WSC 2025 | The need to standardize rehabilitation following stroke to prevent confounding trial outcomes
Adnan Qureshi, MD, The University of Missouri School of Medicine, Columbia, MO, discusses the importance of standardizing rehabilitation following stroke, highlighting that heterogeneity in rehabilitation protocols can confound outcomes of acute interventions. Dr Qureshi notes that studies have shown that structured rehabilitation can lead to better outcomes, but this aspect is often not monitored or standardized in clinical trials. This interview took place at the 17th World Stroke Congress (WSC) in Barcelona, Spain.
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Transcript
So, recently we actually published a study. You know, in clinical trials, essentially, you know, we have an acute intervention. It could be blood pressure reduction for intracerebral hemorrhage. It could be thrombectomy for acute ischemic stroke. But we never really focus on standardizing the rehabilitation that follows. And there’s obviously data to suggest that rehabilitation or dedicated rehabilitation makes a difference on patient outcomes...
So, recently we actually published a study. You know, in clinical trials, essentially, you know, we have an acute intervention. It could be blood pressure reduction for intracerebral hemorrhage. It could be thrombectomy for acute ischemic stroke. But we never really focus on standardizing the rehabilitation that follows. And there’s obviously data to suggest that rehabilitation or dedicated rehabilitation makes a difference on patient outcomes. So while you have acute intervention that you have standardized, but you have made no effort to standardize the rehabilitation that follows, and you are confounding the benefit of your acute intervention by this heterogeneity in the rehabilitation that follows for the next three months. And I think there is ample data to suggest that if you do a structured rehabilitation, you would actually have a better outcome. But in clinical trials, we simply say that whatever rehabilitation is acceptable by institutional standards or maybe just follow the national guidelines, but we don’t make any more effort to specify further or even monitor. So we always monitor compliance to the acute intervention. We always monitor how effectively the acute intervention was delivered, but we never really monitor what happens with rehabilitation. And I think that if you look at studies, so in our recent publication, what we found is that when you actually had a higher level of standardization of rehabilitation in acute stroke studies, you had better outcomes for the patients overall. So there is an element, a strong element that influences patient recovery. And it somehow has not been addressed properly in clinical trials or even in practice, where, you know, you see a large amount of heterogeneity in rehabilitation strategies, I think part of it is driven by cost. I know in the United States, insurance status becomes a big issue, that the quality of rehabilitation that you will receive will partly be determined by what your insurance status is, so not necessarily the level of neurological deficits or what may benefit you the most.
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