Use a qualified rehabilitation team and follow an individualized activity plan
Waiting at home for recovery is not a substitute for appropriate rehabilitation. Organized multidisciplinary stroke care improves survival and independence. But more intense activity is not always better: a trial adding very early, higher-dose mobilization within 24 hours found worse functional outcomes at three months. Timing and intensity should follow the clinical team.
What it takes
The source estimates inpatient rehabilitation at hundreds of RMB daily in China, with local reimbursement and out-of-pocket amounts varying. Treatment can take months of repetitive work.
What you may gain
A Cochrane review included 29 trials and 5,902 participants comparing organized inpatient stroke-unit care with other services. At final follow-up, median one year, OR was 0.77 for poor outcome—death, disability, or institutional care—95% CI 0.69–0.87; 0.76 for death, 0.66–0.88; and 0.75 for death or dependency, 0.66–0.85, with moderate-quality evidence. In absolute terms, per 100 patients, stroke-unit care produced about two additional survivors, six additional people living at home, and six additional people independent in daily life. In AVERT, 2,104 patients in 56 acute stroke units across five countries were randomized to usual care or usual care plus very early, higher-dose mobilization. At three months, favorable modified Rankin scores of 0–2 occurred in 480, 46%, in the very-early group and 525, 50%, in usual care, adjusted OR 0.73, 95% CI 0.59–0.90, P=0.004. Deaths were 88 versus 72, OR 1.34, 0.93–1.93, P=0.113, without a statistically clear difference.
Context & considerations
Both studies concern stroke; transferring exact effects to spinal injury, amputation, or burns is an extrapolation. AVERT challenges “earlier and more is always better,” not appropriate early activity itself. The source describes early activity in both groups, with frequency and total dose differing; the trial should guide clinicians rather than a self-prescribed schedule. Look for a rehabilitation medicine department and qualified rehabilitation and occupational therapists, not merely the word “rehabilitation” on a sign. For referral and deductibles, see chapter 24, entry 1; for community rehabilitation and devices, entry 7.
Research & references
Langhorne P, Ramachandra S; Stroke Unit Trialists' Collaboration (2020). Organised inpatient (stroke unit) care for stroke: network meta-analysis. Cochrane Database of Systematic Reviews, 4, CD000197. https://doi.org/10.1002/14651858.CD000197.pub4; AVERT Trial Collaboration group (2015). Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet, 386(9988), 46–55. https://doi.org/10.1016/S0140-6736(15)60690-0