Safety and Efficacy of Very Early Mobilization in Acute Stroke: A Systematic Review and Meta-Analysis.

Abstract

OBJECTIVE: To evaluate the safety and efficacy of very early mobilization (VEM) after acute stroke through a comprehensive meta-analysis of cohort studies and randomized controlled trials. DATA SOURCES: A systematic literature search was conducted in PubMed, Cochrane Library, Embase, Web of Science, Google Scholar, and Semantic Scholar from inception to May 2024. STUDY SELECTION: Studies were included if they compared VEM with standard care in adult patients with stroke and reported outcomes related to functional recovery, mortality, or medical complications. Both randomized controlled trials and observational cohort studies were eligible. DATA EXTRACTION: Two independent reviewers extracted study and participant characteristics, intervention details, comparator information, and outcome measures (functional recovery, complications, mortality, and length of stay). Discrepancies were resolved through discussion. Effect sizes (risk ratios, standardized mean differences) with 95% confidence intervals were calculated, and methodological quality was assessed using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies. DATA SYNTHESIS: Twenty-three studies, including 84,936 patients in the VEM group and 32,753 in the standard care group, were analyzed. VEM significantly improved functional independence, as measured by the Barthel Index (a validated scale for activities of daily living; standardized mean difference [SMD]=0.61; 95% CI, 0.25-0.98; P<.01) and the modified Rankin Scale (mRS; a disability scale, with scores of 0-2 indicating functional independence; risk ratio [RR]=1.14; 95% CI, 1.03-1.27). It also reduced the length of hospital stay (SMD=-2.53; 95% CI, -4.45 to -0.60; P<.01), pulmonary infection (RR=0.75; 95% CI, 0.57-0.99; P=.04), and urinary tract infection (RR=0.76; 95% CI, 0.71-0.82; P<.01). No significant effects were observed in National Institutes of Health Stroke Scale (a stroke severity scale) scores, mortality, deep vein thrombosis, neurologic deterioration, or falls. CONCLUSIONS: VEM is safe and effective in enhancing functional recovery, reducing complications, and shortening hospitalization after acute stroke. Further high quality studies are needed to optimize timing and dosage of mobilization, particularly considering stroke severity and subtype.