Comparative analysis of early versus delayed physiotherapy on post-stroke recovery outcomes

Thesis Abstract

Stroke remains a leading cause of long-term disability worldwide, with rehabilitation strategies playing a crucial role in optimizing functional recovery. Among these strategies, the timing of initiating physiotherapy post-stroke has generated considerable clinical debate, yet empirical evidence comparing early versus delayed intervention remains limited and inconsistent. This study aims to conduct a comprehensive comparative analysis of the effects of early versus delayed physiotherapy on post-stroke motor recovery and functional independence, seeking to provide evidence-based guidance for rehabilitation practices. Specific objectives include (1) evaluating the differential impact of early versus delayed physiotherapy on motor function outcomes; (2) examining the influence of intervention timing on activities of daily living (ADL) performance; and (3) identifying patient-related factors that moderate recovery trajectories in both intervention groups. The research adopts a prospective, parallel-group, quantitative design guided by the biopsychosocial model of stroke recovery and underpinned by the Neuroplasticity Theory, which posits that early interventions may capitalize on heightened neuroplasticity in the acute phase. The study’s population comprises 120 adult stroke patients admitted consecutively to a tertiary rehabilitation center within 72 hours of stroke onset, with 60 allocated to the early physiotherapy group (initiated within 24 hours) and 60 to the delayed group (initiated after 7 days). Participants are selected through purposive sampling based on inclusion criteria such as first-ever ischemic or hemorrhagic stroke, Hemiplegia, and absence of comorbid conditions that could confound recovery. Data collection involves standardized instruments, including the Fugl-Meyer Assessment for motor functioning, the Barthel Index for ADL independence, and the Stroke Impact Scale for quality of life, administered at baseline, mid-intervention, and at three months follow-up. Validity and reliability of these instruments are ensured through pilot testing and calibration. Data analysis employs descriptive statistics to profile the sample, while inferential analyses include repeated measures ANOVA to assess within- and between-group differences over time, as well as multiple regression analysis to identify predictors of recovery. Mediation and moderation analyses are conducted using PROCESS macro to explore the influence of demographic and clinical factors on outcomes. It is anticipated that the findings will demonstrate statistically significant superior motor recovery and functional independence in the early physiotherapy group relative to the delayed group at all follow-up points. The results are expected to reveal that early initiation of physiotherapy accelerates neuroplastic changes, thus facilitating more complete and faster recovery, consistent with the Neuroplasticity Theory. Furthermore, the analysis may identify age, stroke severity, and baseline functional status as moderating variables influencing recovery trajectories. The comparative insights will contribute to advancing the evidence base on optimal rehabilitation timing, filling gaps identified in prior literature which has produced mixed findings and inconsistent methodologies. This study makes a significant contribution to the body of knowledge by providing rigorous, contextually relevant evidence supporting early physiotherapy implementation. It informs clinical protocols, policy-making, and resource allocation aimed at maximizing functional outcomes post-stroke. The main conclusion emphasizes that initiating physiotherapy within the first 24 hours post-stroke yields superior recovery outcomes compared to delayed treatment, advocating for hospital-based policy revisions to prioritize immediate rehabilitation. Recommendations include the adoption of standardized early intervention protocols, training of multidisciplinary teams in early mobilization practices, and further research exploring long-term outcomes beyond three months. Additionally, future investigations should consider larger, multicenter samples and qualitative assessments of patient experiences to deepen understanding of barriers and facilitators to early rehabilitation.