Very early rehabilitation or intensive telemetry after stroke: a pilot randomised trial.
BACKGROUND
Stroke patients are more likely to make a good recovery if they receive care in a well-organised stroke unit. However, there are uncertainties about how best to provide such care. We studied 2 key aspects of early stroke unit care: early active mobilisation (EM) and automated monitoring (AM) for physiological complications such as hypoxia.


METHODS
This was an observer-blinded, factorial (2 x 2) pilot randomised controlled trial recruiting stroke patients within 36 h of symptom onset. The patients were randomised to 1 of 4 nurse-led treatment protocols: (a) standard stroke unit care, (b) EM, (c) AM or (d) combined EM and AM. The primary outcome was the Rankin score at 3 months. We also report the data on feasibility and safety.


RESULTS
We randomised 32 patients (mean age = 65 years; mean baseline modified NIH score = 6). On unadjusted comparisons, the EM patients were significantly (p < 0.05) more likely to mobilise very early (within 1 h of randomisation) and to achieve walking by day 5 and were less likely to develop complications of immobility. The AM group was significantly (p < 0.05) more likely to have pre-defined physiological complication events detected. All these associations remained, but were less statistically significant, after correcting for age, baseline NIH score and co-interventions. There were no significant safety concerns.


CONCLUSIONS
We have demonstrated the feasibility of implementing EM and AM for physiological complications in a randomised controlled trial. Larger trials are warranted to determine whether these interventions have clinical benefits.
Academic Section of Geriatric Medicine, University of Glasgow, Glasgow, UK. p.langhorne @ clinmed.gla.ac.uk
Peter
P
Langhorne
David
D
Stott
Anne
A
Knight
Julie
J
Bernhardt
David
D
Barer
Caroline
C
Watkins
D000368:Aged; D001331:Automation; D005240:Feasibility Studies; D005260:Female; D006757:Hospital Units; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods*; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D020127:Recovery of Function; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke / Q000451:nursing; D000071939:Stroke Rehabilitation; D013686:Telemetry; D013997:Time Factors; D016138:Walking