Priority 13 Stroke Prevention, Diagnosis, Pre-hospital and Hospital Care

UNCERTAINTY:  What is the best timing and amount of early mobilisation for stroke survivors? (JLA PSP Priority 13)
Overall ranking 13
JLA question ID 0106/13a
Explanatory note

Most people with stroke are nursed in bed for at least the first day after their admission to the stroke unit. Early mobilisation may have beneficial effects and lead to fewer complications such as deep vein thrombosis, pulmonary embolism and pneumonia, however there are uncertainties around how safe and effective it is [Ref. 10].

This question is asking 2 things - how early should people start moving after stroke (mobilisation) and how much movement therapy should there be. Very early mobilisation (VEM, usually within 24 hours and no later than 48 hours) is performed in some stroke units and recommended in some acute stroke clinical guidelines (2018 Cochrane review, see Evidence). The AVERT Trial [Ref. 11] looked at the effectiveness of frequent, higher doses of therapy after mobilisation within 24 hours versus usual care. It concluded that shorter, more frequent mobilisation early after stroke may be associated with a more favourable outcome. However, the question of the best frequency and amount still remains. The AVERT-DOSE Trial may address this, at least in part [Ref. 12].

Ref 10: www.nice.org.uk/guidance/ng128/chapter/Recommendations-for-research, 2019
Ref 11: https://pubmed.ncbi.nlm.nih.gov/28967376/,2017
Ref 12: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376646
Evidence

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006187.pub3/full 
Health Research Classification System category Stroke
Extra information provided by this PSP
Original uncertainty examples I would like to know more about impact of early mobilisation. ~ How intensive should early mobilisation be? Time frames first 24 hours and first 72 hours. ~ Does very early and active mobilisation improve recovery after stroke compared with more delayed mobilisation; what is the optimal timing of commencement, frequency, and duration of mobilisation interventions, and what are the relative harms and benefits of different mobilisation strategies? 
Submitted by Carer x 1, Health/social care professional x 2, Research Recommendations x 1 
PSP information
PSP unique ID 0106
PSP name Stroke prevention, diagnosis, pre-hospital and hospital care
Total number of uncertainties identified by this PSP. 93  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 30th April 2021