Does time spent in rehabilitation make a difference on activity limitation and impairment in people with stroke? - A Cochrane Review summary with commentary.
Francesca Gimigliano
PMID 35980003WHAT IT FOUND
Increasing rehabilitation time did not consistently improve outcomes.
While some subgroup analyses suggested benefits for daily activities and upper limb function when time differences were large, the overall certainty was very low. There is no evidence to recommend a specific minimum daily dose of rehabilitation for stroke patients.
Key findings
01The review found very low certainty about whether the amount of time spent in rehabilitation makes any difference in activities of daily living, upper and lower limb activity, or motor impairments.
02Subgroup analyses showed significant improvements in activities of daily living and upper limb activity when the difference in total rehabilitation time between groups was larger.
03When comparing studies based on minutes of rehabilitation per week rather than total time, no differences were reported for activities of daily living, limb activity, or upper limb motor impairment.
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 overall certainty of the evidence was rated as very low by the review authors. The review could not group studies by similar rehabilitation schedules due to lack of information, so it could only extrapolate minutes per week. Subgroup analyses showed conflicting results: benefits were seen when comparing total time differences but not when comparing minutes per week. This is a summary and commentary of a Cochrane Review, not the full review itself, so details on individual study quality and risk of bias are not provided in this text.
Declared interests
The author of this commentary declares no conflicts of interest.
The easy way to misread this
Do not assume that simply adding more hours to a patient's therapy schedule will guarantee better outcomes. The evidence for a dose-response relationship is very weak, and comparisons based on weekly minutes showed no difference at all.