Efficacy and Safety of Very Early Mobilization in Patients with Acute Stroke: A Systematic Review and Meta-analysis

Abstract

Whether very early mobilization (VEM) improves outcomes in stroke patients and reduces immobilization-related complications (IRCs) is currently unknown. The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of VEM in acute stroke patients following admission. Medline, Embase, and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) that examined the efficacy or safety of VEM in patients with acute stroke. VEM was defined as out of bed activity commencing within 24 or 48 hours after the onset of stroke. A total of 9 RCTs with 2,803 participants were included. Upon analysis, VEM was not associated with favorable functional outcomes (modified Ranking Scale: 0–2) at 3 months [relative risk (RR): 0.96; 95% confidence interval (CI): 0.86–1.06]; VEM did not reduce the risk of IRCs during follow up. With respect to safety outcomes, VEM was not associated with a higher risk of death (RR: 1.04; 95% CI: 0.52–2.09) and did not increase the risk of neurological deterioration or incidence of falls with injury. In conclusion, pooled data from RCTs concluded that VEM is not associated with beneficial effects when carried out in patients 24 or 48 hours after the onset of a stroke.

Heart Rate Variability During Early Mobilization in Patients with Acute Ischemic Stroke

“…EM is also reported to improve self-care ability or promote early discharge in post-stroke patients [10]. As a result, recent systematic reviews have showed that EM is inconsistently associated with recovery from stroke [11,12]. To clarify these inconsistent results, a subgroup analysis for determining the characteristics associated with ND or worse outcome was conducted [8].…”

Mobilisasi Dini Dan Pembelajaran Motorik Pada Pasien Stroke (Sebuah Kajian Pustaka)

“…RCT, sebanyak 5 studi mengikutsertakan pasien dengan berbagai macam tipe stroke, 3 studi dengan stroke iskemik, dan 1 studi dengan stroke perdarahan (Xu et al, 2017 (Olkowski & Shah, 2017). (Olkowski & Shah, 2017).…”

“…VEM cenderung aman dan tidak berhubungan dengan risiko yang lebih tinggi dalam kematian dan tidak meningkatkan risiko perburukan neurologis, serta kejadian jatuh pada stroke. Sebagai simpulan VEM tidak berhubungan dengan efek yang bermanfaat ketika dilakukan pada pasien 24 -48 jam pasca onset (Xu et al, 2017)…”

Mobilisasi Dini Pada Stroke Fase Akut: Review Literatur

“…VEM tidak meningkatkan risiko kematian dan kerusakan neurologis, serta tidak meningkatkan resiko jatuh dengan cedera selama mobilisasi. 10 Alain P. Yelnik dkk pada tahun 2016 melakukan penelitian multicenter uji coba terkontrol acak Active Mobility Very Early After Stroke yang dilakukan pada 103 pasien stroke dengan melakukan mobilisasi dini pada 25 -72 jam pertama disertai latihan fisik intensif tidak terbukti efisien dalam meningkatkan kontrol motorik. 7 Penelitian lain membahas mengenai late mobilization, Mohammad Usman Khan dkk pada tahun 2014 melakukan penelitian cross sectional pada 100 orang pasien dari 3 rumah sakit di Karachi -Pakistan.…”