Physicians Caution Against Early Poststroke Mobilization

Almost two-thirds of physicians have concerns regarding early mobilization of patients after a stroke, particularly for those who have suffered a hemorrhagic stroke, according to a new study.

Researchers at the Sahlgrenska Academy (Göteborg, Sweden) and the Australian National Stroke Research Institute (Heidelberg Heights, Australia) created a nine-item anonymous questionnaire that explored the benefits and harms involved with early mobilization after stroke. The questionnaire was used during interviews of stroke care professionals attending the annual 2008 Stroke Society of Australasia conference. In all, 202 clinicians participated in the survey; 65% were females, 50% under 40-years old, 35% were nurses, 26% medical doctors, 19% physiotherapists, and 12% were occupational therapists.

The results of the survey showed that only 3% of the participants felt that stroke patients should be discouraged from early mobilization; yet 60% expressed concerns about patients undertaking early mobilization (within 24 hours of stroke). Concerns about early mobilization was greater for patients with hemorrhagic (59%) than ischemic stroke (23%). A third of participants thought that patients should be "cardiovascularly stable" before mobilization, whereas 14% believed that the timing of mobilization should be based on patients' physical ability.

The researchers reported variation in responses according to the participants' specialty; physiotherapists, occupational therapists, and speech pathologists predominantly felt patients should achieve cardiovascular stability, whereas medical and nursing specialists placed more importance on physical capabilities. For example, 56% of physiotherapists said that patients with hemorrhagic stroke should have cardiovascular stability before attempting mobilization, compared with 31% of medical professionals. The study was published early online on January 28, 2011, in the International Journal of Stroke.

"It appears that the strongest concerns expressed by professionals were towards their nonexpertise areas," said lead author Thomas Linden, MD, of The Sahlgrenska Academy.
"This raises the question of whether increased communication between disciplines and/or education of nonexpertise areas could reduce concerns regarding early mobilization and improve clinical decision-making."

Related Links:
Sahlgrenska Academy
Australian National Stroke Research Institute