Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is moderate or low to moderate where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes.
Population: Adults with acute stroke (mean age 60 to 77 years) ᵃ
Intervention: Very early mobilisation (median time to mobilisation after stroke 18.5 hours: range 13.1 to 43 hours)
Comparison: Standard care (median time to mobilisation after stroke 33.3 hours: range 22.5 to 71.5 hours)
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Mortality (median 3‐month follow‐up) | No statistically significant difference | Moderate |
Death or dependency (median 3‐month follow‐up) | No statistically significant difference | Moderate |
Death or institutional care | No statistically significant difference | GRADE assessment not performed for this outcome |
Activities of daily living (ADL) score (median 3‐month follow‐up) | Favours intervention | Low |
Able to walk | No statistically significant difference | GRADE assessment not performed for this outcome |
Duration of acute hospital stay | Favours intervention | Low |
Complications (median 3‐month follow‐up) | No statistically significant difference | Low |
Note The Cochrane review which this Cochrane Clinical Answer (CCA) is based on states that a cautious approach to active mobilisation within 24 hours of a stroke is supported due to the evidence suggesting that it may carry some increased risk. It notes that although they included nine studies (N=2958), most of the evidence was based on the largest study (AVERT III, N=2104). The Cochrane review also performed an exploratory network meta-analysis that suggested mobilisation at 24 hours may produce the best outcome (low-quality evidence as assessed by GRADE). ᵃ For the included studies the median percentage of people with an intracerebral haemorrhage was 12%. See CCA for more details.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What is the accuracy of prehospital stroke scales as screening tools for early detection of stroke and transient ischemic attacks (TIAs)?
- How does organized inpatient care compare with care on a general medical ward for people with stroke?
- How does very early mobilization compare with standard care after stroke?
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