Mweshi et al., 2016 The Best Time to Start Stroke Rehabilitation: A Review of the Evidence in Resource-Adequate and Resource Constrained Settings

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Keywords: Stroke, Rehabilitation, Resource Adequate Settings, Resource Constrained Settings


Background: Stroke is a global health problem and one of the major causes of death, disability and impairment among adults worldwide. Post-stroke outcomes vary widely, between and within world regions depending on a range of factors including demographic profile, stroke type, severity and immediate and long-term post stroke care. It has been reported that early initiation of rehabilitation following stroke promotes better long-term outcomes than delayed rehabilitation, although this has been disputed by some researchers in the AVERT (A very early rehabilitation trial) study.

Purpose of Review: To evaluate the best time to start stroke rehabilitation with good outcomes.

Results of the Review: There is limited evidence to show that later rehabilitation is better than early rehabilitation. It also remains unclear whether early mobilization is more effective than mobilization at a later stage, due to insufficient statistical power of the studies that have examined this practice because clinicians around the world are practicing this model to this day. Furthermore, some trial limitations of the AVERT study in line with the uncertainty of the external validity of the results, make generalizability something to be concerned about.

Conclusion: The best time to start stroke rehabilitation is as soon as the patient is clinically stable i.e; as early as possible. The results of the poor outcomes of the AVERT study in providing evidence of the impact of early stroke rehabilitation, should not be interpreted as proof of the ineffectiveness of early physical rehabilitation. Every stroke is different from one person to another because the impact of the damage to the brain is associated with the different functions of several parts of the brain making generalizability quite difficult. Therefore, in the absence of provision of high quality evidence, clinicians like physiotherapists should base their decisions on clinical experience, individual circumstances and patient preferences as appropriate. It is extremely important to develop evidence-based practice protocols that can guide clinical practice on the best time to start stroke rehabilitation and also enhancing plasticity and reducing the negative impact of stroke through pharmacotherapy, especially for survivors in resource constrained places like sub-Saharan Africa.