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

Rethnam, Venesha; Langhorne, Peter; Чурилов, Леонид; Hayward, Kathryn S; Herisson, Fanny; Poletto, Simone Rosa; Tong, Yanna; Bernhardt, Julie

doi:10.1080/09638288.2020.1789229

Cited by 22 publications

(16 citation statements)

References 18 publications

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“…These studies have raised safety concerns while revealing little evidence of a favorable functional outcome. 207 , 208 , 209 , 210 The results of the most influential study, A Very Early Rehabilitation Trial After Stroke, demonstrated deleterious effect of mobilization initiated within 24 hours. 207 , 208 Specifically, there was an increased risk of death in the intervention group at 14 days after stroke.…”

Section: Discussionmentioning

confidence: 99%

“… 207 , 208 , 209 , 210 The results of the most influential study, A Very Early Rehabilitation Trial After Stroke, demonstrated deleterious effect of mobilization initiated within 24 hours. 207 , 208 Specifically, there was an increased risk of death in the intervention group at 14 days after stroke. 209 This is largely consistent with the preclinical evidence indicating greater risk when ET is initiated very early following stroke.…”

Section: Discussionmentioning

confidence: 99%

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Associations Between Time After Stroke and Exercise Training Outcomes: A Meta‐Regression Analysis

Marzolini

Hussein

et al. 2021

JAHA

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Background Knowledge gaps exist regarding the effect of time elapsed after stroke on the effectiveness of exercise training interventions, offering incomplete guidance to clinicians. Methods and Results To determine the associations between time after stroke and 6‐minute walk distance, 10‐meter walk time, cardiorespiratory fitness and balance (Berg Balance Scale score [BBS]) in exercise training interventions, relevant studies in post‐stroke populations were identified by systematic review. Time after stroke as continuous or dichotomized (≤3 months versus >3 months, and ≤6 months versus >6 months) variables and weighted mean differences in postintervention outcomes were examined in meta‐regression analyses adjusted for study baseline mean values (pre‐post comparisons) or baseline mean values and baseline control‐intervention differences (controlled comparisons). Secondary models were adjusted additionally for mean age, sex, and aerobic exercise intensity, dose, and modality. We included 148 studies. Earlier exercise training initiation was associated with larger pre‐post differences in mobility; studies initiated ≤3 months versus >3 months after stroke were associated with larger differences (weighted mean differences [95% confidence interval]) in 6‐minute walk distance (36.3 meters; 95% CI, 14.2–58.5), comfortable 10‐meter walk time (0.13 m/s; 95% CI, 0.06–0.19) and fast 10‐meter walk time (0.16 m/s; 95% CI, 0.03–0.3), in fully adjusted models. Initiation ≤3 months versus >3 months was not associated with cardiorespiratory fitness but was associated with a higher but not clinically important Berg Balance Scale score difference (2.9 points; 95% CI, 0.41–5.5). In exercise training versus control studies, initiation ≤3 months was associated with a greater difference in only postintervention 6‐minute walk distance (baseline‐adjusted 27.3 meters; 95% CI, 6.1–48.5; fully adjusted, 24.9 meters; 95% CI, 0.82–49.1; a similar association was seen for ≤6 months versus >6 months after stroke (fully adjusted, 26.6 meters; 95% CI, 2.6–50.6). Conclusions There may be a clinically meaningful benefit to mobility outcomes when exercise is initiated within 3 months and up to 6 months after stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Associations Between Time After Stroke and Exercise Training Outcomes: A Meta‐Regression Analysis

Marzolini

Hussein

et al. 2021

JAHA

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“…Exercise rehabilitation minimizes post-stroke motor and cognitive dysfunctions and thus appears to be a promising technique for stroke recovery [ 11 ]. The role of factors such as the time of beginning and duration of each session, and the activities and the intensity and type of protocols used for patients immediately after stroke remain to be further studied [ 12 , 13 , 14 , 15 , 16 ]. Most related studies on human models exam ining the period immediately after a stroke have been conducted either within or after the first two weeks of stroke [ 15 , 17 ] and no long-term interventions have been given to the samples tested.…”

