Does evidence really matter? Professionals' opinions on the practice of early mobilization after stroke

Anna Sjöholm^1,2, Monica Skarin^1,2, Thomas Linden^1,2, Julie Bernhardt^2
1Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; ²Stroke Division, Florey Neuroscience Institutes, La Trobe University, Melbourne, Australia

Introduction: Early mobilization after stroke may be important for a good outcome and it is currently recommended in a range of international guidelines. The evidence base, however, is limited and clear definitions of what constitutes early mobilization are lacking.
Aims: To explore stroke care professionals' opinions about (1) when after stroke, first mobilization should take place, (2) whether early mobilization may affect patients' final outcome, and (3) what level of evidence they require to be convinced that early mobilization is beneficial.
Methods: A nine-item questionnaire was used to interview stroke care professionals during a conference in Sydney, Australia.
Results: Among 202 professionals interviewed, 40% were in favor of mobilizing both ischemic and hemorrhagic stroke patients within 24 hours of stroke onset. There was no clear agreement about the optimal time point beyond 24 hours. Most professionals thought that patients' final motor outcome (76%), cognitive outcome (57%), and risk of depression (75%) depends on being mobilized early. Only 19% required a large randomized controlled trial or a systematic review to be convinced of benefit.
Conclusion: The spread in opinion reflects the absence of clear guidelines and knowledge in this important area of stroke recovery and rehabilitation, which suggests further research is required.

Keywords: stroke, rehabilitation, early ambulation, early mobilization observation