STROKE-TIMING & INTENSITY OF REHAB
SUMMARY
1. Significant evidence for early rehabilitation in stroke, TBI, hip fractures, SCI and geriatric rehabilitation.
2. The Canadian Stroke Guidelines recommend that stroke rehabilitation patients should receive a minimum of 3 hrs of direct task-specific therapy, 5/week delivered by an interprofessional team. The evidence on weekend therapy providing better outcomes on 5 day per week therapy is mixed[1]
2. Bernhardt J. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): A randomised controlled trial. The Lancet 2015;386:46-55.
3. French B, Thomas LH, Coupe J, McMahon NE, Connell L, Harrison J, . . . Watkins CL. Repetitive task training for improving functional ability after stroke. Cochrane Database of Systematic Reviews 2016;11:CD006073.
4. Different authors have varying times: Hayes et al, Cifu et al, Teasell, Indredavik Trondheim, Bernhardt et al (AVERT study[2]
).
5. A Cochrane review by French et al. (2016) focused on repetitive task training following stroke and highlights differences between upper (≤ 20 hrs) and lower limb (≥ 20 hrs) rehabilitation[3]
.
6. Indredavik showed better outcomes with early mobilization.
7. An RCT by Ronning & Guldvog (1998) showed significant evidence for benefits of inpatient stroke rehab for moderate to severe strokes, however there is minimal evidence for mild strokes.
Reference(s)
- ↑ Teasell, R., Hussein, N., Mirkowski, M., Vanderlaan, D., Saikaley, M., Longval, M. and Iruthayarajah, J., 2020. Brain Reorganization, Recovery and Organized Care. [online] Ebrsr.com. Available at: Handbook Chapter 4_Upper Extremity Post Stroke_ML.pdf Ebrsr.com [Accessed 11 November 2020].
- ↑ Bernhardt J. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): A randomised controlled trial. The Lancet 2015;386:46-55.
- ↑ French B, Thomas LH, Coupe J, McMahon NE, Connell L, Harrison J, . . . Watkins CL. Repetitive task training for improving functional ability after stroke. Cochrane Database of Systematic Reviews 2016;11:CD006073.
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
