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BMJ neurology open
Par Temraz Y, Moftah E, Aljasir M et 3 autres.
Contenu en anglais
Early mobilisation is widely promoted in acute stroke care, but observational evaluations can be biased because sicker patients often mobilise later.
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To evaluate the association between early out-of-bed mobilisation (≤48 hours) and in-hospital complications and to describe discharge outcomes.
We conducted a retrospective cohort study using routinely collected clinical data from a single centre (admissions from May 2024 to May 2025). Patients were included in the primary analysis if time to first mobilisation was recorded. The exposure was mobilisation within 48 hours versus after 48 hours. The primary outcome was any in-hospital complication. Secondary outcomes were favourable discharge modified Rankin Scale (0-2), discharge to home and length of stay. Confounding by indication was addressed using propensity score overlap weighting based on pre-exposure covariates. Relative risks (RR) were estimated using overlap-weighted modified Poisson regression with robust SEs. Risk differences (RD) used bootstrap resampling (500 replicates). A landmark analysis restricted to length of stay ≥2 days was used to reduce immortal-time bias.
The dataset included 400 admissions; mobilisation timing was recorded for 371 patients (mean age 70.1 years, SD 11.5; 46.6% female; 82.7% ischaemic stroke; median National Institutes of Health Stroke Scale 10 (IQR 6-14)). Among recorded cases, 245 (66.0%) were mobilised within 48 hours. In overlap-weighted analyses, early mobilisation was associated with lower complication risk (RR 0.689, 95% CI 0.498 to 0.953; p=0.024), with RD -0.123 (bootstrap 95% CI -0.233 to -0.005). In the landmark cohort, the association remained similar (RR 0.709, 95% CI 0.513 to 0.979; p=0.036). Discharge outcomes were directionally favourable but less precise after weighting.
In routine acute stroke care, early out-of-bed mobilisation within 48 hours was associated with fewer in-hospital complications and remained robust in a landmark sensitivity analysis. Longer-term functional outcomes should be evaluated in studies with post-discharge follow-up.
Publié dans BMJ neurology open. Le résumé est reproduit tel qu’il a été publié et reste l’œuvre de ses auteurs ; lisez l’article complet à la source.
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