Stroke: intensive rehabilitation improves activities of daily living.

Clinical bottom line (level 1a)

  1. Patients who require rehabilitation after stroke and are given intensive physical and occupational therapy are more likely to have an improvement in activities of daily living, than those given conventional therapy.
Kwakkel et al: Stroke 1997; 28: 1550-1556
Expires December 2002

The study

Systematic review of published controlled studies of
  • Patients: stroke
  • Intervention: intensive rehabilitation compared with conventional rehabilitation
  • Outcome: improvement in activities of daily living


    • Articles found in ?language using MEDLINE, 1966 to 1995 (search terms: stroke, cerebrovascular disorders, dose-response relationship, effectiveness, cost-effectiveness, rehabilitation, therapy, physical therapy, physiotherapy, occupational therapy and exercise therapy ) and references of relevant papers were studied and abstracts published in proceedings of conferences were searched. Investigators of studies were contacted if more information about the study was needed.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: pre experiments were excluded because of a lack of experimental control

    9 controlled studies were included
    There was no significant heterogeneity.
  • On average, the intensive rehabilitation group received almost twice as much physical and occupational therapy daily as the control group.

    • The evidence

    • The overall effect size for activities of daily living was 0.28 ± 0.12.

    Citation

    1. Kwakkel G, Wagenaar RC, Koelman TW, et al: Effects of intensity of rehabilitation after stroke: A research synthesis. Stroke 1997; 28: 1550-1556
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient stroke
    Intervention or Exposure intensive rehabilitation
    Comparison conventional rehabilitation
    Outcome improvement in activities of daily living