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About the Authors

Mark Belokopytov – Adjunct Professor, Ben-Gurion University of the Negev Beer Sheva, Israel, This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID: 0000-0002-7830-8764

Abstract

Objective: This review aims to synthesize the findings from high-quality clinical trials conducted in the past decade regarding the timing of motor rehabilitation initiation after a stroke. The goal is to identify best practices, highlight controversies, and propose areas for future research to optimize therapeutic outcomes.

Methods: A comprehensive literature search was conducted using PubMed/MEDLINE databases, focusing on studies published between January 2014 and May 2024. Search terms included MeSH headings related to stroke, motor rehabilitation, and patient outcomes, combined with keywords such as "early rehabilitation," "delayed rehabilitation," and "post-acute rehabilitation." The inclusion criteria were clinical trials on adults, published in English, and available in full text. The Cochrane Risk of Bias tool was utilized for quality assessment.

Results: Out of 54 articles reviewed, 6 were directly relevant to the timing of post-stroke rehabilitation. These studies provided mixed evidence on the benefits of early rehabilitation, with some suggesting potential risks associated with very early mobilization (within 24 hours). The AVERT trial highlighted the adverse outcomes of very early mobilization, while other studies demonstrated that early but cautious rehabilitation initiation could lead to significant improvements in motor recovery. The findings underscore the complexity of determining the optimal timing for rehabilitation onset. Early rehabilitation, initiated within 24-48 hours post-stroke, is generally beneficial if patients are medically stable. However, very early and intensive mobilization may increase the risk of adverse outcomes, particularly in patients with severe strokes or unstable conditions. There is a need for personalized rehabilitation plans and further research to understand the long-term impacts of different rehabilitation timing on patient outcomes.

Conclusion: Early initiation of motor rehabilitation post-stroke can enhance recovery and improve the quality of life if tailored to the individual patient's needs and medical status. Future studies should focus on refining the timing and intensity of rehabilitation interventions to maximize therapeutic benefits and minimize risks.

Keywords

Stroke, neurological rehabilitation, physical therapy modalities, early rehabilitation, delayed rehabilitation, rehabilitation guidelines.

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