Table 1. Summary of recommendations (See Supplementary Data 1 for a summary in Korean).
| KQ | Division | Recommendation | LoE | LoR |
|---|---|---|---|---|
| KQ 1. Early mobilization | Update | 1-1. Early mobilization is recommended within 24–48 hours of stroke onset as it improves functional independence and walking ability in stroke patients, unless contraindicated. | Low | A |
| 1-2. Selective consideration is given to very early mobilization within 24 hours of stroke onset. | High | B | ||
| *Early mobilization: Out-of-bed activities such as sitting, standing, and walking performed during the acute phase of stroke | ||||
| KQ 2. Total amount | Update | 2. It is recommended to increase the total amount of exercise therapy, considering the patient's neurological and medical status, to improve activities of daily living and motor function in stroke patients. | Low | B |
| KQ 3. Exercise therapy method | Update | 3. As there is no superior exercise therapy method among various methods that have the effect of improving motor function, such as exercise relearning, neurophysiological approach, and biomechanical approach, it is recommended to apply them individually in combination according to the patient’s condition. | Moderate | A |
| KQ 4. Task-specific training | Update | 4-1. Task-specific training is recommended for the improvement of upper limb function. | Low | A |
| 4-2. Task-specific training is recommended for the improvement of lower limb function. | Moderate | A | ||
| KQ 5. Progressive resistance training | Update | 5-1. For stroke patients with upper limb weakness, progressive resistance training of the upper limb is recommended for improving upper limb strength, motor function, and activities of daily living, compared to not receiving rehabilitation therapy. | Very low | A |
| 5-2. For stroke patients with upper limb weakness, there is no significant difference in improving upper limb strength, motor function, and activities of daily living between progressive resistance training of the upper limb and other rehabilitation methods. Therefore, it is considered to apply depending on the patient's condition. | Low | B | ||
| 5-3. For stroke patients with lower limb weakness, progressive resistance training of the lower limb is recommended for improving lower limb strength and motor function, compared to not receiving rehabilitation therapy. | Moderate | A | ||
| 5-4. For stroke patients with lower limb weakness, there is no significant difference in improving lower limb strength and motor function between progressive resistance training of the lower limb and other rehabilitation methods, so it is recommended depending on the patient's condition. | Low | B | ||
| KQ 6. Aerobic exercise | Update | 6-1. Regular aerobic exercise, considering appropriate medical evaluation and functional limitations due to concurrent diseases, is recommended for stroke patients as it has a positive effect on cardiorespiratory function, motor function, disability improvement, and quality of life. | Moderate | A |
| 6-2. High intensity interval training (HIIT) in chronic stroke patients can have positive effects on the recovery of cardiovascular and motor function, so it is recommended with appropriate medical evaluation and consideration of coexisting conditions and functional limitations. | Moderate | B | ||
| 6-3. Educating home-returning stroke patients on aerobic exercise, considering comorbidities and functional limitations as well as accessibility, and providing community-based long-term intervention may help improve their exercise capacity, so it is recommended depending on the patient’s condition. | Moderate | B | ||
| KQ 7. Treadmill exercise | Update | 7-1. In stroke patients, gait training in a treadmill is recommended over no intervention, as it is more effective in improving walking function. | High | A |
| 7-2. Compared to conventional therapy, it cannot be said that gait training in a treadmill is superior in improving walking function, so it should be applied selectively. | High | B | ||
| KQ 8. Functional electrical stimulation | Update | 8-1. Functional electrical stimulation therapy is recommended for improving upper limb function and performing daily activities in stroke patients. | High | A |
| 8-2. Functional electrical stimulation therapy is recommended for improving lower limb function. | High | A | ||
| 8-3. Functional electrical stimulation therapy is recommended for improving shoulder joint subluxation. | High | A | ||
| KQ 9. Ankle-foot orthosis | Update | 9-1. In stroke patients with foot drop, considering the use of an ankle-foot orthosis is recommended, as it improves walking. | Moderate | B |
| 9-2. Regarding whether ankle-foot orthosis or functional electrical stimulation therapy is more effective in improving walking in stroke patients with foot drop, no method can be said to be superior, so they should be applied selectively according to the patient's condition. | Moderate | B | ||
| In this statement, functional electrical stimulation therapy, compared to ankle-foot orthosis, is limited to a treatment method that uses electrical stimulation to prevent foot drop in accordance with the walking cycle. | ||||
| KQ 10. Repetitive transcranial magnetic stimulation | Update | 10-1. Adding repetitive transcranial magnetic stimulation to rehabilitation therapy in stroke patients has a positive effect on improving upper limb motor function, grip strength, and hand function, so it is recommended depending on the patient's condition. | Low | B |
| 10-2. The evidence for repetitive transcranial magnetic stimulation to improve lower limb function in stroke patients is insufficient, so a recommendation level cannot be determined. | I | |||
| 10-3. Adding repetitive transcranial magnetic stimulation to rehabilitation therapy in stroke patients has a positive effect on improving upper limb spasticity, so it is recommended depending on the patient's condition. | Low | B | ||
| 10-4. The evidence for repetitive transcranial magnetic stimulation to improve lower limb spasticity in stroke patients is insufficient, so a recommendation level cannot be determined. | I | |||
