Early Mobilization after Stroke: Changes in Clinical Opinion Despite an Unchanging Evidence Base.
BACKGROUND
We sought to determine whether Australasian health professionals' opinions regarding early mobilization after stroke changed between 2008 and 2014, when a large international trial of early mobilization (A Very Early Rehabilitation Trial, AVERT) was underway.


METHODS
Attendees at the two major Australasian stroke conferences in 2008 and 2014 were surveyed. Participants rated their agreement with statements about the risks and benefits of commencing mobilization within 24 hours of hemorrhagic and ischemic stroke using a 5-point Likert scale. Participants in 2014 were asked about their awareness of AVERT. Logistic regressions were performed to determine whether the time point (2008 versus 2014) or awareness of AVERT influenced opinions about early mobilization.


RESULTS
Surveys were completed by 443 health professionals (2008: N = 202; 2014: N = 241). Most respondents in 2014 reported that early mobilization was beneficial and not harmful to people with ischemic and hemorrhagic stroke. Opinions regarding mobilization after ischemic stroke did not change significantly between 2008 and 2014. In 2014, a significantly greater proportion of respondents believed that early mobilization after hemorrhagic stroke was helpful (2008: n = 98 of 202 [49%] versus 2014: n = 170 of 241 [71%], P < .01). Awareness of AVERT was significantly associated with the opinion that early mobilization was beneficial and not harmful to patients with stroke (P < .05).


CONCLUSIONS
Australasian health professionals' opinions of early mobilization after hemorrhagic stroke changed between 2008 and 2014, prior to reporting of the AVERT trial. Our results suggest that awareness of an ongoing research trial can lead to changes in opinions before the efficacy of the experimental intervention is known.
Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia. Electronic address: elizabeth.lynch@adelaide.edu.au.
Elizabeth A
EA
Lynch
Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
Toby
T
Cumming
Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Stroke Service, Hunter New England Local Health District, Newcastle, New South Wales, Australia.
Heidi
H
Janssen
Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
Julie
J
Bernhardt
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001315:Australia; D004434:Early Ambulation / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D020300:Intracranial Hemorrhages; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D020521:Stroke; D000071939:Stroke Rehabilitation; D013997:Time Factors; D055815:Young Adult
Stroke; clinical opinion; early mobilization; questionnaire