Post-thrombectomy rehabilitation strategies and 90-day outcomes in acute ischemic stroke patients enrolled in randomized controlled trials: A systematic review and meta-analysis.
Muhammad Shakir, Moeez Ahmed, Zayan Alidina et al.
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In 30 seconds
This systematic review and meta-analysis examined post-thrombectomy rehabilitation strategies and 90-day functional outcomes across 23 randomized controlled trials involving 6,649 patients with acute ischemic stroke. Rehabilitation was most often described as following institutional care (52%); 17% of trials used national guidelines. In trial-level meta-regression, rehabilitation strategy was associated with the proportion of patients achieving mRS 0–2 at 90 days (QM (df = 1) = 5.06, p = 0.025). Both institutional-care and national-guideline approaches were associated with higher odds of a greater proportion achieving this outcome, but the analysis does not establish that either strategy caused better recovery.
Key findings
- Across 23 RCTs and 6,649 patients, institutional-care rehabilitation was reported in 52% of trials and national-guideline rehabilitation in 17%.
- Rehabilitation strategy was associated with the trial-level proportion achieving mRS 0–2 at 90 days (QM (df = 1) = 5.06, p = 0.025).
- Institutional-care rehabilitation was associated with higher odds of a greater proportion achieving mRS 0–2 (log OR = 0.64, 95% CI [0.42, 0.87], p < 0.01); national-guideline rehabilitation showed a similar association (log OR = 0.58, 95% CI [0.07-1.08], p = 0.02).
Why it matters
Post-thrombectomy rehabilitation is part of the recovery pathway, yet the included trials used differing approaches. The association between rehabilitation strategy and 90-day functional outcomes highlights that rehabilitation practices may affect how trial outcomes are interpreted and compared. Clearer reporting and consistency in rehabilitation protocols could help future thrombectomy trials assess treatment effects more reliably.
What to keep in mind
The meta-regression compares rehabilitation strategies across trials, so the associations do not establish that a strategy caused better outcomes. Rehabilitation approaches were also not specified in all trials.