Interpreting the CPASS Trial: Do Not Shift Motor Therapy to the Subacute Phase

Area of Science:

• Neurorehabilitation
• Stroke Recovery
• Physical Therapy

Background:

• Understanding critical periods for motor recovery after stroke is crucial for optimizing rehabilitation.
• Previous interpretations of the Critical Periods After Stroke Study (CPASS) have suggested shifting therapy to later phases.
• The role of usual customary care (UCC) in conjunction with intensive therapy needs consideration.

Purpose of the Study:

• To analyze the impact of intensive upper limb therapy timing on motor recovery post-stroke.
• To clarify the findings of the CPASS study regarding optimal therapy delivery windows.
• To provide evidence-based recommendations for stroke rehabilitation therapy allocation.

Main Methods:

• The Critical Periods After Stroke Study (CPASS) involved 72 participants receiving intensive upper limb therapy at different post-stroke intervals (acute, subacute, chronic).
• Outcomes were measured using the Action Research Arm Test.
• Participant therapy data included both experimental intensive therapy and usual customary care (UCC).

Main Results:

• Additional intensive therapy yielded significant gains in the subacute (2-3 months) and acute (0-1 month) groups, exceeding minimal clinically important differences in the subacute phase.
• The chronic group (6-9 months) did not show statistically significant improvement.
• Participants received substantial hours of UCC occupational therapy (OT) throughout the initial post-stroke months.

Conclusions:

• Intensive upper limb therapy is most effective when initiated during the acute and subacute phases post-stroke.
• CPASS findings support preserving and potentially increasing inpatient UCC, rather than shifting therapy to outpatient settings at 2-3 months.
• Further multi-site trials are recommended to explore optimal dosing and timing of intensive motor therapy within the first 2-3 months post-stroke.