A systematic review and meta-analysis of clinical efficacy of early and late rehabilitation interventions for ischemic stroke

INTRODUCTION: At present, stroke has become the first cause of death and disability among Chinese adults. With the coming of the aging population in China, the disease burden brought by stroke will be increasingly aggravated. And stroke is a leading cause of disability. There is a golden plastic period after stroke, during which timely and safe intervention and rehabilitation therapy can effectively improve the disability status. However, there is still controversy about the duration of interventional rehabilitation after stroke. This study conducted a meta-analysis on the influence of intervention in early and late ischemic stroke rehabilitation. METHOD: Chinese language databases such as CNKI, Wanfang, and VIP, and English language databases such as Embase, PubMed, Web of Science, and The Cochrane Library were searched, and RCT related to early and late rehabilitation of ischemic stroke from the establishment of the database to October 2023 was collected. Review Manager 5.4.1 was used for relevant analysis. The main outcomes were Barthel Index or Modified Barthel Index, Fugl-Meyer Assessment scale, NIHSS, China Stroke Scale. Standardized Mean Difference (SMD) was used as an effective indicator of continuity variables, and the estimated interval was expressed by 95% confidence interval (CI). RESULTS: A total of 1908 patients were included in 16 studies. The results showed that, compared with late rehabilitation, early rehabilitation improved clinical efficacy. Barthel Index or Modified Barthel Index score was SMD = 1.40, 95%CI(1.16,1.63), p < 0.001; the score of Fugl-Meyer Assessment Scale was SMD = 1.18, 95%Cl (0.85, 1.52), P < 0.001; the score of NIHSS was SMD= -0.44, 95% CI(-0.65, -0.24), P < 0.001; the result of China Stroke Scale score was SMD= -0.37, 95%CI(-0.56, -0.18), P < 0.001. CONCLUSION: In comparison with late rehabilitation, early rehabilitation can significantly improve self-care abilities, daily activities, and neurological functions of ischemic stroke patients. TRIAL REGISTRATION: This meta-analysis has been registered with Prospero, and the registration number is CRD42022309911. The registration period is March 22, 2022.