Acute Phase Predictors of 6-Month Functional Outcome in Italian Stroke Patients Eligible for In-Hospital Rehabilitation.
Marco Franceschini, Stefania Fugazzaro, Maurizio Agosti and 4 others
PMID 29369053WHAT IT FOUND
Getting stroke patients sitting out of bed within 48 hours predicted better independence at six months.
However, early formal rehab starting within 72 hours was linked to worse outcomes, suggesting mobilization timing matters more than immediate intensive therapy.
Key findings
01Early out-of-bed mobilization within 48 hours was a strong independent predictor of favorable functional outcome (Barthel Index ≥75 and modified Rankin Scale 0–2) at 6 months.
02Patients who began formal rehabilitation with physiotherapists within 72 hours had a higher odds ratio for poor outcome (Barthel Index <75) at 6 months.
03Younger age, absence of total anterior circulation infarct (TACI) syndrome, and good continence were also independent predictors of favorable recovery.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study excluded patients who died within 24 hours or those unable to consent in the first 48 hours, likely underestimating mortality and excluding the most severe cases. The finding that early formal rehab (within 72 hours) was linked to worse outcomes may be confounded by patient severity; sicker patients might have been mobilized later or required different care pathways. Results are specific to Italian rehabilitation guidelines and hospital care standards, which may not generalize to other healthcare systems. The study did not measure the intensity or specific content of the rehabilitation provided, only the start time.
Declared interests
No conflicts of interest were reported by the authors or individuals in control of the content.
The easy way to misread this
Do not interpret the finding that early formal rehabilitation (within 72 hours) predicted worse outcomes as a reason to withhold therapy. This likely reflects confounding by indication, where patients with more severe strokes or complications were unable to tolerate early intensive rehab, or were mobilized later. The positive driver was simple early out-of-bed mobilization within 48 hours.