Early Rehabilitation Interventions for Neurological Function Recovery in Patients with Acute Cerebral Infarction: A Meta-Analysis

Summary

This protocol outlines a reproducible method for conducting a meta-analysis of predominantly East Asian studies to evaluate the efficacy of early rehabilitation interventions on neurological recovery in patients with acute cerebral infarction.

Abstract

Acute cerebral infarction causes substantial neurological disability, and the efficacy of early rehabilitation-based interventions remains uncertain. This meta-analysis evaluated their effects on neurological recovery. PubMed, Cochrane Library, Embase, Web of Science, and China National Knowledge Infrastructure were searched for randomized controlled trials comparing early rehabilitation-based interventions with standard care. Random-effects models with restricted maximum likelihood and Hartung-Knapp adjustment were applied, and risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Eight randomized controlled trials (RCTs) involving 711 patients were included in the primary analysis after exclusion of one non-RCT evaluating pharmacological reperfusion therapy without a rehabilitation component. Early rehabilitation showed a non-significant trend toward improved National Institutes of Health Stroke Scale scores (SMD: -2.75; 95% CI: -5.94 to 0.45; I² = 95.5%; τ² = 3.84), with a wide 95% prediction interval (-9.74 to 4.25). Cognitive outcomes also showed a non-significant trend favoring intervention (SMD: -0.89; 95% CI: -1.87 to 0.09). Although early rehabilitation may support neurological recovery, marked clinical heterogeneity, selective reporting concerns, and the predominantly East Asian evidence base limit confidence and generalizability. Larger, methodologically rigorous trials with standardized intervention reporting are needed.

Introduction

Acute cerebral infarction, commonly known as ischemic stroke, represents a significant global health challenge, accounting for approximately 87% of all stroke cases worldwide1. This condition occurs when blood flow to a specific region of the brain is obstructed, leading to rapid neuronal death and potentially severe neurological deficits2. With an estimated 13.7 million new stroke cases occurring annually, the burden on public health and socioeconomic structures is substantial3.

Over the past few decades, the management of acute cerebral infarction has undergone considerable evolution, shifting from purely acute medical interventions towar....

Protocol

This study is not subject to ethical review and participant consent.

1. Literature search strategy

1. Access the following electronic databases: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Web of Science Core Collection, and China National Knowledge Infrastructure (CNKI).
2. In PubMed, construct the search strategy by combining three blocks of terms using the Boolean operator AND.
3. For the intervention block, enter the following search string in the PubMed Advanced Search Builder: (‘Early rehabilitation’ OR ‘Early mobilization’ OR ‘Early ambu....

Results

The comprehensive literature search initially identified 528 potentially relevant records across the five databases: PubMed (n = 74), Cochrane Library (n = 57), Embase (n = 12), Web of Science (n = 20), and CNKI (n = 365). After removing duplicates, 274 unique records remained for screening. Following title and abstract review, 186 records were excluded for not meeting initial screening criteria. Of the remaining 88 records screened at the abstract level, 69 were excluded for various reasons, including inappropriate stud.......

Discussion

This meta-analysis evaluated the efficacy of early rehabilitation-based interventions on neurological function recovery in patients with acute cerebral infarction. The comprehensive analysis of 8 RCTs (primary synthesis) encompassing 711 participants provides important insights into both the potential benefits and the substantial challenges in synthesizing evidence in this field. The primary analysis using REML estimation with HK adjustment revealed a trend toward improvement in NIHSS scores with early rehabilitation-bas.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
CNKI	Tsinghua Univ./CNKI	https://www.cnki.net/
Cochrane Library	Cochrane Collaboration	https://www.cochranelibrary.com/
Cochrane RoB 2 tool	Cochrane Collaboration	https://www.riskofbias.info/
Covidence	Veritas Health Innovation	https://www.covidence.org/
Embase	Elsevier	https://www.embase.com/
Google Scholar	Google LLC	https://scholar.google.com/
meta R package	CRAN	https://cran.r-project.org/package=meta
metafor R package	CRAN	https://cran.r-project.org/package=metafor
Microsoft Excel	Microsoft Corporation	https://www.microsoft.com/excel
PubMed/MEDLINE	National Library of Medicine	https://pubmed.ncbi.nlm.nih.gov/
R software (version 4.3.1+)	R Foundation	https://www.r-project.org/
robvis R package	CRAN	https://cran.r-project.org/package=robvis
Web of Science	Clarivate Analytics	https://www.webofscience.com/