One issue that physiotherapists frequently deal with is mobilising patients after they have suffered a stroke. Previously, it was thought that the best thing in these cases was to encourage the patient to move as soon as possible, even if that just meant sitting up. However, a review of the available evidence has found this is not the correct approach.
The National Institute for Health and Care Excellence (NICE) looked over six studies of very early mobilisation in acute stroke victims, as well as two of standard early mobilisation. It found that high-intensity mobilisation within the first 24 hours after a stroke was associated with clinical harm.
This was not the case with all patients; NICE found harm mainly occurred when subjects needed help to sit up, get out of bed, stand or walk. Those who were able to be independently mobile during the first 24 hours could still benefit from help with early mobilisation, so the guidance has not changed in this case.
Before now, the impact of early mobilisation on morbidity and mortality was not known. The review has made it clear that it can be harmful in certain cases, so physiotherapists are recommended to avoid it wherever possible in cases where patients need help with their initial mobility until 24 hours have passed since the onset of symptoms.
This review of the evidence was spurred on by the publication of a large international randomised controlled trial (AVERT). The Association of Chartered Physiotherapists in Neurology (ACPIN) - a professional network of the Chartered Society of Physiotherapists - welcomed the change.
Dr Jonathan McCrea, ACPIN board member for public affairs, said: “ACPIN very much welcomes this carefully considered evidence-based guideline recommendation. It will aid physiotherapists working with patients in the initial 48 hours after onset of stroke symptoms.”
Written by Matthew Horton
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