{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:54:10Z","timestamp":1789433650480,"version":"build-2803163510"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Rehabil. Sci."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To determine whether increased rehabilitation duration improved upper-limb outcomes in people with subacute and chronic stroke. Where possible, we explored evidence for dose-response relationship or a ceiling effect for recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was conducted by searching Medline, EMBASE, EMCARE and PsycInfo. Randomised trials delivering the same type of upper-limb rehabilitation, but with a\u2009&amp;gt;\u200950% greater duration in one group (high dose) compared to another (low dose) were included. Risk of bias was assessed using the Cochrane risk of bias tool. Certainty of evidence was assessed using GRADE. Meta-analyses explored effects of increased rehabilitation duration and subgroup analyses explored a 50%\u2013100%, 100%\u2013150% and \u2265200% increases in dose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four studies (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009151) were included. Fugl-Meyer Assessment data were available from a single multi-arm trial, from which two intervention-control comparisons were derived based on therapy dose (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200925), demonstrating greater rehabilitation duration led to improvement (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009). Meta-analyses including three studies (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200989) found and a non-significant effect on the Action Research Arm Test (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.266), both with a low certainty of evidence. Subgroup analyses showed that smaller dose increases (50%\u2013150%) had limited benefits but doses \u2265200% led to significant improvements in upper-limb function on the Action Research Arm Test (MD\u2009=\u200913.86, 95% CI: 3.43 to 24.29;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Greater rehabilitation duration can lead to better upper-limb outcomes; however, an increase of at least 200% in duration might be required.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>PROSPERO CRD42024604104.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fresc.2026.1753677","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T06:32:36Z","timestamp":1772433156000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Does more rehabilitation lead to better upper limb outcomes after stroke? A systematic review"],"prefix":"10.3389","volume":"7","author":[{"given":"Manush","family":"Patel","sequence":"first","affiliation":[{"name":"Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, College of Health, Adelaide University","place":["Adelaide, SA, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"Serrada","sequence":"additional","affiliation":[{"name":"Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, College of Health, Adelaide University","place":["Adelaide, SA, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenton","family":"Hordacre","sequence":"additional","affiliation":[{"name":"Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, College of Health, Adelaide University","place":["Adelaide, SA, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/S1474-4422(24)00369-7","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132021: a systematic analysis for the global burden of disease study 2021","volume":"23","author":"Feigin","year":"2024","journal-title":"Lancet Neurol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1186\/s12916-019-1397-3","article-title":"Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: an ecological analysis from the global burden of disease study 2017","volume":"17","author":"Avan","year":"2019","journal-title":"BMC Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"3059","DOI":"10.1080\/09638288.2022.2120097","article-title":"Stroke survivors\u2019 views on their priorities for upper-limb recovery and the availability of therapy services after stroke: a longitudinal, phenomenological study","volume":"45","author":"Purton","year":"2023","journal-title":"Disabil Rehabil"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1781","DOI":"10.1212\/WNL.0b013e318270401d","article-title":"Age at stroke","volume":"79","author":"Kissela","year":"2012","journal-title":"Neurology"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.736684","article-title":"Dependency in activities of daily living during the first year after stroke","volume":"12","author":"Wurzinger","year":"2021","journal-title":"Front Neurol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.jht.2024.08.005","article-title":"Exploring the reasons behind the low focus on upper limb rehabilitation in the early stages after a stroke: a qualitative study","volume":"38","author":"Wodu","year":"2025","journal-title":"J Hand Ther"},{"key":"B7","doi-asserted-by":"publisher","first-page":"431","DOI":"10.3233\/NRE-161374","article-title":"What is current practice for upper limb rehabilitation in the acute hospital setting following stroke? 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