| KQ 11. Robot | Update | 11-1. In stroke patients, when applying machine-assisted training, including upper limb robots, there is an improvement in upper limb function and daily living ability compared to conventional rehabilitation therapy, so it is recommended depending on the patient's condition and the medical institution's circumstances. | High | B |
| 11-2. In stroke patients, when applying machine-assisted training, including lower limb robots, there is an improvement in balance ability compared to conventional rehabilitation therapy, so it is recommended depending on the patient's condition and the medical institution's circumstances. | High | B | ||
| KQ 12. Virtual reality | Update | 12-1. Virtual reality therapy for stroke patients is more effective in improving upper limb motor function compared to conventional rehabilitation therapy, but it can have side effects, so it is recommended depending on the patient’s condition. | Low | B |
| 12-2. Virtual reality therapy for stroke patients is effective in improving balance compared to conventional rehabilitation therapy, but it can have side effects. | Low | B | ||
| KQ 13. Transcranial direct current stimulation | Update | 13-1. Transcranial direct current stimulation can have a positive effect on improving upper limb motor/function in stroke patients, and it is recommended in conjunction with rehabilitation therapy considering the patient’s condition. | High | B |
| 13-2. Transcranial direct current stimulation can have a positive effect on improving the ability to perform daily life activities in stroke patients, and it is recommended in conjunction with rehabilitation therapy considering the patient’s condition. | Moderate | B | ||
| KQ 14. Individualized exercise and functional task training | Update | 14-1. Individualized exercise and functional task training are recommended to improve upper limb motor function in stroke patients. | Moderate | A |
| 14-2. Individualized exercise and functional task training are recommended to improve the ability to perform daily life activities in stroke patients. | Low | B | ||
| KQ 15. Constraint induced movement therapy | Update | 15-1. In stroke patients with hemiparesis, if constraint-induced movement therapy (CIMT) is deemed feasible given the affected upper extremity strength, CIMT is recommended to improve upper limb motor function and daily life activity performance. | Moderate | A |
| KQ 16. Mirror therapy | Update | 16-1. Mirror therapy can have a positive effect on the recovery of upper limb motor function and the ability to perform daily life activities in stroke patients, and it is recommended in conjunction with other rehabilitation therapies depending on the patient's condition. | Low | B |
| 16-2. Mirror therapy can have a positive effect on the recovery of lower limb function in stroke patients, it is recommended in conjunction with other rehabilitation therapies depending on the patient's condition. | Moderate | B | ||
| KQ 17. Motor imagery training | Update | 17-1. To enhance the recovery of upper limb motor function after a stroke, motor imagery training is recommended in addition to rehabilitation using actual movements, but it can be selectively applied depending on the patient's condition. | Moderate | B |
| 17-2. To enhance the recovery of upper limb function after a stroke, motor imagery training is recommended in addition to rehabilitation using actual movements, but it can be selectively applied depending on the patient's condition. | Moderate | B | ||
| 17-3. To improve the ability to perform daily life activities after stroke, motor imagery training is recommended in addition to rehabilitation using actual movements, but it can be selectively applied depending on the patient's condition. | Moderate | B | ||
| KQ 18. Balance training | Update | 18. Balance training is recommended for stroke patients with impaired balance, as it can improve balance, gait, and reduce the risk of falls. | Moderate | A |
| KQ 19. Balance training method | Update | 19. Recommended effective balance training methods include trunk training/sitting balance training, task-specific training, and biofeedback using force plates. | Moderate | B |
| KQ 20. Medication for motor recovery | Update | 20-1. Serotonergic agents and Cerebrolysin is recommended for improving motor function in stroke patients, depending on the patient's condition and risk of side effects. | Very low | B |
| 20-2. Additional research is needed to establish the efficacy of dopamine agonists in improving motor function in stroke patients. | I | |||
| KQ 21. Spasticity prevention | Update | 21-1. Proper posture, joint exercises, and stretching are recommended for preventing and treating stiffness in stroke patients. | Expert Consensus | |
| 21-2. Foot braces are recommended when lying down or standing to prevent foot contracture in stroke patients. | Expert Consensus | |||
| KQ 22. Botulinum toxin | Update | 22-1. Botulinum toxin injections are recommended for reducing spasticity in stroke patients. | High | A |
| 22-2. It is recommended to perform splinting or casting in conjunction with botulinum toxin injection therapy for the treatment of contracture in stroke patients, as there are reports that this helps improve contracture due to spasticity. | Very low | B | ||
| KQ 23. Medication for spasticity | Update | 23-1. Oral administration of tizanidine (LoE: Low), baclofen (LoE: Very low), and dantrolene (LoE: Low) are recommended because they improve clinical muscle tone with a low risk of serious adverse events (LoE: Low). | Low | B |
| Very low | ||||
| Low | ||||
| 23-2. Benzodiazepines such as diazepam should not be orally administered for controlling spasticity in stroke patients during the recovery phase, except when specifically needed, due to their negative impact on functional recovery. | Low | C | ||
| KQ 24. Intrathecal baclofen | New | 24. Intrathecal baclofen infusion is recommended for the treatment of severe spasticity that does not respond to conventional spasticity therapy. | Moderate | B |
KQ, key question; LoE, level of evidence; LoR, level of recommendation.
*LoR A: strong for recommend; LoR B: conditional for recommend; LoR C: conditional against recommend; LoR D: strong against recommend; LoR I: inconclusive.