Department of Neurology, Medical Division, Akershus University Hospital, N-1478 Lørenskog, Norway.
Stroke. 2012 Sep;43(9):2389-94. doi: 10.1161/STROKEAHA.111.646687. Epub 2012 Jun 14.
Very early mobilization (VEM) is considered to contribute to the beneficial effects of stroke units, but there are uncertainties regarding the optimal time to start mobilization. We hypothesized that VEM within 24 hours after admittance to the hospital would reduce poor outcome 3 months poststroke compared with mobilization between 24 and 48 hours.
We conducted a prospective, randomized, controlled trial with blinded assessment at follow-up. Patients admitted to the stroke unit within 24 hours after stroke were assigned to either VEM within 24 hours of admittance or mobilization between 24 and 48 hours (control group). Primary outcome was the proportion of poor outcome (modified Rankin scale score, 3-6), whereas secondary outcomes were death rate, change in neurological impairment (National Institutes of Health Stroke Scale score), and dependency (Barthel Index 0-17).
Fifty-six patients were included (mean age±SD, 76.9±9.4 years), 27 were in the VEM group and 29 were in the control group. VEM patients had nonsignificant higher odds (adjusted for age and National Institutes of Health Stroke Scale score on admission) of poor outcome (OR, 2.70; 95% CI, 0.78-9.34; P=0.12), death (OR, 5.26; 95% CI, 0.84-32.88; P=0.08), and dependency (OR, 1.25; 95% CI, 0.36-4.34; P=0.73). The control group, having milder strokes (National Institutes of Health Stroke Scale score±SD: control group, 7.5±4.2; VEM, 9.2±6.5; P=0.26), had better neurological improvement (P=0.02).
We identified a trend toward increased poor outcome, death rate, and dependency among patients mobilized within 24 hours after hospitalization, and an improvement in neurological functioning in favor of patients mobilized between 24 and 48 hours. Very early or delayed mobilization after acute stroke is still undergoing debate, and results from ongoing larger trials are required.
早期活动（VEM）被认为有助于发挥卒中单元的有益作用，但对于开始活动的最佳时间仍存在不确定性。我们假设与 24-48 小时后开始活动相比，入院后 24 小时内开始 VEM 可降低卒中后 3 个月的不良结局。
我们开展了一项前瞻性、随机、对照试验，在随访时进行盲法评估。在卒中发病后 24 小时内收入卒中单元的患者被分配至入院后 24 小时内开始 VEM 或 24-48 小时开始活动（对照组）。主要结局为不良结局（改良 Rankin 量表评分 3-6）的比例，次要结局为死亡率、神经功能缺损变化（国立卫生研究院卒中量表评分）和依赖（Barthel 指数 0-17）。
共纳入 56 例患者（平均年龄±标准差，76.9±9.4 岁），27 例患者在 VEM 组，29 例患者在对照组。VEM 组不良结局的可能性（校正年龄和入院时国立卫生研究院卒中量表评分后）虽略有升高（OR，2.70；95%CI，0.78-9.34；P=0.12），但差异无统计学意义，死亡率（OR，5.26；95%CI，0.84-32.88；P=0.08）和依赖（OR，1.25；95%CI，0.36-4.34；P=0.73）的差异也无统计学意义。对照组患者的卒中较轻（国立卫生研究院卒中量表评分±标准差：对照组，7.5±4.2；VEM 组，9.2±6.5；P=0.26），神经功能改善更好（P=0.02）。
我们发现，与入院后 24-48 小时开始活动的患者相比，入院后 24 小时内开始活动的患者不良结局、死亡率和依赖性的发生率更高，而神经功能的改善更好。急性卒中后早期或延迟活动仍存在争议，需要来自正在进行的更大规模试验的结果。
