STROKE-TIMING & INTENSITY OF REHAB

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SUMMARY

TIMING
1. Significant evidence for early rehabilitation in stroke, TBI, hip fractures, SCI and geriatric rehabilitation. However, for stroke patients, starting intensive out-of-bed activities within 24 hours of stroke onset is not recommended[1]

2. Langhorne P, Collier JM, Bate PJ, Thuy MN, Bernhardt J : Very early versus delayed mobilisation after stroke. The Cochrane database of systematic reviews, 2018;10 CD006187.
3. Bernhardt J, Langhorne P, Lindley RI, Thrift AG, Ellery F, Collier J, Churilov L, Moodie M, Dewey H, Donnan G : Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet (London, England), 2015;386(9988):46-55.
4. Lynch E, Hillier S, Cadilhac D : When should physical rehabilitation commence after stroke: a systematic review. International journal of stroke : official journal of the International Stroke Society 2014;9(4):468-78.
5. 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].[2]
[3].
2. All stroke patients should commence mobilisation (out-of-bed activity) within 48 hours of stroke onset unless otherwise contraindicated (e.g. receiving end-of-life care)[4]
[5].
3. For patients with mild and moderate stroke, frequent, short sessions of out-of-bed activity should be provided, but the optimal timing within the 48-hour post-stroke time period is unclear[6]
.
DURATION
4. 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[7]
.

5. Different authors have varying times: Hayes et al, Cifu et al, Teasell, Indredavik Trondheim, Bernhardt et al (AVERT study)[8].

6. 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) for optimal rehabilitation[9].


Reference(s)

  1. ↑ Rethnam, V., Langhorne, P., Churilov, L., Hayward, K.S., Herisson, F., Poletto, S.R., Tong, Y. and Bernhardt, J., 2022. Early mobilisation post-stroke: a systematic review and meta-analysis of individual participant data. Disability and rehabilitation, 44(8), pp.1156-1163.
  2. ↑ Langhorne P, Collier JM, Bate PJ, Thuy MN, Bernhardt J : Very early versus delayed mobilisation after stroke. The Cochrane database of systematic reviews, 2018;10 CD006187.
  3. ↑ Bernhardt J, Langhorne P, Lindley RI, Thrift AG, Ellery F, Collier J, Churilov L, Moodie M, Dewey H, Donnan G : Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet (London, England), 2015;386(9988):46-55.
  4. ↑ Bernhardt J, Langhorne P, Lindley RI, Thrift AG, Ellery F, Collier J, Churilov L, Moodie M, Dewey H, Donnan G : Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet (London, England), 2015;386(9988):46-55.
  5. ↑ Lynch E, Hillier S, Cadilhac D : When should physical rehabilitation commence after stroke: a systematic review. International journal of stroke : official journal of the International Stroke Society 2014;9(4):468-78.
  6. ↑ Bernhardt J, Langhorne P, Lindley RI, Thrift AG, Ellery F, Collier J, Churilov L, Moodie M, Dewey H, Donnan G : Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet (London, England), 2015;386(9988):46-55.
  7. ↑ 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].
  8. ↑ 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.
  9. ↑ 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].

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