Functional task-focused rehabilitation appears to offer the most durable improvement in everyday independence after stroke compared with other rehabilitation approaches.
This systematic review identified randomised controlled trials evaluating physical rehabilitation for adults after stroke through comprehensive searches of international medical databases and trial registers. Two reviewers independently selected eligible studies, extracted outcome data, assessed study bias, and evaluated confidence in the evidence. The review compared rehabilitation with minimal treatment, attention-based control, additional usual care rehabilitation, and alternative rehabilitation approaches, focusing on daily independence, motor function, balance, walking speed, hospital stay, and harms.
Physical rehabilitation improved functional independence, motor recovery, balance, and walking speed compared with minimal or no rehabilitation, while extra rehabilitation alongside usual care provided further benefits. Approaches centred on practising meaningful functional tasks showed sustained advantages for daily independence and may improve motor function more than other methods. Neurophysiological approaches were no more effective, and may be less effective, than alternative rehabilitation methods for independence. Interpretation is limited by variation among interventions, participants, and study quality.
