Physicians cautious on early post-stroke mobilization
MedWire News: Nearly two-thirds of physicians have concerns regarding early mobilization of patients after a stroke, particularly for those who have suffered a hemorrhagic stroke, research shows.
"Clinical practice guidelines in the area are not specific, with recommendation of mobilization 'as early as possible' after stroke common," say Thomas Linden (The Sahlgrenska Academy at Gothenburg University, Sweden) and team.
"This study suggests that there is a clear need for high-quality research in the field to inform clinical practice."
As reported in the International Journal of Stroke, the researchers surveyed 202 clinicians taking part in the 2008 Stroke Society of Australasia conference. Of these, just 3% felt that stroke patients in general need lots of bed rest and should be discouraged from early mobilization.
Yet 60% of participants had concerns about patients undertaking early mobilization, ie, within 24 hours of stroke, despite accumulating evidence that such a strategy is not harmful and may boost patients' recovery.
The proportion of participants with concerns about early mobilization was greater for patients with hemorrhagic than ischemic stroke, at 59% versus 23%.
A third of participants thought that patients should be "cardiovascularly stable" before mobilization, whereas 14% believed that the timing of mobilization should be based on patients' physical ability.
The researchers report "interesting variation" in responses according to the participants' specialty. They say that physiotherapists, occupational therapists, and speech pathologists predominantly felt patients should achieve cardiovascular stability, whereas medical and nursing specialists placed more importance on physical capabilities.
For example, 56% of physiotherapists said that patients with hemorrhagic stroke should have cardiovascular stability before attempting mobilization, compared with 31% of medical professionals. But 23% of the latter group thought that physical ability was the key determinant, compared with just 5% of physiotherapists.
"It therefore appears that the strongest concerns expressed by professionals were towards their nonexpertise areas," say Linden et al.
"This raises the question of whether increased communication between disciplines and/or education of nonexpertise areas could reduce concerns regarding early mobilization and improve clinical decision-making."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Eleanor McDermid