Very early mobilisation in cases of acute stroke

Since the first stroke units were established in the 1990s, early mobilisation has formed a key part of the acute treatment. In the context of an updating of national clinical guidelines for stroke, the Norwegian Directorate of Health commissioned the Institute of Public Health to prepare a systematic review of the efficacy and safety of very early mobilisation (within 24 hours) after stroke, compared with current practice, which is early mobilisation (within 48 hours).

We have written a systematic review based on a previous review from the Cochrane Collaboration published in 2009. We performed literature searches for randomised controlled studies in MEDLINE, EMBASE and CENTRAL.

Three randomised controlled studies were included. Very early mobilisation showed no statistically significant difference in mortality or functional level compared with early mobilisation. We have very little confidence in the results and are therefore uncertain of the efficacy of the intervention. Very early mobilisation, when prolonged and given regularly, can most likely result in increased mortality and poorer functional level.

Early mobilisation is useful for many patients, but very early mobilisation, when frequent and prolonged, may also cause injury. Based on current research, we are uncertain of the optimal time to initiate mobilisation after stroke.