A cross-sectional study was conducted through anonymous distribution using an online survey to explore rehabilitation students at King Saud University (KSU), Riyadh, Saudi Arabia, regarding their knowledge of stroke and its risk factors and warning signals. Students were recruited via an email from the rehabilitation department containing a link to an online questionnaire. All participants signed a written consent form before participating in the study.

A cross-sectional study design assessed the rehabilitation students’ knowledge regarding stroke and its risk factors and warning signals at King Saud University in Riyadh, Saudi Arabia. A convenience sampling approach was used to recruit participants, with all students enrolled in the university’s rehabilitation department invited to participate. The study was approved by the Institutional Review Board of King Saud University (no. E-23-8358).

Only rehabilitation students enrolled at King Saud University in Riyadh, Saudi Arabia, during the study period were eligible to participate. Students were invited to participate in an anonymous online survey using the Google platform. The survey was accessible online from February 7 to April 1, 2024. Invitations were emailed through the rehabilitation department containing a link to an online questionnaire. The research procedures and objectives were explained to all participants, and informed consent was obtained before participation. Informed consent entails details about the participants’ right to withdraw from the study at any time and ensures the confidentiality of the information they are given. To protect participants’ privacy, each participant was assigned a unique code, and the data collection sheets were securely stored in a locked online folder to maintain confidentiality.

A self-administered questionnaire was used to collect data from rehabilitation students regarding their general stroke knowledge, with selected items related to ischemic stroke, Stroke risk factors, and warning Signals, adapted from previous studies (34, 38–40). The questionnaire used in this study was developed based on a structured, self-administered online format using the Google Document platform. management. It comprises 24 closed-ended questions categorized into three main sections: 8 questions on demographics and general information, three questions on practice toward stroke and awareness of stroke risk factors and warning signals, and 13 questions regarding knowledge about stroke, its treatment, and its consequences. The items in the questionnaire were designed similarly to those used in previous studies focusing on knowledge regarding stroke and awareness of its risk factors and warning signals assessment. The demographic section of the questionnaire aimed to gather information about participants’ age, gender, level of education, specialty, and sources of information.

Six experts from the Department of Rehabilitation Sciences at King Saud University were selected to assess the questionnaire’s content validity and research experience according to their corresponding level of expertise. The research objective and questionnaire items were distributed with clear instructions to evaluate each item based on clarity and relevance. Recommendations from the experts were incorporated to enhance the questionnaire’s face and content validity. The modified survey achieved satisfactory levels of validity, as indicated by the computed scale-level content validity index based on the average method (S-CVI/Avg) (41–44). To evaluate the survey’s content validity, the experts’ item scores were converted to 1 (if the item relevance score was 3 or 4) or 0 (if the item was given a relevance score of 2 or 1). The scale-level content validity index was computed using the average method (S-CVI/Avg) to assess the scale’s content validity (41, 45, 46). To attain satisfactory content validity, an S-CVI/Avg score of at least 0.83 is required (41). The questionnaire achieved sufficient levels of content validity, with 0.94 and 0.93 for clarity and relevance, respectively, indicating that it is an accurate and reliable tool for measuring knowledge on stroke, its risk factors, and warning signals. The experts provided feedback on the clarity and relevance of each item, and their recommendations were incorporated to enhance the questionnaire’s content validity, which was edited in the final questionnaire form.

Our sample size was estimated based on previous research, which suggests that a sample size of 100 subjects is recommended for survey research (47, 48). Our sample size was 203, which exceeds 100, ensuring that our study is adequately powered for statistical analysis. This is also considered a large sample size (49, 50).

Statistical analyses were performed using IBM SPSS Software, Version 26. Descriptive statistics summarized the participants’ characteristics, sources of information regarding stroke, general knowledge about stroke, knowledge of stroke risk factors, and knowledge of stroke warning signs. Descriptive statistics were used to summarize the study participants’ characteristics and responses to the survey questions. Categorical variables were reported as frequencies and percentages, while continuous variables were presented as means and standard deviations (SD). The knowledge scores were computed based on correct responses, with one point for each correct answer and zero for incorrect or uncertain responses.

The survey assessed three main dimensions: knowledge about stroke, knowledge of treatment, and consequences of stroke. Each dimension consisted of multiple questions, with responses categorized as correct or incorrect. The frequency and percentage of correct and incorrect answers were calculated for each question to provide an overview of participants’ knowledge. To generate dimension scores, the total score for each dimension was computed by summing the correct responses across all related questions. The overall knowledge score was then obtained by summing the scores of the three dimensions. Mean and SD were calculated for each dimension and for the overall knowledge score to assess the central tendency and variability of participants’ knowledge levels. The knowledge scores were categorized as low, moderate, or high based on Bloom’s cut-off point method (28). The percentage scores were calculated by dividing the raw scores in the “total score” column by the maximum possible score (12) and multiplying by 100 (30). Based on these percentage scores, participants were categorized into three levels of knowledge: Low (≤59%), Moderate (60%–79%), and High (≥80%) (30).

To evaluate differences in knowledge scores across gender, residence area, and awareness of the nearest hospital, independent samples t-tests were performed. These tests assessed whether significant differences existed in the mean scores of knowledge about stroke, knowledge about treatment, consequences of stroke, and overall knowledge between the groups. A p-value of less than 0.05 was considered statistically significant. For comparisons involving multiple groups, the Kruskal-Wallis H test was used to examine differences in stroke knowledge scores based on marital status, academic level, specialty, and source of information. This non-parametric test was chosen due to the ordinal nature of the variables and the potential for a non-normal distribution of scores. The significance level for all tests was set at α = 0.05.

The study was approved by the Institutional Review Board of King Saud University (no. E-23-8358). Before engaging in the online survey, each participant received written informed consent that outlined the study’s objectives and asked for their permission to participate.

In terms of our participants’ immediate response (practice) when asked how they would react to stroke symptoms, a small proportion reported incorrect responses, such as contacting a doctor or family, taking aspirin, using hot compresses, or simply resting. These misconceptions suggest gaps in stroke emergency knowledge, emphasizing the need for targeted educational initiatives to reinforce correct stroke response behaviors among future healthcare professionals. Meanwhile, the majority correctly indicated that they would contact an ambulance and transfer the patient to the nearest hospital, aligning with best medical practices for stroke management (14). This may reflect that most participants resided in urban areas. In comparison, fewer lived in rural regions, which may have influenced their access to healthcare services and stroke-related information. Also, more than half of our participants indicated that the Internet, academic coursework, or self-directed learning were the common sources of information, which may highlight the dominant role of digital platforms and coursework in disseminating their health-related responses. Additionally, the majority of participants reported knowing the location of the nearest hospital, a positive indicator of accessibility to emergency care and stroke-related information, similar to previous studies (14), and most participants resided in urban areas. However, those who were unaware could face delays in seeking immediate medical assistance during emergencies, which in turn could impact their response to stroke symptoms.

In terms of identifying stroke risk factors, the most recognized stroke risk factors across our participants were hypertension, followed by smoking, aging, cardiac disease, and psychological stress. These findings suggest that students have a fair understanding of well-established stroke risk factors, particularly hypertension, which is a leading modifiable cause of stroke (7). However, less emphasis was placed on dyslipidemia, poor compliance with antiplatelet therapy, and genetic predisposition. This indicates possible gaps in awareness of these contributors, given that these factors may be out of the scope of the rehabilitation specialists’ knowledge and may be related to other specialized medical fields. Meanwhile, the recognition of multiple lifestyle-related factors, such as obesity and lack of physical exercise (23–25, 28), highlights a growing awareness of the role of these relevant modifiable risk factors in stroke prevention among our rehabilitation specialist students.

On the other hand, among stroke warning signs, speech difficulty was the most frequently recognized symptom, followed by loss of balance, headache, facial asymmetry, and change in consciousness. These findings suggest a reasonable awareness of key stroke symptoms, particularly speech impairment and motor deficits (30–32). These were aligned with our participants’ field of study in different rehabilitation programs where motor and speech problems are hallmark signs of acute stroke problems treated by rehabilitation therapists (16–20, 30–32). However, less emphasis was placed on vertigo and double vision, which can also be critical indicators of posterior circulation strokes, less common than anterior circulation cerebrovascular strokes (52) that require rehabilitation interventions, which may impact the students’ knowledge regarding these symptoms.

Regarding our participants’ knowledge about strokes, the results revealed moderate awareness among rehabilitation students regarding stroke-related concepts. However, specific misconceptions were evident in their responses, highlighting areas where further education may be needed. One of the most concerning findings was that only a small portion of participants correctly identified stroke as a disease of the brain, while the majority answered incorrectly. This suggests a fundamental gap in understanding stroke pathophysiology despite its critical relevance to rehabilitation professionals. Conversely, most participants correctly recognized that stroke is not a contagious disease, demonstrating good awareness in this regard. However, the fact that a noticeable subset of respondents believed stroke to be contagious indicates that some misconceptions persist. The perception of stroke as a condition primarily affecting older individuals was also evident in the responses, with more than half correctly rejecting this notion. In comparison, a considerable proportion still believed that stroke is exclusive to the elderly. Although advanced age is a well-established risk factor, stroke can also occur in younger populations due to genetic predisposition, lifestyle factors, and other medical conditions (53, 54). Awareness of the hereditary component of stroke was relatively high, with most students recognizing its genetic influence, though a considerable proportion remained unaware of this association.

Encouragingly, the highest proportion of correct responses was observed in stroke prevention, recognizing that stroke can be prevented to some extent. This indicates that most students understand the role of modifiable risk factors, such as hypertension, smoking, and physical inactivity, in reducing stroke risk. However, the overall level of knowledge remains below optimal, especially regarding the nature of stroke as a cerebrovascular disorder. These findings underscore the need for targeted educational efforts to address misconceptions and improve stroke knowledge among future rehabilitation professionals.

Meanwhile, participants’ knowledge of stroke treatment showed a generally good understanding of stroke management among rehabilitation students, though some critical gaps still exist. Most participants recognized the importance of time in stroke management, reflecting a strong awareness of “time is brain,” and emphasizing the need for rapid intervention to minimize neurological damage. Similarly, participants understood that timely management can improve disability outcomes, suggesting that most students acknowledge the potential for recovery and functional improvement after acute stroke treatment. These findings indicate a promising level of awareness regarding the urgency of stroke care and the role of early intervention in reducing long-term disability. This is especially important for rehabilitation, considering the well-established evidence supporting early rehabilitation intervention to promote neuroplasticity and functional recovery after stroke (55, 56). However, knowledge about endovascular clot extraction was notably lower, with only about half of the participants recognizing this intervention as a possible treatment option, while a similar proportion were unaware of it. This may reflect that such advanced interventional procedures are often outside the routine scope of rehabilitation specialists’ clinical practice, consistent with findings from previous studies (14). While rehabilitation students demonstrate a good understanding of the urgency of stroke treatment and the benefits of early intervention, their limited awareness of endovascular clot extraction highlights an area for improvement. Improving education on advanced stroke treatments could further enhance their preparedness for clinical practice and help improve patient outcomes in stroke rehabilitation.

Conversely, participants’ knowledge of stroke consequences shows that most rehabilitation students have a strong understanding of the potential long-term effects of stroke, which is essential for their future patient care and recovery roles. The highest awareness was observed for movement and functional impairments, with the majority of participants correctly identifying these as stroke consequences. This is expected, as motor deficits such as hemiparesis and loss of coordination are among the most visible and well-known stroke complications managed by rehabilitation specialists (16–20). Similarly, most respondents recognized cognitive and memory impairments, indicating a solid grasp of the neurocognitive effects of stroke. This awareness is critical as cognitive dysfunction can greatly influence rehabilitation outcomes and the patient’s ability to regain independence. Participants also widely recognized long-term disabilities caused by stroke, reflecting an understanding of the chronic and often disabling nature of stroke, which aligns with core principles of rehabilitation medicine. Most respondents acknowledged emotional and personality changes, demonstrating general awareness of the psychosocial impact of stroke. However, a notable subset did not identify this as a possible consequence, pointing to an area for further education. Given the high rates of post-stroke depression and emotional disturbances (9, 10), it is crucial for future rehabilitation professionals to fully understand the importance of addressing both physical and psychological aspects of recovery. In contrast, visual problems, including vision loss, were the least recognized consequences among participants. While most respondents were aware of these complications, the recognition level was noticeably lower compared to other stroke-related impairments. Since visual deficits such as hemianopia and diplopia can significantly impact a patient’s quality of life and independence (10), incorporating this aspect more prominently in stroke education could be beneficial.

Overall, these findings suggest that rehabilitation students have a strong foundational understanding of stroke-related consequences, particularly in terms of motor, cognitive, and long-term disabilities. However, the lower awareness of emotional and visual complications underscores the need for further emphasis on these aspects in training programs to ensure a more comprehensive approach to stroke rehabilitation. In addition, although students demonstrated awareness of the urgency of stroke management, greater emphasis is needed on key acute treatment principles, including intravenous thrombolysis and the time- and tissue-dependent nature of stroke care, which are essential for optimizing patient outcomes. The aggregation of stroke knowledge scores among our participants was correlated with their source of knowledge, level of education, and specialty, consistent with previous studies (14, 22, 34). Overall, the results indicate that while rehabilitation students have a solid understanding of stroke and its treatment and consequences, there is room for improvement in their knowledge of stroke treatment and some aspects of stroke-related knowledge. Strengthening education in these areas could enhance students’ preparedness for clinical practice and ability to provide high-quality care to stroke patients in rehabilitation settings.

This study has several limitations. It was conducted at a single institution, King Saud University, which, although recognized as the largest and oldest academic institution in Saudi Arabia, may restrict the generalizability of the findings to other educational or healthcare settings. The use of convenience sampling and voluntary participation may have introduced selection bias, potentially affecting the sample’s representativeness. Additionally, reliance on self-reported knowledge may not fully capture actual clinical competence or behavior. By focusing exclusively on stroke-related knowledge and practices among rehabilitation students, the study may have overlooked other contextual or systemic factors influencing stroke management. Moreover, the questionnaire did not include items addressing the broader role of neurorehabilitation personnel, nor did it assess key acute stroke treatment concepts such as intravenous thrombolysis or the time/tissue window for intervention, which could have provided a more comprehensive evaluation of students’ preparedness for stroke care.

Future research should involve multiple institutions and a more diverse population to enhance external validity and mitigate sampling bias. Longitudinal or interventional study designs are recommended to examine how improvements in stroke knowledge influence clinical decision-making and patient outcomes. Furthermore, integrating simulation-based or practical assessments could provide a more comprehensive understanding of how theoretical knowledge translates into real-world clinical performance.