Time to Rethink Long-Term Rehabilitation Management of Stroke Patients

Teasell, Robert MD, FRCPC
Mehta, Swati MA
Pereira, Shelialah PT, MSc
McIntyre, Amanda MSc
Janzen, Shannon MSc
Allen, Laura MSc (c)
Lobo, Liane BA
Viana, Ricardo MD

¹Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario;
²Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London Ontario;
³St. Joseph's Health Care, Parkwood Hospital, London, Ontario, Canada

Topics in Stroke Rehabilitation 19(6):p 457-462, November-December 2012. | DOI: 10.1310/tsr1906-457

Background:

It has long been assumed that stroke patients plateau in their recovery within 3 to 6 months of their stroke, and evidence for rehabilitation during the chronic stage is limited. As a consequence, rehabilitation resources for the management of chronic stroke are minimal.

Objective:

The primary objective was to identify randomized controlled trials (RCTs) across the continuum of stroke rehabilitation for interventions initiated 6 months or more following the onset of stroke. The secondary objective was to determine whether treatments provided post 6 months are effective in improving outcomes among stroke survivors.

Methods:

Multiple databases were used to identify all RCTs published from 1970 to June 2012 in the English language where the stroke rehabilitation interventions were initiated more than 6 months after the onset of the stroke. Data abstraction was performed using a standardized data abstraction form that included general citation information, study participant characteristics, methodology, outcomes assessed, and overall findings.

Results:

The results of our analysis revealed 339 RCTs. The mean number of subjects per study was 73. Two hundred fifty-six RCTs were related to motor recovery, 39 to cognitive function, and only 19 to psychosocial issues and community reintegration. The majority of the RCTs demonstrated a significant positive benefit.

Conclusions:

There is a robust evidence-base for stroke rehabilitation interventions in chronic stroke. This research synthesis reveals a paradox, whereby an impressive evidencebase contrasts with the limited optimism and resources available for rehabilitation in chronic stroke.