Feng Chen, Yanjie Yin, Baiyuan Min
Acute cerebral infarction causes substantial neurological disability, and the efficacy of early rehabilitation-based interventions remains uncertain. This meta-analysis evaluated their effects on neurological recovery. PubMed, Cochrane Library, Embase, Web of Science, and China National Knowledge Infrastructure were searched for randomized controlled trials comparing early rehabilitation-based interventions with standard care. Random-effects models with restricted maximum likelihood and Hartung-Knapp adjustment were applied, and risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Eight randomized controlled trials (RCTs) involving 711 patients were included in the primary analysis after exclusion of one non-RCT evaluating pharmacological reperfusion therapy without a rehabilitation component. Early rehabilitation showed a non-significant trend toward improved National Institutes of Health Stroke Scale scores (SMD: -2.75; 95% CI: -5.94 to 0.45; I2 = 95.5%; τ2 = 3.84), with a wide 95% prediction interval (-9.74 to 4.25). Cognitive outcomes also showed a non-significant trend favoring intervention (SMD: -0.89; 95% CI: -1.87 to 0.09). Although early rehabilitation may support neurological recovery, marked clinical heterogeneity, selective reporting concerns, and the predominantly East Asian evidence base limit confidence and generalizability. Larger, methodologically rigorous trials with standardized intervention reporting are needed.