Paper
Thursday, 20 July 2006
This presentation is part of : Using Evidence to Enhance Patient Care
Early Mobilisation of Acute Stroke Patients
Lorraine N. Smith, BScN, MEd, PhD, Nursing, University of Glasgow, Glasgow, United Kingdom and Monica Arias, BScN, MScHC, Nursing, Bournemouth University, Bournemouth, United Kingdom.
Learning Objective #1: understand the level of consensus among healthcare professionals regarding the implementation of early mobilisation of acute stroke patients.
Learning Objective #2: crtitique the relationship between clinical guidelines, lack of evidence and the requirement to deliver good practice.
 
Research Questions 1.        What are healthcare professionals’ views and knowledge about early mobilisation of acute stroke patients?
2.        What is the level of consensus among healthcare professionals regarding the implementation of early mobilisation [EM] of acute stroke patients?
3.        What areas require further research in relation to early mobilisation of acute stroke patients?
 
Population/Sample All stroke units (n=34) in the 14 Scottish health boards identified in the ‘Coronary Heart Disease and Stroke Strategy for Scotland’ constituted the sampling frame.  The lead, acute stroke physician in each unit (n=61), the lead stroke nurse (n=65) and the physiotherapist (n=32) most involved in acute stroke care were identified and contacted personally.  A 62.3% response rate was obtained.
 
Study Design
Postal survey using a self-administered questionnaire and SAE with a ‘return by’ date; one reminder letter sent to all non-responders.
 
Ethics Approval
Multi-centre Research Ethics approval granted prior to piloting.
 
Data Analysis
Data analysed using Minitab 13 and SSPS version 12.0 with a 95% confidence level, p= 0.05.   Multiple comparisons; a Level established by Bonferroni’s correction minimizing the risk of Type I error inflation (p<0.016).  Free-text responses analysed using content analysis.
 
Results
There was no consensus across professional groups regarding ‘early mobilisation’.  Healthcare professionals differed in terms of:
·         what constitutes EM;
·         when patients should be mobilised;
·         who should assess when a patient is ready to be mobilised;
·         how patients should be assessed; and
·         what are appropriate EM strategies.
 
Conclusion American, UK and European clinical guidelines urge EM in acute stroke.  However there is no evidence base for clinical decision-making or the way in which clinical decision-making should be conducted in order to arrive at the judgement that an acute stroke patient should be mobilised.  RCTs are required to establish the duration, frequency, intensity, risk/benefits and activities associated with EM.
 
 
 
 

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