Early Mobilization Decision after an Acute Ischemic Stroke: Protocol for an Umbrella Review


  • Catarina Fernandes Serviço de Neurologia. Unidade Local de Saúde de Coimbra. Coimbra.
  • João André Sousa Serviço de Neurologia. Unidade Local de Saúde de Coimbra. Coimbra.
  • Sara Bernardo-Castro Serviço de Neurologia. Unidade Local de Saúde de Coimbra. Coimbra.
  • Fernando Silva Serviço de Neurologia. Unidade Local de Saúde de Coimbra. Coimbra.
  • Helena Donato Documentation and Scientific Information Service. Centro Hospitalar e Universitário de Coimbra. Coimbra.
  • João Sargento-Freitas Serviço de Neurologia. Unidade Local de Saúde de Coimbra. Coimbra; Faculdade de Medicina. Universidade de Coimbra. Coimbra.




Cerebrovascular Disorders, Early Ambulation, Meta-analysis, Stroke, Systematic Review


Introduction: Stroke is considered one of the greatest public health challenges worldwide, with the ischemic subtype being the most prevalent. Various acute stroke clinical guidelines recommend early rehabilitation interventions, including very early mobilization. However, despite the studies conducted in recent years regarding when to initiate mobilization after an acute stroke, there are few systematic and personalized protocols based on the factors for which patient mobilization should ideally be performed. We aim to conduct an umbrella review of systematic reviews and meta-analyses to study the early mobilization decision after an acute ischemic stroke in comparison with conventional care and correlate the different approaches with patient clinical outcomes.
Methods and Analysis: We will perform a systematic search on PubMed/MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Epistemonikos and Web of Science Core Collection databases. Retrieved studies will be independently reviewed by two authors and any discrepancies will be resolved by consensus or with a third reviewer. Reviewers will extract the data and assess the risk of bias in the selected studies. We will use the 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist as the critical appraisal tool to assess cumulative evidence and risk of bias of the different studies. This will be the first umbrella review that compares early mobilization approaches in post-acute ischemic stroke. This study may help to define the optimal early mobilization strategy in stroke patients. PROSPERO registration number: CRD42023430494


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Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20:795-820.

Wafa HA, Wolfe CD, Emmett E, Roth GA, Johnson CO, Wang Y. Burden of stroke in Europe: thirty-year projections of incidence, prevalence, deaths, and disability-adjusted life years. Stroke. 2020;51:2418-27.

Jauch EC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke AHA/ASA guideline. Stroke. 2013;44:870-947.

Hurford R, Sekhar A, Hughes TA, Muir KW. Diagnosis and management of acute ischaemic stroke. Pract Neurol. 2020;20:306-18.

Rethnam V, Hayward KS, Bernhardt J, Churilov L. Early mobilization after stroke: do clinical practice guidelines support clinicians’ decision-making? Front Neurol. 2021;12:606525.

Bernhardt J. Very early mobilization following acute stroke: controversies, the unknowns, and a way forward. Ann Indian Acad Neurol. 2018;11:S88-98.

Ahmed N, Audebert H, Turc G, Cordonnier C, Christensen H, Sacco S, et al. Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11–13 November 2018. Eur Stroke J. 2019;4:307-17.

Langhorne P, Wu O, Rodgers H, Ashburn A, Bernhardt J. very early rehabilitation trial after stroke (AVERT): a phase III, multicentre, randomised controlled trial. Health Technol Assess. 2017;21:1-120.

Ding R, Zhang H. Efficacy of very early mobilization in patients with acute stroke: a systematic review and meta-analysis. Ann Palliat Med. 2021;10:11776-84.

Langhorne P, Collier JM, Bate PJ, Thuy MN, Bernhardt J. Very early versus delayed mobilisation after stroke. Cochrane Database Syst Rev. 2018;10:CD006187.

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:e0149466.

Martins AI, Sargento-Freitas J, Silva F, Jesus-Ribeiro J, Correia I, et al. Recanalization modulates association between blood pressure and functional outcome in acute ischemic stroke. Stroke. 2016;47:1571-6.

Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.




How to Cite

Fernandes C, Sousa JA, Bernardo-Castro S, Silva F, Donato H, Sargento-Freitas J. Early Mobilization Decision after an Acute Ischemic Stroke: Protocol for an Umbrella Review. Acta Med Port [Internet]. 2024 Mar. 15 [cited 2024 Jun. 24];. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/20715



Study Protocols