Outcome after mobilization within 24 hours of acute stroke: a randomized controlled trial.
OBJECTIVE
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 age±SD, 76.9±9.4 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; P=0.12), death (OR, 5.26; 95% CI, 0.84-32.88; P=0.08), and dependency (OR, 1.25; 95% CI, 0.36-4.34; P=0.73). The control group, having milder strokes (National Institutes of Health Stroke Scale score±SD: control group, 7.5±4.2; VEM, 9.2±6.5; P=0.26), had better neurological improvement (P=0.02).


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.
Department of Neurology, Medical Division, Akershus University Hospital, N-1478 Lørenskog, Norway. antje.sundseth@medisin.uio.no
Antje
A
Sundseth
Bente
B
Thommessen
Ole Morten
OM
Rønning
D000368:Aged; D003627:Data Interpretation, Statistical; D004434:Early Ambulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012307:Risk Factors; D018401:Sample Size; D020521:Stroke / Q000145:classification / Q000523:psychology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome