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- Skarin, Monica, et al.
(författare)
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'Better wear out sheets than shoes': a survey of 202 stroke professionals' early mobilisation practices and concerns
- 2011
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Ingår i: International Journal of Stroke. - 1747-4949. ; 6:1, s. 10-15
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Tidskriftsartikel (refereegranskat)abstract
- Background Stroke unit care improves the outcome for patients. One component responsible for this may be that patients are mobilised earlier and more intensively. An ongoing randomised controlled trial is investigating the potential benefits of early mobilisation, but currently there is limited evidence for the practice. Therefore, current practices may be driven by historical precedent and/or clinical opinion, and varying approaches to mobilisation are likely. This study aims to examine different health professionals' concerns regarding early mobilisation in acute stroke. In this study, early mobilisation was defined as frequent out of bed activities within the first 24 h after stroke onset. Methods A nine-item anonymous questionnaire exploring benefits and harms with early mobilisation after stroke was used during interviews of stroke care professionals attending the annual Australasian stroke conference in 2008. Results The survey was completed by 202 professionals, representing 38% of all conference attendees. Sixty-five per cent were females, 50% under 40-years old, 46% worked in acute stroke and 31% in rehabilitation. Thirty-five per cent were nurses, 26% medical doctors, 19% physiotherapists and 12% occupational therapists. Two-thirds had <10-years experience with stroke. Sixty per cent of the surveyed professionals had concerns about early mobilisation and there were significantly more professionals concerned about early mobilisation for haemorrhagic (59%) than ischaemic (23%) stroke patients. Conclusion Our study shows that most clinicians had concerns in relation to early mobilisation of stroke patients and more clinicians had concerns for haemorrhagic than for ischaemic stroke. The evidence underlying these concerns is shallow.
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- Cumming, Toby B, et al.
(författare)
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Hemispatial neglect and rehabilitation in acute stroke.
- 2009
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Ingår i: Archives of physical medicine and rehabilitation. - : Elsevier BV. - 1532-821X .- 0003-9993. ; 90:11, s. 1931-6
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To compare 2 methods for determining neglect in patients within 2 days of stroke, and to investigate whether early neglect was related to rehabilitation practice, and whether this relationship was affected by an early, intensive mobilization intervention. DESIGN: Data were collected from patients participating in a phase II randomized controlled trial of early rehabilitation after stroke. SETTING: Acute hospital stroke unit. PARTICIPANTS: Stroke patients (N=71). INTERVENTION: The 2 arms of the trial were very early mobilization (VEM) and standard care (SC). MAIN OUTCOME MEASURES: Neglect was assessed using the Star Cancellation Test and the National Institutes of Health Stroke Scale (NIHSS) inattention item within 48 hours of stroke onset, and therapy details were recorded during the hospital stay. RESULTS: Assessing neglect so acutely after stroke was difficult: 29 of the 71 patients were unable to complete the Star Cancellation Test, and agreement between this test and the NIHSS measure was only .42. Presence of neglect did not preclude early mobilization. SC group patients with neglect had longer hospital stays (median, 11d) than those without neglect (median, 4d); there was no difference in length of stay between patients with and without neglect in the VEM group (median, 6d in both). CONCLUSION: Early mobilization of patients with neglect was feasible and may contribute to a shorter acute hospital stay.
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- Ha, Jason, 1985, et al.
(författare)
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Bed rest or mobilization after rt-PA? A case-crossover study of factors influencing clinical decision making in stroke services
- 2013
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Ingår i: International journal of stroke. - : SAGE Publications. - 1747-4949 .- 1747-4930. ; 8:3, s. 172-179
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Tidskriftsartikel (refereegranskat)abstract
- Background Acute stroke management is a dynamic field. Treatment with recombinant tissue plasminogen activator is standard care in Australia, but there are no evidence-based practice guidelines about first out of bed activity (mobilization) after recombinant tissue plasminogen activator. Aims To identify factors influencing clinicians' decisions to delay or allow mobilization. Methods Case-crossover design. Using hypothetical case vignettes, we explored the factors that clinicians consider when deciding to first mobilize a patient after recombinant tissue plasminogen activator. Acute stroke physicians and nurses from Australian hospitals known to treat with recombinant tissue plasminogen activator participated. Information about hospital recombinant tissue plasminogen activator protocols and perceived benefits and harms of mobilization after recombinant tissue plasminogen activator were also captured. Results Fifty-four clinicians, 52% senior nurses, and 48% senior physicians from all states of Australia participated. Of the factors influencing decisions about mobilization after recombinant tissue plasminogen activator, neurological decline (0·29; confidence interval 0·12, 0·46; P=0·001), neurological decline with symptomatic intracerebral hemorrhage (0·41; confidence interval 0·24, 0·59; P<0·0001), infection of uncertain cause (0·32; confidence interval 0·14, 0·50; P=0·0010), severe chest infection (0·35; confidence interval 0·16, 0·53; P=0·0004), severe stroke (0·29; confidence interval 0·12, 0·46; P=0·0010), drowsiness (0·47; confidence interval 0·29, 0·63; P<0·0001), and confusion (0·31; confidence interval 0·15, 0·47; P=0·0001) significantly influenced decisions. Falls risk was a common concern (85%). Conclusion Growing interest in development of clear protocols that guide first mobilization after recombinant tissue plasminogen activator prompted this study. We have identified factors that may influence decisions about when to allow patients to mobilize after recombinant tissue plasminogen activator. These, combined with emerging evidence of risks and benefits of early mobilization, should help protocol development in the future.
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