Impact of rehabilitation start time on functional outcomes after stroke.
Satoshi Otokita, Hironori Uematsu, Susumu Kunisawa and 3 others
PMID 33284355WHAT IT FOUND
Starting stroke rehabilitation on day 1 or 2 was linked to better discharge outcomes than starting later.
For haemorrhagic stroke specifically, starting on day 1 was worse than day 2. This is an observational association, not proof that timing causes the difference.
Key findings
01Patients starting rehabilitation on day 1 or 2 had better modified Rankin Scale scores at discharge than those starting on day 3 or later.
02In haemorrhagic stroke cases, starting rehabilitation on the day of admission was associated with less favourable functional outcomes compared with starting on day 2.
03The study found an association between timing and outcome but cannot prove causation because it was an observational database analysis.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study is observational and can only show association, not causation. Sicker patients may have been delayed in starting rehab, which could bias results. Rehabilitation details were not recorded, so it is unclear if 'early rehab' meant out-of-bed activity or just therapy sessions. Outcomes were measured at discharge (mean 20.8 days), not at 3 months, so long-term recovery differences are unknown. Severity adjustment was limited by available data; NIHSS scores were not available, so patients with severe strokes who were delayed in starting rehab might look worse simply because they were sicker. The study excluded patients who received tPA, so results do not apply to thrombolysed patients. Data comes from Japanese hospitals where weekend rehabilitation availability varies, potentially confounding start times for Friday admissions.
Declared interests
The authors have no conflicts of interest to declare.
The easy way to misread this
Do not change practice based on this alone. The study shows an association, not proof that waiting until day 2 causes better outcomes. Sicker patients often start later, which can make late starters look worse regardless of the rehab timing itself.