Physical Medicine

Higher-dose post-acute stroke rehab benefits patients with better baseline ADLs

In this national target-trial emulation of 6259 ischemic stroke patients, ≥2 hours/day of in-hospital rehab improved 60-day mRS 0–2 by 15.3%. Benefit was greatest in patients with relatively preserved ADLs at transfer, especially self-care, mobility, and excretion control domains. Treatment effect heterogeneity was also influenced by sex, age, pre-admission mRS, and length of acute hospitalization. Findings support prioritizing higher-dose therapy for patients with better baseline function rather than uniformly intensifying for all. 1

Mobile-based respiratory training augments early functional recovery after acute stroke

This single-center RCT randomized 40 acute stroke inpatients with reduced FVC to a 2-week mobile respiratory program plus usual rehab versus usual rehab alone. The intervention, delivered via a WeChat-based platform, achieved 96% adherence with only mild, transient adverse events. Compared with controls, the intervention group had greater FVC gain and improvements in maximal inspiratory and expiratory pressures at 2 weeks. Modified Barthel Index also improved more with the mobile program, while FEV₁ and peak expiratory flow changes were similar between groups. 2

Meta-analysis shows meaningful language gains with rTMS for post-stroke aphasia

This meta-analysis pooled 26 RCTs including 419 active and 318 control participants with post-stroke aphasia. rTMS produced a significant positive effect on language recovery (SMD 0.80; 95% CI 0.48–1.11). Both inhibitory and excitatory protocols were beneficial, with greatest gains from inhibitory stimulation of the right inferior frontal gyrus in the subacute phase. Individualized targeting did not clearly outperform standard protocols, highlighting parameter rather than personalization effects as current key levers. 3

Exercise mitigates disuse-related weakness, especially when started during hospitalization

This meta-analysis synthesized randomized and nonrandomized trials of exercise during and after disuse across hospitalization, bed rest, and spaceflight. During hospitalization, exercise significantly increased muscle strength (ES 0.60) with preserved effects in multilevel analyses (ES 0.58). Exercise preserved or increased muscle mass during bed rest and spaceflight, despite small or nonsignificant pooled strength effects in multilevel models. Post-disuse therapeutic exercise showed only a trend toward strength improvement, underscoring prevention over reversal of disuse atrophy. Resistance and mixed exercise emerge as key strategies but with variable efficacy depending on disuse model and analytic approach. 4