People Often Inactive, Alone After a Stroke

In the early days after having a stroke, most patients spend most of their time alone resting in bed, when they should be encouraged to be active.

Complications of immobility account for as many as half the deaths in the first month after a stroke, explain the authors of an article in the medical journal Stroke, but little information is available about early mobilization.

Dr. Julie Bernhardt from the National Stroke Research Institute in Heidelberg, Victoria, Australia, and colleagues investigated the physical activity of 58 patients from five acute stroke units in metropolitan Melbourne during the first 13 days after an acute stroke.

"Fifty-three percent of the time, patients were resting in bed," the team reports, though only nine patients were restricted to bed.

Patients were in or beside their beds for 89 percent of the observation time, the report indicates, and only 13 percent of the day was spent being active. People with severe stroke spent even a higher proportion of their days (96 percent) in bed.

Patients spent 60 percent of their time alone and 15 percent with friends or family, the researchers note. Contact with therapists accounted for only 5 percent of the day, including an average of 23 minutes in occupational therapy, 33 minutes in speech and language therapy, and 24 minutes in physical therapy.

"The amount of activity currently occurring among stroke patients in some hospitals is very minimal," Bernhardt stated, "and these levels may not represent the early rehabilitation that we believe is or should be happening as part of organized stroke care."

The team hopes to at least double the activity of patients in the first two weeks after stroke, she said.

"What remains unknown is whether this will improve the outcome of patients in the short or long term. That is why we need 'AVERT,' a randomized controlled trial of very early rehabilitation," Bernhardt explained.

The first aim with the project "is to see whether the intervention works (i.e., whether there are fewer people dying or living in a nursing home at 3 months after stroke).'

But money may be a problem. "Trials of pharmaceuticals are well funded, whereas we face a considerable challenge to fund trials of other, simple interventions," Bernhardt added.

SOURCE: Stroke, April 2004.

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