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

Abstract

To investigate the safety and efficacy of early mobilisation (EM) compared to usual care by meta-analysing individual participant data (IPD). 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. 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). The commencement of mobilisation should only be considered after 24 h post-stroke. 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.