Very early versus delayed mobilisation after stroke.
Very early versus delayed mobilisation after stroke.
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DOI：
10.1002/14651858.cd006187.pub2
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发表时间：
2009-01-21
期刊：
影响因子：
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通讯作者：
Legg, Lynn A
中科院分区：
文献类型：
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作者：
Bernhardt, Julie;Thuy, Matthew Nt;Legg, Lynn A
背景：在一些卒中单元中进行极早期活动，并在急性卒中临床指南中推荐。目前尚不清楚是否非常早期动员独立改善中风后outcome. Adjectives：以确定的好处和危害非常早期动员（中风后48小时内开始）相比，传统的caregy. Objectives. We检索了科克伦中风组试验注册（最后一次检索2008年4月）。此外，我们检索了25个数据库，包括科克伦对照试验中心注册库（科克伦图书馆第3期，2007）、MEDLINE（1950年至2007年8月）、EMBASE（1980年至2007年9月）、CINAHL（1982年至2006年12月）和AMED（1985年至2007年1月）。我们还检索了相关的正在进行的试验和研究登记册（2007年1月检索）和中国医学数据库Wanfangdata（2007年3月检索）、手工检索期刊、检索参考文献列表并联系该领域的研究人员。急性卒中患者的无混杂随机对照试验，比较在中风后48小时内开始下床活动并旨在减少首次活动时间和/或增加活动量或频率的干预组（资料收集与分析：一位综述作者排除了明显不相关的记录;两位综述作者独立地将选择标准应用于剩余的研究。主要结局为计划随访结束时的死亡或不良结局（依赖性或机构化）。次要结果包括死亡率，依赖性，制度化，日常生活活动（ADL），生活质量，步行时间，不良事件（如深静脉血栓形成）和患者mood.Main结果：一项研究，涉及71名参与者，被列入。在这项研究中，实验组比对照组有更早和更频繁的活动（实验组卒中后中位数为18.1小时，对照组为30.8小时;实验组入院期间活动167分钟（四分位距（IQR）62至305），对照组为69分钟（IQR 31至115））。接受早期和频繁动员的患者在3个月时死亡或残疾的人数较少，但这没有统计学意义，置信区间较宽（比值比（OR）0.67，95%置信区间（CI）0.25至1.79，P = 0.42）。未发现任何感兴趣的次要结局有显着差异。作者结论：与传统护理相比，我们发现没有足够的证据支持或反驳中风后常规极早期动员的功效。需要更多的研究来确定中风后早期活动的益处和危害。
BACKGROUND: Very early mobilisation is performed in some stroke units and recommended in acute stroke clinical guidelines. It is unclear whether very early mobilisation independently improves outcome after stroke.OBJECTIVES: To determine the benefits and harms of very early mobilisation (commenced within 48 hours of stroke) compared with conventional care.SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched April 2008). In addition, we searched 25 databases including the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2007), MEDLINE (1950 to August 2007), EMBASE (1980 to September 2007), CINAHL (1982 to December 2006), and AMED (1985 to January 2007). We also searched relevant ongoing trials and research registers (searched January 2007) and the Chinese medical database Wanfangdata (searched March 2007), handsearched journals, searched reference lists and contacted researchers in the field.SELECTION CRITERIA: Unconfounded RCTs of acute stroke patients, comparing an intervention group that started out of bed mobilisation within 48 hours of stroke and aimed to reduce time to first mobilisation and/or increase the amount or frequency (or both) of mobilisation, with conventional care.DATA COLLECTION AND ANALYSIS: One review author eliminated obviously irrelevant records; two review authors independently applied selection criteria to remaining studies. The primary outcome was death or poor outcome (dependency or institutionalisation) at the end of scheduled follow up. Secondary outcomes included mortality, dependency, institutionalisation, activities of daily living (ADLs), quality of life, time to walking, adverse events (e.g. deep vein thrombosis) and patient mood.MAIN RESULTS: One study, involving 71 participants, was included. In this study the experimental group had earlier and more frequent mobilisation than the control group (median 18.1 hours post stroke for experimental group versus 30.8 hours control; 167 minutes of mobilisation (interquartile range (IQR) 62 to 305) during admission for experimental group versus 69 (IQR 31 to 115) minutes control). Fewer patients who received early and frequent mobilisation were dead or disabled at three months, but this was not statistically significant and the confidence intervals were wide (odds ratio (OR) 0.67, 95% confidence interval (CI) 0.25 to 1.79, P = 0.42). No significant difference on any secondary outcomes of interest were found.AUTHORS' CONCLUSIONS: We found insufficient evidence to support or refute the efficacy of routine very early mobilisation after stroke, compared with conventional care. More research is required to determine the benefits and harms of very early mobilisation after stroke.