Early motor rehabilitation following ischaemic stroke: A systematic review with meta-analysis
DOI:
https://doi.org/10.62827/fb.v27i8.1268Keywords:
Stroke; Ischemic Stroke; Early Ambulation; Stroke Rehabilitation.Abstract
Introduction: Stroke is one of the leading causes of disability and mortality worldwide. Early mobilisation has been proposed to reduce complications associated with immobility and to promote functional recovery; however, its benefits remain controversial. Objective: To describe the effects of early mobilisation on the functional independence of patients with ischaemic stroke through a meta-analysis of randomised clinical trials. Methods: A systematic review was conducted in the PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), Cochrane Library and LILACS (Latin American and Caribbean Health Sciences Literature) databases, covering the period from January 2015 to May 2026. Studies were included involving adults with ischaemic stroke who underwent early mobilisation or rehabilitation initiated within seven days of the event. The primary outcome was functional independence at three months, defined preferably as a score of 0–2 on the Modified Rankin Scale. Results: Six studies, totalling 2,583 participants, were included. The pooled analysis showed no statistically significant benefit of early mobilisation on functional independence at three months compared with usual care. Although some studies showed improvement in specific motor domains, others suggested possible adverse effects associated with very early, high-intensity mobilisation within the first 24 hours after stroke. Conclusion: Early mobilisation proved to be safe and feasible, but was not associated with a significant improvement in functional independence at three months. The intensity, frequency and timing of the intervention may influence its effectiveness, reinforcing the need for individualised rehabilitation strategies.
References
Zhang M, Long Z, Liu P, Qin Q, Yuan H, Cao Y, et al. Global burden and risk factors of stroke in young adults, 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021. J Am Heart Assoc. 2025;14(10):e039387. doi:10.1161/JAHA.124.039387.
Hou S, Zhang Y, Xia Y, et al. Global, regional, and national epidemiology of ischemic stroke from 1990 to 2021. Eur J Neurol. 2024;31:e16481. doi:10.1111/ene.16481.
Qian N, Lu C, Wei T, Yang W, Wang H, Chen H, Li J, Zhu S, Wang W, Shao N. Epidemiological trends and forecasts in stroke at global, regional and national levels. J Stroke Cerebrovasc Dis. 2025;34(8):108347. doi:10.1016/j.jstrokecerebrovasdis.2025.108347.
Baggio JAO, Nascimento BRL, Suassuna AF, Andrade LA, Bezerra-Santos M, Rocha LJA. The 2019 National Health Survey: what does it teach us about the epidemiological profile of stroke in Brazil? BMC Public Health. 2025;25(1):1-8. doi:10.1186/s12889-025-25656-y.
Herisson F, Godard S, Volteau C, Le Blanc E, Guillon B, Gaudron M, et al. Early sitting in ischemic stroke patients (SEVEL): a randomized controlled trial. PLoS One. 2016;11(3):e0149466. doi:10.1371/journal.pone.0149466.
Anjos JM, Neto MG, Tapparelli YA, et al. Efficacy and safety of very early mobilization after thrombolysis in acute ischemic stroke: a randomized clinical trial. J Neurol. 2023;270(2):843-50. doi:10.1007/s00415-022-11411-5.
Poletto SR, Rebello LC, Valença MJ, Rossato D, Almeida AG, Brondani R, et al. Early mobilization in ischemic stroke: a pilot randomized trial of safety and feasibility in a public hospital in Brazil. Cerebrovasc Dis Extra. 2015;5(1):31-40. doi:10.1159/000381417.
Tong Y, Cheng Z, Rajah GB, Duan H, Cai L, Zhang N, Du H, Geng X, Ding Y. High intensity physical rehabilitation later than 24 h post stroke is beneficial in patients: a pilot randomized controlled trial study in mild to moderate ischemic stroke. Front Neurol. 2019;10:113. doi:10.3389/fneur.2019.00113.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.
Wu X, Han L, Zhang L, et al. Early mobilization/early rehabilitation in acute ischemic stroke patients. Stroke Vasc Neurol. 2020;5(1):1-6. doi:10.1136/svn-2019-000324.
AVERT Trial Collaboration. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet. 2015;386(9988):46-55. doi:10.1016/S0140-6736(15)60690-0.
Wei X, Sun S, Zhang M, Zhao Z. A systematic review and meta-analysis of clinical efficacy of early and late rehabilitation interventions for ischemic stroke. BMC Neurol. 2024;24(1):91. doi:10.1186/s12883-024-03565-8.
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Diretrizes de atenção à reabilitação da pessoa com acidente vascular cerebral. Brasília: Ministério da Saúde; 2013.
Gordon NF, Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ, et al. Physical activity and exercise recommendations for stroke survivors: an American Heart Association scientific statement from the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention. Stroke. 2004;35(5):1230-40. doi:10.1161/01.STR.0000127303.19261.19.
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