The evidence against the use of early mobilisation interventions soon after stroke onset has been strengthened with an Australian-led study showing a higher risk of early death.
A new analysis of the AVERT (A Very Early Rehabilitation Trial) study has shown there were higher mortality rates for people with ischaemic and haemorrhagic stroke who had early mobilisation (out-of-bed activity and mobility training) started within 24 hours of stroke onset, compared to usual care.
The study randomised 2104 stroke patients to early mobilisation or usual care, and its previously released findings showed worse outcomes at three months for the patients who received ‘very early mobilisation’ (VEM). This involved a higher level of out-of-bed, task specific training of sitting, standing, and walking, commenced within 24 hours of stroke onset and continued for 14 days or hospital discharge if sooner.
The latest analysis, which focused on mortality, showed that there was a low overall case fatality rate at 14 days post-stroke of 3.8%, but there was a higher odds of death (age and severity adjusted OR 1.76).
The difference translated into 16 excess deaths in the early mobilisation group, and this difference persisted to three months. Fatalities more prominent in people aged over 80 years and those with intracerebral haemorrhage.
The analysis also found that stroke progression was more common in very early mobilisation, but no difference was seen in non-fatal severe adverse events between the two groups
Writing in Neurology, the study investigators said one hypothesis that to explain early harm with upright activity after stroke related to disturbance of cerebral autoregulation in this hyper-acute phase.