer, S.C conducted the highest number of investigations, totaling 19 (2.02% of the total). Followed by Ytterberg, C. 16 (1.7%), Eng, J.J., English, C. & Langhorne, P 13 (1.38%), Cramer, S.C, a researcher from David Geffen School of Medicine at UCLA, Los Angeles, United States, has been identified as the most productive author in the field of exercise therapy at home for stroke patients. Her pioneering efforts attracted considerable attention, as evidenced by her highest TLS and high citation rate.

Out of 7566 writers, 133 have produced 5 papers or more; the most related group of 70 authors was found in 9 clusters, according to our co-authorship analysis. A node’s label will display the name of the author, and the size of the node will reflect the total number of publications. In Figure 5, thicker links indicate more collaboration between the 2 writers, and links linking 2 nodes indicate co-authorship.

Figure 5.

VOSviewer coauthorship analysis network visualization map.

References were vital in academic research as they served as the foundation for intellectual inquiries. Through the use of reference co-citation analysis, we can gain insights into the development of knowledge in the field and pinpoint the current areas of research concentration. Our analysis of the co-cited references revealed that a total of 50,791 references were cited in 1493 articles. There was a total of 43 references that were cited together more than 10 times. Table 3 displays the 10 most often co-cited references.

Over the course of 517 journals, articles were published regarding home exercise therapy for stroke patients. Meanwhile, VOSviewer identified 517 cocited journals in the last decade (see Figure 6) and 77 journals that have a minimum document count of 4 in 6 clusters. The 10 highest-ranking publications publishing on this subject are all listed in Table 4. Following Topics in Stroke Rehabilitation (49; 4.4%) and Journal of Stroke and Cerebrovascular Diseases (57; 5.2%), Disability and Rehabilitation published the most papers (73; 6.6%). A total of 36.3% of the publications included in this analysis were published in the top 10 journals.

Figure 6.

VOSviewer network visualization of the Journal analysis.

The top journal with the highest citation score is owned by the Stroke journal, with a score of 12.9 (SJR 2.746). Despite being ranked eighth in terms of the number of publications in the field of exercise therapy at home for stroke patients research, this indicates that the journal has a very high and significant impact in the academic community and this field.

The annual number of publications on homebased exercise therapy for stroke patients in the top 10 article-producing journals is shown in Figure 7. The Journal of Stroke and Cerebrovascular Diseases reached its peak in 2021 with 12 documents (Scitescore 4.3; SJR 0.713; SNIP 0.89), while the journal of Disability and Rehabilitation reached its peak in 2022 with 12 documents (Scitescore 4.4; SJR 0.76; SNIP 1.63)

Figure 7.

Report every year by source.

A study examined home-based exercise therapy efficacy for stroke patients across 25 specific research locations. Figure 8 illustrates these locations covered in publications between 2013 and 2023. Fields, such as Medicine, Health Professions, Neuroscience, and Nursing, had the highest publication rates, comprising 47.2%, 12.9%, 7.6%, and 7.5%.

Figure 8.

Subject areas on home-based exercise therapy for stroke patients’ research from 2013 to 2023.

In this study, VOSviewer identified 2786 keywords from 1493 articles. Among these, 117 keywords appeared at least 7 times. VOSviewer was utilized to generate a knowledge map depicting keyword occurrences, revealing 73 terms grouped into 8 clusters (see Figure 9A). The top 10 keywords are “stroke” (807 occurrences; TLS 712), followed by “rehabilitation” (436 occurrences; TLS 400), “telerehabilitation” (72 occurrences; TLS 70), “Upper Extremity” (55 occurrences; TLS 55), “virtual reality” (50 occurrences; TLS 156), “exercise” (47 occurrences; 124 TLS), “occupational therapy” (42 occurrences: TLS 114), “activity of daily living” (42 occurrences; TLS 95), “quality of life” (40 occurrences; TLS 105), and “physical therapy” (32 occurrences; TLS 96).

Figure 9.

High-frequency terms in author keywords of home-based exercise therapy for stroke patients’ publications from 2013 to 2023.

In Figure 9B, the most recent appearance of the keywords is depicted. The keywords highlighted in yellow represent the newest additions, including “telerehabilitation,” “telehealth,” “home-based,” “machine learning,” “home discharge,” “mirror therapy,” and “traumatic brain injury,” among others, while the purple keywords have been present for an extended period.

As the first bibliometric study based on SCOPUS, we found that a total of 1493 articles worldwide have been published in the field of home-based exercise therapy for stroke patients between 2013 and 2023. The results indicate a significant increase in the past decade. Changes in the number of academic publications in a field serve as important indicators of emerging trends in that field.¹⁵

Journals discussing home-based exercise therapy for stroke patients have gained significant attention in the medical field. Cramer, S.C. is noted as one of the most productive researchers in this area, having published the highest number of articles on the topic. Additionally, the majority of the top 10 most productive authors and the top 5 institutions are from the United States, establishing the country as a leading center of productivity in this global research domain. According to Chen, Abel, Janecek, Chen, Zheng, and Cramer,²⁶ stroke stands as a primary cause of serious and longterm disability in the United States. This drives American researchers to continuously innovate in efforts to assist in the post-stroke recovery of patients at home.

According to the findings of Hammel, Magasi, Heinemann, Gray, Stark, Kisala, Carlozzi, Tulsky, Garcia, and Hahn,¹⁷ titled “Environmental Barriers and Supports to Everyday Participation: A Qualitative Insider Perspective from People with Disabilities,” it is the top-cited reference globally in this field. This research highlights the importance of understanding how environmental factors influence the participation of people with disabilities, particularly in the context of home-based exercise therapy for stroke patients. These factors include buildings, nature, assistive technology, transportation, access to information and technology, support and social attitudes, systems and policies, as well as economics. Therefore, a deep understanding of how these environmental factors affect the participation of people with disabilities in home-based therapy for stroke patients is crucial. This helps in designing effective and inclusive interventions, ensuring optimal rehabilitation outcomes.

The co-occurrence network of keywords shows that “stroke,” “rehabilitation,” and “telerehabilitation” occur most frequently; thus, the subject of rehabilitating stroke patients remains among the top topics in the domain of exercise for stroke. Based on Figure 9 out of 10 frequently occurring keywords, there are 5 keywords related to home exercise therapy programs for stroke patients: telerehabilitation, virtual reality (VR), exercise, occupational therapy, and physical therapy. This indicates that the differences in home exercise therapy programs for stroke patients have become a hot research topic in this field. The 3 research trends are as follows: