Objective: To investigate factors shaping the delivery of acute inpatient stroke therapy (i.e. occupational therapy, physiotherapy, and speech and language therapy). Data sources: A systematic search using electronic databases: AMED, CINAHL, Medline, Web of Knowledge and EMBASE. Study selection: Qualitative studies (n = 31) investigating delivery of inpatient stroke therapy, published since 1998, were included. Data extraction: Narrative synthesis was used as the review method. Textual descriptions, tabulation and thematic analysis were used to categorize findings and explore relationships between studies. Data synthesis: Data synthesis generated the following themes: the need for a therapeutic environment; power and decision-making; intensity, motivation and appropriateness for active therapy; therapy behind the scenes; the role of teamwork in creating a therapeutic environment. Delivery of therapy was influenced by conceptual, individual and professional factors. Conclusion: Conceptual, individual and professional factors impact on the delivery of rehabilitation. Further research is needed to examine how therapists negotiate the sometimes conflicting factors shaping delivery of therapy.