This is the second issue on Stroke Rehabilitation by Richard Bohannon and a follow-up to my previous From the editor. I would like to take my thoughts on stroke rehabilitation in a different direction. Many myths abound in the area of stroke rehabilitation. For example, many clinicians, payors, and patients believe that after the first 3 months after a stroke very little progress occurs. One can take this information in either direction. Jorgenson1 in a study entitled “Outcome and time course of recovery in stroke patients” found that the best ADL function was reached by 80% of patients with initially mild strokes in 3 weeks, within 7 weeks for patients with moderate strokes, and within 11.5 weeks for patients with severe or very severe strokes. Dean2 in an article entitled “Task related circuit training improves performance of locomotor tasks in chronic stroke: a randomized controlled pilot trial,” found that patients who were at least 3 months status post stroke and worked on a 3 times a week 4-week strength training program had significant improvements in function that they retained for 2 months follow-up period.
Some of the earlier studies may discuss outdated treatment techniques and may therefore be perpetuating the 3-month no improvement myth. Many myths abound as to what treatment techniques are most effective for stroke rehabilitation and if one receives more training in a certain technique the therapist may be vested in, this particular technique may ignore evidence-based research. At this point I caution therapists to be very careful about investing too much energy learning one specific treatment technique. Frequently we become so vested in that one technique that we lose sight whether it is truly the most valid technique for each individual patient based on what has been proven to date.
Dr Bohannon and the other authors in this issue present outstanding evidence-based articles that justify the current state of the art for evaluation and treatment for disabilities related to stroke. I thank them for a wonderful issue. With issue such as this we will be able to convince payors that there are myths that could be very harmful to our patients. Providing evidence-based information and care will help us provide our patients with the most effective care and best outcomes.
Carole B. Lewis PhD, PT, GCS, MSG, MPA
1. Jorgensen HS, Nakayama H, Raaschou HO, Vive-Larsen J, Stoier M, Olsen TS. Outcome and time course of recovery in stroke. Part I: Outcome. The Copenhagen Stroke Study. Arch Phys Med Rehabil.
2. Dean CM, Richards CL, Moalouin F. Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Arch Phys Med Rehabil.