Rehabilitation Timing for Stroke

(PRESERVE Trial)

This trial aims to determine the best time to start rehabilitation therapy after a stroke. Researchers are examining whether beginning physical therapy on or after the third day from stroke onset improves recovery for individuals with blocked arteries in the brain. The trial compares delayed mobilization (DeM, starting therapy on or after day 3) with standard care (starting therapy within 48 hours). It is suitable for those who have recently experienced an ischemic stroke, still have blocked arteries, and face significant neurological issues. The goal is to enhance recovery and reduce long-term disabilities. As an unphased trial, it offers participants the chance to contribute to important research that could improve stroke recovery strategies for future patients.

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

Research has shown that starting rehabilitation too soon after a stroke might not always be safe. Some studies have indicated that beginning physical therapy within 24 hours can lead to worse outcomes, including higher chances of death and dependency. This suggests that starting therapy too early might be harmful for some stroke patients.

Conversely, waiting three days or more to start physical therapy is under study for its potential benefits. The idea is to allow the brain some time to settle before beginning active therapy. This approach can be especially important for patients with large strokes or ongoing blood vessel blockages. While more research is needed, waiting a bit longer to start therapy might help improve recovery and reduce the risk of further harm.

Researchers are excited about the trial for delayed mobilization (DeM) after a stroke because it challenges the traditional approach of starting rehabilitation promptly. Unlike standard care, which begins therapy within 48 hours of a stroke, DeM involves waiting at least three days. This delay might offer insights into optimizing recovery by potentially reducing stress on the body soon after a stroke, allowing for tailored rehabilitation when the patient is more stable. Understanding the timing could lead to improved strategies for stroke recovery, focusing on patient-specific needs rather than a one-size-fits-all approach.

Research has shown mixed results about when to start rehabilitation after a stroke. Some studies suggest that moving within 24 hours might not improve recovery or survival rates. In fact, starting physical activity too soon could worsen outcomes or increase dependency. In this trial, one group will receive Delayed Mobilization (DeM), where active therapy begins on or after day 3 from stroke symptom onset. This approach is based on studies suggesting that waiting until day 3 or later to begin rehabilitation could be better, especially for those with ongoing artery blockages. This delay might help reduce further brain damage and improve recovery. Overall, the timing of rehabilitation is crucial, and waiting a bit longer could lead to better long-term results for some stroke survivors.¹²⁵⁶⁷