title: Early mobilization in ischemic stroke: a pilot randomized trial of safety and feasibility in a public hospital in Brazil.
abstract: BACKGROUND
  The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial.
  
  
  METHODS
  The primary outcomes were time to first mobilization, total duration of mobilization, complications during early mobilization, falls within 3 months, mortality within 3 months, and medical complications of immobility. We included adult patients with CT- or MRI-confirmed ischemic stroke within 48 h of symptom onset who were admitted from March to November 2012 to the acute vascular unit or general emergency unit of a large urban emergency department (ED) at the Hospital de Clínicas de Porto Alegre. The severity of the neurological deficit on admission was assessed by the National Institutes of Health Stroke Scale (NIHSS). The NIHSS and modified Rankin Scale (mRS, functional outcome) scores were assessed on day 14 or at discharge as well as at 3 months. Activities of daily living (ADL) were measured with the modified Barthel Index (mBI) at 3 months.
  
  
  RESULTS
  Thirty-seven patients (mean age 65 years, mean NIHSS score 11) were randomly allocated to an intervention group (IG) or a control group (CG). The IG received earlier (p = 0.001) and more frequent (p < 0.0001) mobilization than the CG. Of the 19 patients in the CG, only 5 (26%) underwent a physical therapy program during hospitalization. No complications (symptomatic hypotension or worsening of neurological symptoms) were observed in association with early mobilization. The rates of complications of immobility (pneumonia, pulmonary embolism, and deep vein thrombosis) and mortality were similar in the two groups. No statistically significant differences in functional independence, disability, or ADL (mBI ≥85) were observed between the groups at the 3-month follow-up.
  
  
  CONCLUSIONS
  This pilot trial conducted at a public hospital in Brazil suggests that early mobilization after acute ischemic stroke is safe and feasible. Despite some challenges and limitations, early mobilization was successfully implemented, even in the setting of a large, complex ED, and without complications. Patients from the IG were mobilized much earlier than controls receiving the standard care provided in most Brazilian hospitals.
authors.affiliation: Hospital de Clínicas de Porto Alegre, Brazil ; Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Simone Rosa
authors.initials: SR
authors.lastname: Poletto
authors.affiliation: Hospital de Clínicas de Porto Alegre, Brazil.
authors.forename: Letícia Costa
authors.initials: LC
authors.lastname: Rebello
authors.affiliation: Hospital de Clínicas de Porto Alegre, Brazil.
authors.forename: Maria Júlia Monteiro
authors.initials: MJ
authors.lastname: Valença
authors.affiliation: Hospital de Clínicas de Porto Alegre, Brazil.
authors.forename: Daniele
authors.initials: D
authors.lastname: Rossato
authors.affiliation: Hospital de Clínicas de Porto Alegre, Brazil ; Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Andrea Garcia
authors.initials: AG
authors.lastname: Almeida
authors.affiliation: Hospital de Clínicas de Porto Alegre, Brazil.
authors.forename: Rosane
authors.initials: R
authors.lastname: Brondani
authors.affiliation: Hospital de Clínicas de Porto Alegre, Brazil.
authors.forename: Márcia Lorena Fagundes
authors.initials: ML
authors.lastname: Chaves
authors.affiliation: Hospital de Clínicas de Porto Alegre, Brazil.
authors.forename: Luiz Antônio
authors.initials: LA
authors.lastname: Nasi
authors.affiliation: Hospital de Clínicas de Porto Alegre, Brazil ; Hospital Moinhos de Vento, Porto Alegre, Brazil.
authors.forename: Sheila Cristina Ouriques
authors.initials: SC
authors.lastname: Martins
keywords: Early mobilization; Physical therapy; Rehabilitation; Stroke