Inclusion Criteria- Adults (≥18 years，and≤79 years);
- Recent (<1 month) first-ever acute ischemic/hemorrhagic/undifferentiated stroke patients;or recurrent patients with the result of Modified Rankin Scale (MRS) no more than 2 points.
- With a reasonable expectation of 6 month survival post-discharge (i.e. not palliative, no evidence of widespread cancer etc.);
- Residual disability (requiring physical assistance for core activities of daily living defined as a Barthel Index score of 80 or lower)
Exclusion Criteria- Unable to identify a suitable family-nominated caregiver for training and subsequent delivery of care
- Unable to provide informed consent from both the patient (or by proxy) and the caregiver