Early mobilisation post-stroke: a systematic review and meta-analysis of individual participant data

Bad conclusion. I see nothing here that showed that any objective damage diagnosis was done.  And with no damage diagnosis putting the blame on early mobilization is incorrect.

Early mobilisation post-stroke: a systematic review and meta-analysis of individual participant data

Venesha Rethnam , Peter Langhorne , Leonid Churilov , Kathryn S. Hayward , Fanny Herisson , Simone R. Poletto , show all

Received 07 May 2020, Accepted 25 Jun 2020, Published online: 16 Jul 2020

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• https://doi.org/10.1080/09638288.2020.1789229
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Abstract

Purpose

To investigate the safety and efficacy of early mobilisation (EM) compared to usual care by meta-analysing individual participant data (IPD).

Materials and methods

IPD were sought from randomised controlled trials comparing out-of-bed mobilisation starting within 48 h from stroke onset to usual care for acute stroke patients. Six trials were sourced from a recent Cochrane review. Favourable outcome (modified Rankin Scale 0–2) and death at 3 months post-stroke were compared between both groups using mixed-effect logistic regression modelling. Adjusted odds ratios (aORs) with respective 95% confidence intervals (95%CI) were reported.

Results

Out of 2630 participants, 1437 (54.6%) were assigned to EM and 1193 (45.4%) to usual care. Intervention protocols varied considerably between trials. The median (interquartile range) delay to starting mobilisation post-stroke onset was 20 h (14.5–23.8) for EM and 23 h (16.7–34.3) for usual care group. Fewer EM participants had a favourable outcome at 3 months post-stroke compared to the usual care group (678 [48%] vs. 611 [52%]; aOR = 0.75, 95%CI: 0.62–0.92, p = 0.005). No difference in death at 3 months post-stroke between EM and usual care was observed (102 [7%] vs. 84 [7%]; aOR = 1.46, 95%CI: 0.92–2.31, p = 0.108).

Conclusion

The commencement of mobilisation should only be considered after 24 h post-stroke.(Why?) Further research is required to identify safe, optimal dose, and timing of EM post-stroke.

• IMPLICATIONS FOR REHABILITATION

• Patients who commenced mobilisation early after stroke had worse outcome than usual care.
• Insufficient detail about mobilisation interventions or usual care in many studies limits any further interpretation.
• The commencement of mobilisation should only be considered after 24-h post-stroke.(Why?)

Keywords: Stroke, mobility, acute, recovery, rehabilitation

Additional information

Funding

V.R. was supported by a Postgraduate Scholarship from NHMRC Centre of Research Excellence in Stroke Recovery and Brain Rehabilitation [1077898]. P.L. was supported by the NIHR Cochrane Incentive Grant. NHMRC of Australia Fellowships supported KSH [1088449] and JB [1154904].

Acknowledgments

We thank all the investigators from the contributing trials for generously sharing their data, and the participants in these trials, their families and the many individuals who provided support. We acknowledge the funding sources for the included trials: AVERT II was supported by the National Heart Foundation of Australia (G 04M 1571), Affinity Health, and Austin Health Medical Research Fund; AVERT III was supported by the National Health and Medical Research Council (NHMRC) of Australia (386201 and 1041401), Chest Heart and Stroke Scotland (Res08/A114), Northern Ireland Chest Heart and Stroke, Singapore Health (SHF/FG401P/2008), UK Stroke Association (TSA2009/09), and UK National Institute of Health Research (HTA Project 12/01/16); Tong et al. was supported by the Beijing Municipal Science Technology Commission (Z151100003915134), National Natural Science Foundation of China (81501141), Science and Technology Project of Beijing Municipal Education Commission (KM201610025028), Beijing NOVA program (xx2016061), and Science and Technology Plan of Beijing Tongzhou District (KJ2017CX043); VERIS-Brazil was supported by the HCPA Research and Event Incentive Fund (FIPE); VERITAS was supported by Chest, Heart and Stroke Scotland and Welch Allyn Inc. The Florey is supported by the Victorian government via the Operational Infrastructure Support Scheme.

Disclosure statement

P.L., F.H., S.R.P., Y.T., and J.B. were lead authors from the included trials. They were not involved in the trial selection and rating processes. No other conflicts of interest were reported by the authors.

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