Section: Introductionmentioning

confidence: 99%

Can Early Neuromuscular Rehabilitation Protocol Improve Disability after a Hemiparetic Stroke? A Pilot Study

et al. 2022

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Background: The impairment of limb function and disability are among the most important consequences of stroke. To date, however, little research has been done on the early rehabilitation trial (ERT) after stroke in these patients. The purpose of this study was to evaluate the impact of ERT neuromuscular protocol on motor function soon after hemiparetic stroke. The sample included twelve hemiparetic patients (54.3 ± 15.4 years old) with ischemic stroke (n = 7 control, n = 5 intervention patients). ERT was started as early as possible after stroke and included passive range of motion exercises, resistance training, assisted standing up, and active exercises of the healthy side of the body, in addition to encouraging voluntary contraction of affected limbs as much as possible. The rehabilitation was progressive and took 3 months, 6 days per week, 2–3 hours per session. Fugle-Meyer Assessment (FMA), Box and Blocks test (BBT) and Timed up and go (TUG) assessments were conducted. There was a significantly greater improvement in the intervention group compared to control: FMA lower limbs (p = 0.001), total motor function (p = 0.002), but no significant difference in FMA upper limb between groups (p = 0.51). The analysis of data related to BBT showed no significant differences between the experimental and control groups (p = 0.3). However, TUG test showed significant differences between the experimental and control groups (p = 0.004). The most important finding of this study was to spend enough time in training sessions and provide adequate rest time for each person. Our results showed that ERT was associated with improved motor function but not with the upper limbs. This provides a basis for a definitive trial.

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“…Rehabilitation must be available in almost all healthcare settings and in all phases of care (acute, post-acute long-term) (Gutenbrunner et al 2018;WHO, 2017a). In acute care coordinated rehabilitation interventions can contribute to speeding recovery and to achieve better long-term outcomes for a number of diseases (Marti et al 2020;Rethnam et al 2020). It also supports intensive care and may shorten duration of intensive care.…”

Section: Introductionmentioning

confidence: 99%

Nursing – a core element of rehabilitation

Gütenbrunner

Stıevano²,

Nugraha

et al. 2021

International Nursing Review

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Aim: 2020 was been acknowledged by the World Health Organization as the International Year of the Nurse and the Midwife. On this occasion, the Global Rehabilitation Alliance and the International Council of Nurse would like to conceptually reflect the role of nurses in rehabilitation. Background: Rehabilitation and nursing are strictly ingrained. Rehabilitation aims at improving, reaching and maintaining optimal functioning of persons with disability and persons with health conditions experiencing disability. Nursing is defined as use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life. Nursing has a crucial role in all phases of rehabilitation care (acute, post-acute and long-term rehabilitation). Nurses deliver rehabilitation in many settings, in nursing homes and community-based rehabilitation. The main principle is not to deliver care for the patient but deliver care with the patient. This includes explaining, demonstrating and practising with the goal to help the patient to (re-)gain independence. Discussion: Nurses play an important role in delivering rehabilitation and are involved in all aspects of the multidimensional rehabilitation process. One of the important points is that in most settings, nurses are the professionals with a prolonged relationship with patients and families, and may have the best insight into the patients' personal and contextual factors with regard to the rehabilitation process. Conclusion and implications for Nursing and/or Health Policy: Strengthening nursing in rehabilitation is a vital factor to deliver high-quality rehabilitation and to achieve optimum outcomes. For this reason, we urge all relevant stakeholders at governmental and rehabilitation service provider levels to work towards these goals.

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

Cited by 22 publications

References 18 publications

Associations Between Time After Stroke and Exercise Training Outcomes: A Meta‐Regression Analysis

Associations Between Time After Stroke and Exercise Training Outcomes: A Meta‐Regression Analysis

Can Early Neuromuscular Rehabilitation Protocol Improve Disability after a Hemiparetic Stroke? A Pilot Study

Nursing – a core element of rehabilitation

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