Scientific basis and active ingredients of current therapeutic interventions for stroke rehabilitation

BACKGROUND: Despite tremendous advances in the treatment and management of stroke, restoring motor and functional outcomes after stroke continues to be a major clinical challenge. Given the wide range of approaches used in motor rehabilitation, several commentaries have highlighted the lack of a clear scientific basis for different interventions as one critical factor that has led to suboptimal study outcomes. OBJECTIVE: To understand the content of current therapeutic interventions in terms of their active ingredients. METHODS: We conducted an analysis of randomized controlled trials in stroke rehabilitation over a 2-year period from 2019-2020. RESULTS: There were three primary findings: (i) consistent with prior reports, most studies did not provide an explicit rationale for why the treatment would be expected to work, (ii) most therapeutic interventions mentioned multiple active ingredients and there was not a close correspondence between the active ingredients mentioned versus the active ingredients measured in the study, and (iii) multimodal approaches that involved more than one therapeutic approach tended to be combined in an ad-hoc fashion, indicating the lack of a targeted approach. CONCLUSION: These results highlight the need for strengthening cross-disciplinary connections between basic science and clinical studies, and the need for structured development and testing of therapeutic approaches to find more effective treatment interventions.