Early rehabilitation for stroke patients: a new look.

Many investigators have argued that early rehabilitation is important to maximize recovery from stroke and have documented a correlation between better outcomes and earlier admission to rehabilitation. But is this correlation good evidence for causation? In a sample of 94 stroke patients admitted to a comprehensive rehabilitation hospital, shorter onset-admission intervals definitely correlated with functional status outcomes (r = 0.27, p less than or equal to 0.006). However, when functional status upon admission, prior acute care improvement, level of consciousness shortly after the stroke, and other patient characteristics were partialled out, the correlation disappeared (partial r = -0.03, ns). The putative effect of early rehabilitation was attributable to the better health of stroke patients who could be admitted earlier to rehabilitation. Indications were that optimal timing for rehabilitation may differ depending upon side of paralysis. Rather than assuming that earlier is always better, future research and practice should concentrate on grading rehabilitative efforts to the capacities and needs of patients.