Therapy-based rehabilitation services for patients living at home more than one year after stroke

It is unclear if rehabilitation provided more than one year after a stroke can improve recovery. People who are recovering from a stroke for one year or more often have persistent disabilities. Although therapy-based rehabilitation for such patients is an accepted part of stroke management, the evidence base for such practice is unclear. We identified only five clinical trials, including 487 participants, which showed a tendency towards improved recovery but the results were inconclusive.

Authors' conclusions: 

This review highlights the dearth of evidence investigating long-term therapy-based rehabilitation interventions for patients with stroke.

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Background: 

Current practice of rehabilitation intervention mainly concentrates on the first six months of stroke. At present, there is no agreed consensus about the benefits of such a service more than one year after stroke.

Objectives: 

To ascertain whether therapy-based rehabilitation services can influence outcome one year or more after stroke.

Search strategy: 

We searched the trials registers of the following Cochrane Review Groups: Stroke Group (last searched September 2007), Effective Practice and Organisation of Care Group (last searched October 2006) and Dementia and Cognitive Improvement Group (last searched October 2006). We also searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2006), MEDLINE (1966 to October 2006), EMBASE (1980 to October 2006), CINAHL (1982 to October 2006), AMED (1985 to October 2006), PEDro (1952 to October 2006), British Nursing Index (1993 to October 2006), DARE (1994 to October 2006), HMIC (1979 to October 2006) and NHS EED (1991 to October 2006). We also searched dissertation databases and ongoing trials and research registers, scanned reference lists and contacted researchers and experts in the field.

Selection criteria: 

All randomised controlled trials of community-based stroke patients, in which at least 75% were recruited one year after stroke and received a therapy-based rehabilitation intervention that was compared with conventional care.

Data collection and analysis: 

Two review authors independently selected trials and extracted data on a number of pre-specified outcomes. The primary outcomes were the proportion of participants who had deteriorated or were dependent in personal activities of daily living at the end of scheduled follow up.

Main results: 

We identified five trials of 487 participants that were eligible for the review. Overall, there was inconclusive evidence as to whether therapy-based rehabilitation intervention one year after stroke was able to influence any relevant patient or carer outcome. Trials varied in design, type of interventions provided, quality, and outcomes assessed.

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