Post-thrombectomy rehabilitation strategies and 90-day outcomes in acute ischemic stroke patients enrolled in randomized controlled trials: A systematic review and meta-analysis.

Abstract

BackgroundThe post-thrombectomy recovery phase has significant influence on long-term patient outcomes. Our study aims to explore the effect of post-thrombectomy rehabilitation strategies on modified Rankin Scale (mRS) at 90-day.MethodsA search of PubMed, Scopus, Web of Science, ClinicalTrials.gov, and the Cochrane Library from inception to April 2024. Randomized controlled trials (RCTs) were included and assessed for quality using the Cochrane risk of bias tool. The rehabilitation strategies were divided into three groups: as per institutional care, as per national guideline, or not specified. We performed meta-regression to identify the association between rehabilitation strategy used and 90-day outcome defined using mRS.Results23 RCTs were included with 6649 patients (mean age 67 and 26% of patients were men). Rehabilitation "as per institutional care" was the most common (52%, 95% confidence interval (CI):31%-72%), followed by "as per national guidelines" (17%, 95% CI:5%-39%). We found statistically significant variations in proportions of rehabilitation strategies (F(2,97) = 0.035, p = 0.01). A two-proportion z-test indicated a borderline significant difference between "as per institutional care" (52%) and "as per national guidelines" (17%) (χ²(1) = 3.52, p = 0.06). In meta-regression, rehabilitation strategies used in the RCT significantly influenced the proportion of patients enrolled in the RCT who achieved mRS 0-2 at 90 days post-thrombectomy (QM (df = 1) = 5.06, p = 0.025). Trials using rehabilitation "as per institutional care" (log odds ratio (OR) = 0.64, 95% CI [0.42, 0.87], p < 0.01) and those using rehabilitation "as per national guidelines" (log odds ratio = 0.58, 95% CI [0.07-1.08], p = 0.02) were associated with statistical significantly higher odds of having higher proportion of patients with mRS 0-2 at 90 days.ConclusionsThere is variation in rehabilitation strategies utilized post-thrombectomy which influences functional outcomes at 90 days. Rehabilitation protocols should be standardized in RCTs evaluating thrombectomy in acute ischemic stroke patients.