Over the past two decades, neurorehabilitative research has conducted numerous randomised, multicentre studies on specific therapy methods. While some studies showed significant successes, particularly in regaining walking ability after a stroke, others could not demonstrate a clear superiority of new interventions compared to standard therapies. Previous and current issues of THERAPY also reported on this. The following essay summarises the author’s fundamental thoughts on this subject.

The “negative” finding – no reason for nihilism but a catalyst for precision

That a therapeutic intervention shows no signi­fi­­cant effect in a large, ethically well-founded study is often hastily judged a “failure”. Such suppo­sedly “negative” findings can make a valuable contribution to the acquisition of know­ledge: they illustrate that a clear objective and an appropriate classification of underlying principles of interventions are key. If, for example, a specific ability such as walking speed, endurance or everyday competence is to be improved, training methods and con­tent must have this specific focus and be carried out with sufficient intensity. Nega­tive study results do not signal a failure of neurorehabilitation, but rather indicate po­tential for optimisation. They call for a more precise definition of dose-response relationships, target criteria and stronger integration of interventions into everyday care. Thus, seemingly sobering findings also contribute to the further develop­ment of more effective therapeutic approaches.

From lab to life

The clinic remains essential for diagnosis, therapy and monitoring, but limited time and staff resources make flexible, individually tailored neurorehabilitation difficult. The shift of therapeutic measures to the domestic and community-based setting is therefore becoming increasingly important. Patients can practise movement sequences in familiar surroundings – while shopping, walking or climbing the stairs at home. This enables sustainable training that can be better adapted to daily life, personal needs, rhythms and preferences.

Another advantage is that it reinforces personal responsibility and self-efficacy. If pa­tients can integrate and adapt their training to their daily lives, this often motivates them to continue their rehabilitation. Digital techno­logies and therapeutic aids help them to share data with their healthcare teams, document progress and receive targeted feedback – all without face-to-face appointments.

The combination of inpatient therapy and lifeoriented rehabilitation creates a flexible, forward-looking model that better combines intensity, continuity and individualisation in neuroreha­bilitation. Developing tailored con­cepts that optimise the benefits of both approaches is critical.

Conclusion: no reason for resignation

Large-scale studies with no clinically relevant difference do not show the limitations of re­ha­bilitation research, but emphasise the impor­tance of dose-response relationships, target specification and environmental factors – in theory and practice. Technological innovations and combination therapies offer opportunities to increase effectiveness, while individual support sustainably improves everyday walking ability and quality of life.

In this way, a supposedly “negative” picture of the current body of evidence once again proves to be an impetus for new perspectives and innovative approaches. The challenge is to specify interventions with a view to different target groups and contexts, to make sensible use of larger data pools and to promote close inte­gration of research and everyday clinical practice. This is the key to advancing rehabilitation research – and to sustainably strengthening the partici­pation and autonomy of people after a stroke.