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Meta-Analysis
. 2017 Jul 26;7(1):6550.
doi: 10.1038/s41598-017-06871-z.

Efficacy and Safety of Very Early Mobilization in Patients with Acute Stroke: A Systematic Review and Meta-analysis

Tao Xu  1 , Xinyuan Yu  1 , Shu Ou  1 , Xi Liu  1 , Jinxian Yuan  1 , Yangmei Chen  2
Affiliations
Meta-Analysis

Efficacy and Safety of Very Early Mobilization in Patients with Acute Stroke: A Systematic Review and Meta-analysis

Tao Xu et al. Sci Rep. .

Abstract

Whether very early mobilization (VEM) improves outcomes in stroke patients and reduces immobilization-related complications (IRCs) is currently unknown. The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of VEM in acute stroke patients following admission. Medline, Embase, and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) that examined the efficacy or safety of VEM in patients with acute stroke. VEM was defined as out of bed activity commencing within 24 or 48 hours after the onset of stroke. A total of 9 RCTs with 2,803 participants were included. Upon analysis, VEM was not associated with favorable functional outcomes (modified Ranking Scale: 0-2) at 3 months [relative risk (RR): 0.96; 95% confidence interval (CI): 0.86-1.06]; VEM did not reduce the risk of IRCs during follow up. With respect to safety outcomes, VEM was not associated with a higher risk of death (RR: 1.04; 95% CI: 0.52-2.09) and did not increase the risk of neurological deterioration or incidence of falls with injury. In conclusion, pooled data from RCTs concluded that VEM is not associated with beneficial effects when carried out in patients 24 or 48 hours after the onset of a stroke.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flowchart of the literature search performed.
Figure 2
Figure 2
Forest plots of efficacy and safety outcomes of very early mobilization at 3 months. The diamond indicates the estimated relative risk (RR) or standardized mean differences (SMD) (95% confidence interval). The p-value showed on each figure is for heterogeneity test. The modified Rankin Scale (0–2): p for overall effect = 0.40, Q = 6.73 (A). Mortality: p for overall effect = 0.90, Q = 13.62 (B). Barthel Index: p for overall effect = 0.23, Q = 43.22 (C). National Institutes of Health Stroke Scale: p for overall effect = 0.54, Q = 0.11 (D).
Figure 3
Figure 3
Forest plots of primary efficacy and safety outcomes stratified by starting time of very early mobilization. The diamond indicates the estimated relative risk (RR) (95% confidence interval). The p-value showed on each figure is for heterogeneity test. The modified Rankin Scale (0–2) at 3 months: within 24 hours, p for overall effect = 0.98, Q = 15.20; within 48 hours, p for overall effect = 0.95, Q = 0.12 (A). Mortality stratified by starting time of VEM: within 24 hours, p for overall effect = 0.23, Q = 5.03; within 48 hours, p for overall effect = 0.05, Q = 1.35 (B).
Figure 4
Figure 4
Forest plots of primary efficacy and safety outcomes stratified by stroke type. The diamond indicates the estimated relative risk (RR) (95% confidence interval). The p-value showed on each figure is for heterogeneity test. Modified Rankin Scale (0–2) at 3 months: ischemic stroke, p for overall effect = 0.90, Q = 0.13; any stroke, p for overall effect = 0.82, Q = 13.07 (A). Mortality at 3 months: ischemic stroke, p for overall effect = 0.40, Q = 0.65; any stroke, p for overall effect = 0.10, Q = 3.47 (B).
Figure 5
Figure 5
Risk of bias: A summary table for each risk of bias item for each study.
See this image and copyright information in PMC

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