Authors: (including presenting author): :
Ching PH, Leung HC, Tang LM, Tsui YC
Affiliation: :
Physiotherapy Department, Prince of Wales Hospital
Keyword 1: :
Physiotherapy
Keyword 2: :
Rehabilitation
Keyword 3: :
Acute stroke
Introduction: :
Early mobilisation following acute stroke is advocated to enhance functional recovery and reduce hospital-related complications (Zhang et al., 2021). However, safety of initiating intensive training in the acute stroke patients remains controversial. Recent evidence demonstrates that with careful patient selection and vigilant monitoring, early intensive rehabilitation can be safely implemented to improve functional outcomes (Lou et al., 2024).
Objectives: :
To implement and evaluate the safety and effectiveness of the Early Intensive Physiotherapy Rehabilitation Program for acute stroke patients in the Acute Stroke Unit (ASU) in Prince of Wales Hospital.
Methodology: :
The clinical trial was conducted in the ASU from February to October 2025. Inclusion criteria included functional impairment compared to premorbid status, being medically stable and communicable. Exclusion criteria included unstable hemodynamic or neurological status . Individualized bi-daily rehabilitation was initiated as early as possible after admission with flexible duration based on patient tolerance. Exercises included sessions of strengthening and mobility training as indicated. The program comprised two phases: Phase I (1-2 days post-stroke) conducted at bedside to minimise interruption of intravenous treatment and telemetry monitoring; Phase II (post-stroke day 3 onwards) was conducted at bedside or in a satellite gym with specialized equipment, tailored to patient progress. Blood pressure was regularly measured and maintained within physician-prescribed limits, whereas heart rate and oxygen saturation (SpO2) were continuously monitored before, during and after training. Training was immediately terminated if systolic blood pressure changed ≥20 mmHg. Patients were regularly assessed for subjective symptoms of exertion, or discomfort, with immediate cessation of training if any were reported. A 1:1 patient-to-supervision ratio was maintained during satellite gym training.
Result & Outcome: :
124 patients were recruited, receiving an average of 2.65 bi-daily training sessions before transfer or discharge from the ASU. Notably, no adverse events were reported during any supervised training sessions, demonstrating the effectiveness of safety measures. A statistically significant improvement in weak-side handgrip strength was observed with a mean improvement of +2.74 kg (Wilcoxon Signed-Rank Test, Z = −5.12, p < 0.001). Modified Functional Ambulation Categories (MFAC) also showed statistically significant improvement from admission to discharge (Z = −7.93, p < 0.001). With cautious patient selection and vigilant safety monitoring, intensive stroke rehabilitation can be safely commenced from the early acute phase to optimise patient outcomes.
