Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery and Community Participation Following Stroke. Part One: Stroke Rehabilitation Planning for Optimal Care Delivery, 7th Edition Update 2025.
Michelle LA Nelson, Jing Shi, M Patrice Lindsay and 51 others
PMID 41257448WHAT IT FOUND
Stroke unit care reduces poor outcomes.
Early mobilization within 24 hours increased mortality and reduced favorable outcomes in the AVERT trial. Virtual rehab is effective for motor, cognitive, and speech goals. Multidisciplinary discharge planning improves transitions but mixed evidence exists on specific clinical outcomes.
Key findings
01Stroke unit care is associated with significant reductions in poor outcomes, death, and institutional care compared to general wards, with benefits independent of age or sex.
02Very early mobilization (within 24 hours) resulted in significantly fewer patients having a favorable outcome at 3 months and was associated with increased risk of early mortality compared to usual care.
03Virtual stroke rehabilitation is feasible and can be as effective as in-person care for motor, cognitive, and communication impairments, including speech and language therapy.
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
Guidelines synthesize existing evidence rather than presenting new primary data. The AVERT trial's negative finding on early mobilization contrasts with some smaller RCTs, suggesting timing and intensity are critical variables. Evidence for discharge planning in stroke-specific populations is limited compared to general medical populations. Virtual care evidence is rapidly expanding, and long-term outcomes are less established than in-person care.
Declared interests
Funded entirely by Heart & Stroke. No commercial funding from pharmaceutical or device companies. Writing group members are volunteers. Some authors have declared conflicts including research grants, honoraria, and consulting fees from various health organizations and some pharmaceutical companies (e.g., Merz, AbbVie, Ipsen), though these are stated to be mitigated by the multidisciplinary consensus model.
The easy way to misread this
Do not interpret 'early mobilization' as 'mobilization within 24 hours.' The guideline explicitly cites the AVERT trial showing that very early, intensive mobilization increased mortality and reduced favorable outcomes compared to usual care. Timing and dose must be individualized.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →