When should physical rehabilitation commence after stroke: a systematic review

Area of Science:

• Neurology
• Rehabilitation Medicine
• Evidence-Based Practice

Background:

• Timely physical rehabilitation is crucial for stroke survivors' recovery and efficient healthcare.
• Determining the optimal timing for initiating rehabilitation post-stroke is essential.

Purpose of the Study:

• To evaluate the effects of early physical rehabilitation (within 7 days) on mortality, function, and complications.
• To assess the impact of early transfer to rehabilitation services when acute units lack sustained support.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies.
• Meta-analysis of 3 RCTs (159 participants) comparing rehabilitation within 24h vs. 48h post-stroke.
• Analysis of 38 cohort studies examining early initiation and transfer to rehabilitation.

Main Results:

• Early rehabilitation within 24h showed a trend towards increased mortality (OR 2.58, P=0.06) but no difference in complications or health outcomes.
• Cohort studies indicated benefits from commencing rehabilitation on admission day, within 3 days, or 'sooner rather than later'.
• 88% of cohort studies favored earlier transfer to rehabilitation for improved post-stroke function, irrespective of specific timeframes.

Conclusions:

• The benefits of initiating physical rehabilitation within 24 hours post-stroke are not definitively established by current evidence.
• Early commencement of physical rehabilitation and timely transfer to rehabilitation services appear beneficial for functional recovery in stroke survivors.