Outcome After Mobilization Within 24 Hours of Acute Stroke

Abstract

Background and Purpose-Very early mobilization (VEM) is considered to contribute to the beneficial effects of stroke units, but there are uncertainties regarding the optimal time to start mobilization. We hypothesized that VEM within 24 hours after admittance to the hospital would reduce poor outcome 3 months poststroke compared with mobilization between 24 and 48 hours. Methods-We conducted a prospective, randomized, controlled trial with blinded assessment at follow-up. Patients admitted to the stroke unit within 24 hours after stroke were assigned to either VEM within 24 hours of admittance or mobilization between 24 and 48 hours (control group). Primary outcome was the proportion of poor outcome (modified Rankin scale score, 3-6), whereas secondary outcomes were death rate, change in neurological impairment (National Institutes of Health Stroke Scale score), and dependency (Barthel Index 0 -17). Results-Fifty-six patients were included (mean ageϮSD, 76.9Ϯ9.4 years), 27 were in the VEM group and 29 were in the control group. VEM patients had nonsignificant higher odds (adjusted for age and National Institutes of Health Stroke Scale score on admission) of poor outcome (OR, 2.70; 95% CI, 0.78 -9.34; Pϭ0.12), death (OR, 5.26; 95% CI, Pϭ0.08), and dependency (OR, 1.25; 95% CI, 0.36 -4.34; Pϭ0.73). The control group, having milder strokes (National Institutes of Health Stroke Scale scoreϮSD: control group, 7.5Ϯ4.2; VEM, 9.2Ϯ6.5; Pϭ0.26), had better neurological improvement (Pϭ0.02). Conclusions-We identified a trend toward increased poor outcome, death rate, and dependency among patients mobilized within 24 hours after hospitalization, and an improvement in neurological functioning in favor of patients mobilized between 24 and 48 hours. Very early or delayed mobilization after acute stroke is still undergoing debate, and results from ongoing larger trials are required.

A Very Early Rehabilitation Trial after stroke (AVERT): a Phase III, multicentre, randomised controlled trial

“…[25][26][27][28] A favourable outcome for the VEM group was also observed in a similar pilot trial in the UK 27 and in an individual-patient meta-analysis of two small EM trials. 28 However, a non-significant increase in unfavourable outcome was reported in a more recent small Norwegian trial 65 comparing VEM (< 24 hours) versus later mobilisation (> 24 hours). It is not yet clear if the results of the current AVERT are simply providing greater precision around these smaller estimates or if there is some qualitative difference in the nature of the intervention.…”

“…Results are presented as the OR (95% CI) of the early versus delayed mobilisation group. 65 Bernhardt 35 AVERT 31 Chippala 60 Chippala 63 Poletto 61 Herisson 62 T his project met its initial objectives of effectively delivering our VEM protocol with a resulting change in practice. 30 We observed earlier, more frequent and higher dose (amount of) out-of-bed mobility in terms of sitting, standing and walking activity.…”

Efficacy and Safety of Platelet Glycoprotein Receptor Blockade in Aged and Comorbid Mice With Acute Experimental Stroke

“…6 It has been shown that platelet function 21 and outcome in experimental stroke studies depend on age 22,23 and comorbidities. 24 Nevertheless, and despite consensus statements such as the Stroke Treatment Academic …”

The early post-stroke mobilization

“…Sundseth и соавт. [23] провели рандомизиро-ванное исследование, в котором сравнивали эффек-ты мобилизации пациентов в 1-е сутки (27 человек) и на 2-е сутки (29 человек) после инсульта. В группе мобилизации в 1-е сутки после инсульта через 3 мес отмечались худшие исходы (выше летальность и сте-пень инвалидизации), в то же время у пациентов, ко-торые были мобилизированы в течение 2-х суток по-сле инсульта, отмечался меньший неврологический дефицит, однако эти различия не достигли статисти-ческой значимости.…”

“…В группе мобилизации в 1-е сутки после инсульта через 3 мес отмечались худшие исходы (выше летальность и сте-пень инвалидизации), в то же время у пациентов, ко-торые были мобилизированы в течение 2-х суток по-сле инсульта, отмечался меньший неврологический дефицит, однако эти различия не достигли статисти-ческой значимости. Авторы подчеркивают, что не-большое число пациентов в исследовании не позво-ляет делать однозначных выводов по полученным результатам [23]. Анализ факторов, которые могли бы объяснить лучшие исходы в когорте пациентов, не выявил какой-либо конкретный фактор [24].…”