From the Research
Approximately 30-40% of patients with major stroke require follow-up by a rehabilitation physician in the chronic phase of stroke, as supported by the most recent and highest quality study available 1. This percentage varies based on stroke severity, residual deficits, and individual recovery trajectories. Patients with significant functional impairments, such as mobility limitations, speech difficulties, cognitive deficits, or those requiring ongoing therapy adjustments typically need rehabilitation physician oversight beyond the acute and subacute phases. The chronic phase, generally considered to begin 3-6 months post-stroke, often requires continued rehabilitation management to address evolving needs, prevent complications, optimize function, and manage secondary conditions like spasticity or post-stroke pain. Some key points to consider in the management of stroke patients in the chronic phase include:
- The importance of comprehensive assessment and multidisciplinary care coordination by rehabilitation physicians 2
- The need for ongoing therapy adjustments and management of secondary conditions like spasticity or post-stroke pain 3
- The potential benefits of physical rehabilitation approaches that focus on functional task training 1
- The limited evidence for the effectiveness of neurophysiological approaches to physical rehabilitation in improving outcomes 1 Rehabilitation physicians provide comprehensive assessment, coordinate multidisciplinary care, adjust medication regimens (such as baclofen or botulinum toxin for spasticity), prescribe appropriate assistive devices, and monitor for complications like depression or shoulder subluxation. This ongoing specialized care is crucial as recovery can continue for years after stroke, though at a slower pace than in earlier phases, and helps patients achieve their maximum functional potential and quality of life. It is also important to note that the evidence for chronic stroke rehabilitation interventions is limited, and there is a need for high-quality randomized controlled trials to examine the effectiveness of these interventions in addressing activities and participation outcomes 4. Overall, the management of stroke patients in the chronic phase requires a comprehensive and multidisciplinary approach, with a focus on optimizing function, preventing complications, and improving quality of life.