Optimal Timing of Rehabilitation: Overview of the Evidence in the Literature

ABSTRACT

Stroke results in chronic disability which is a major burden in various ways and thus regaining functional independence is an important goal for the stroke patients and caregivers. Early rehabilitative training after stroke onset takes place in most stroke centers. However, optimal timing of rehabilitation after stroke remains controversial and debate on the complications and other issues induced by the early rehabilitation is still ongoing despite considerable amount evidence in the literature that supports early rehabilitation. There is uncertainty about whether very early mobilization within 24 to 48 hours of stroke onset improves outcome after stroke. Emphasis on early mobilization with increasing frequency and dose of mobilization in the early phase of stroke may contribute to improved functional outcomes after stroke. In this article, superiority of the very early mobilization after stroke is demonstrated by reviewing supporting evidence from animal studies by showing changes in task performance and anatomy, clinical comparative data by comparing outcome measurement scores, AVERT studies, a large scale randomized controlled trial currently in progress to provide sufficient clinical evidence, and the current Clinical Practice Guidelines.