Is early mobilization associated with functional improvement in acute middle cerebral artery ischemic stroke treated with recombinant tissue plasminogen activator? A proof of concept and retrospective single-center study

Background: The benefit of commencing early mobilization for patients after ischemic stroke (IS) is well established. However, the timing and benefits of early mobilization in recombinant tissue plasminogen activator (rtPA)-treated patients remain mostly undefined.Methods: In this retrospective observational cohort study, we analyzed rtPA-treated patients after a first-episode middle cerebral artery (MCA)-IS, that were admitted in a Stroke Center, using electronic medical records during the period of January 1, 2015 through December 31, 2017. These patients who received a standard early rehabilitation during the stay in the Stroke Center served as the control group. We examined the association between early mobilization via early rehabilitation within 24-72 hours and activities of daily living and postural control improvements, as indicated by the Barthel Index (BI) effectiveness and the Postural Assessment Scale for Stroke (PASS) effectiveness, respectively.Results: Total 60 patients with a first MCA-IS treated after rtPA were analyzed. Multiple linear regression analysis indicated that BI and PASS effectiveness were positively correlated with not only age and the stroke severity at 24 hours after rtPA treatment but commencing early mobilization within 24-72 hours after stroke in patients with a first MCA-IS treated after rtPA.Conclusions: This study concludes that early mobilization may be associated with an acceleration of functional improvement in patients with a first MCA-IS treated with rtPA within four weeks after the onset.