Interpreting the CPASS Trial: Do Not Shift Motor Therapy to the Subacute Phase.
Matthew A Edwardson, Kathaleen Brady, Margot L Giannetti and 9 others
PMID 36575958WHAT IT FOUND
Do not shift standard stroke rehabilitation to the subacute phase.
The trial compared added therapy at different times, not moving care. Standard therapy was already concentrated early. Participants received an average of 27.9 hours of standard therapy in the first two months.
Key findings
01Participants received an average of 27.9 hours of standard occupational therapy during the first 2 months post-stroke, and 9.8 hours during months 3 and 4.
02The trial was not designed to determine whether the improvement for the subacute group was significantly greater than that for the acute group.
03As a phase II study, the results should not change current rehabilitation practice until further studies are conducted.
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 trial was a phase II study with only 72 participants, designed to test for any differences between groups over time, not to determine the optimal timing window. The study was not designed to compare the acute group directly against the subacute group to see which phase was better. The experimental therapy was added to usual care, not substituted for it, so the results cannot support shifting existing services.
The easy way to misread this
Do not interpret the subacute group's significant result as evidence that therapy should be delayed or moved from the acute phase. The subacute group received both usual care and the added intensive therapy, while the usual care itself was already concentrated in the first two months. The study did not prove subacute therapy is better than acute therapy, only that both showed significant recovery compared to controls.