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Early Mobilization After Stroke: Do Clinical Practice Guidelines Support Clinicians' Decision-Making?
Venesha Rethnam1,2, Kathryn S Hayward1,2,3, Julie Bernhardt1,2
1Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia.
Frontiers in Neurology
|February 26, 2021
Summary
Clinical practice guidelines (CPGs) for early mobilization post-stroke often lack specificity and applicability. Improvements are needed to support clinicians in making evidence-based decisions for diverse patient needs.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Clinical Practice Guidelines
Background:
- Early mobilization is crucial in acute stroke care but patient heterogeneity complicates decision-making.
- Current clinical practice guidelines (CPGs) require enhancement for effective clinical application.
Purpose of the Study:
- To evaluate the quality and applicability of CPGs for early mobilization post-stroke.
- To identify clinician-perceived gaps and areas for improvement in CPGs to support patient-level decision-making.
Main Methods:
- A review of CPGs (post-2015) using AGREE-REX criteria focused on decision-making.
- Semi-structured interviews with Australian stroke clinicians (physicians, physiotherapists, nurses) were conducted.
Main Results:
- Many CPGs inadequately addressed "Evidence" and "Applicability to Patients" criteria.
- 47% of clinicians found CPGs too broad; 40% relied on clinical judgment.
- Key suggestions for improvement included granular patient/stroke characteristics, clinical flexibility guidance, intervention dose, and safety parameters.
Conclusions:
- Current CPGs for early stroke mobilization lack specificity and adaptability for heterogeneous patient populations.
- Enhancements are needed to improve the clinical utility and applicability of CPGs in stroke care.
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