title: Time to rethink long-term rehabilitation management of stroke patients.
abstract: BACKGROUND
  It has long been assumed that stroke patients plateau in their recovery within 3 to 6 months of their stroke, and evidence for rehabilitation during the chronic stage is limited. As a consequence, rehabilitation resources for the management of chronic stroke are minimal.
  
  
  OBJECTIVE
  The primary objective was to identify randomized controlled trials (RCTs) across the continuum of stroke rehabilitation for interventions initiated 6 months or more following the onset of stroke. The secondary objective was to determine whether treatments provided post 6 moths are effective in improving outcomes among stroke survivors.
  
  
  METHODS
  Multiple databases were used to identify all RCTs published from 1970 to June 2012 in English language where the stroke interventions were initiated more than 6 months after the onset of the stroke. Data abstraction was performed using standardized data abstraction form that included general citation information, study participant characteristics, methodology, outcomes accessed, and overall findings.
  
  
  RESULTS
  The results of our analysis revealed 339 RCTs. The mean number of subjects per study was 73. Two hundred fifty-six RCTs were related to motor recovery, 39 to cognitive function, and only 19 to psychosocial issues and community reintegration. The majority of the RCT s demonstrated a significant positive benefit.
  
  
  CONCLUSIONS
  There is a robust evidence-base for stroke rehabilitation interventions in chronic stroke. This research synthesis reveals a paradox, whereby an impressive evidence-base contrasts with the limited optimism and resources available for rehabilitation in chronic stroke.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
authors.forename: Swati
authors.initials: S
authors.lastname: Mehta
authors.forename: Shelialah
authors.initials: S
authors.lastname: Pereira
authors.forename: Amanda
authors.initials: A
authors.lastname: McIntyre
authors.forename: Shannon
authors.initials: S
authors.lastname: Janzen
authors.forename: Laura
authors.initials: L
authors.lastname: Allen
authors.forename: Liane
authors.initials: L
authors.lastname: Lobo
authors.forename: Ricardo
authors.initials: R
authors.lastname: Viana
mesh_terms: D001037:Aphasia / Q000209:etiology / Q000534:rehabilitation; D003072:Cognition Disorders / Q000209:etiology / Q000534:rehabilitation; D016208:Databases, Factual / Q000706:statistics & numerical data; D005684:Gait / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D009068:Movement / Q000502:physiology; D009069:Movement Disorders / Q000209:etiology / Q000534:rehabilitation; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D020127:Recovery of Function; D012046:Rehabilitation; D012919:Social Behavior; D020521:Stroke / Q000150:complications* / Q000523:psychology; D000071939:Stroke Rehabilitation; D034941:Upper Extremity / Q000503:physiopathology