Physical Activity Early after Stroke and Its Association to Functional Outcome 3 Months Later
Abstract
Background Early rehabilitation that includes early mobilization and increased amount of motor activity is hypothesized to be one of the most important factors contributing to the beneficial effect of comprehensive stroke unit treatment, whereas too much bed rest is hypothesized to be harmful. The purpose of the present study was to assess the association between early activity/bed rest and functional outcome 3 months later.Methods This was a prospective cohort study including patients with the diagnosis of stroke admitted to Trondheim University Hospital, Norway. Patients were eligible if they were less than 14 days poststroke and did not receive palliative care. Motor activity/bed rest was recorded in the acute phase using a standard method of observation, and the outcome was assessed by the modified Rankin Scale (mRS) score 3 months later. A proportional odds model was used to analyze the association between motor activity/bed rest and outcome. All analyses were adjusted for age, gender, stroke severity, time from stroke to observation, and prestroke function.Results A total of 106 patients (mean age 79.0 years, 56.6% men) were included. The odds ratio for a higher mRS score (poor outcome) was 1.04 (95% confidence interval [CI] 1.02-1.07, P = .001) as time in bed increased and .97 (95% CI .93-1.02, P = .283) as time in motor activity increased.Conclusions This study confirms that time in bed in the early phase is associated with poor functional outcome 3 months later, indicating that too much bed rest should be avoided in the early phase after stroke.
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Non-ambulatory stroke survivors are at the highest risk of inactivity, which is the greatest challenge to the healthcare system.
“In turn, non-ambulatory stroke survivors are at the highest risk of inactivity, which is the greatest challenge to the healthcare system [9,13].”
From Physical Activity, Psychological and Functional Outcomes in Non-Ambulatory Stroke Patients during Rehabilitation—A Pilot Study (2022) · cites this paper as [9]
Time in bed in the early phase is associated with poor functional outcomes 3 and 6 months later.
“In turn, time in bed in the early phase is associated with poor functional outcomes 3 and 6 months later [9,10].”
From Physical Activity, Psychological and Functional Outcomes in Non-Ambulatory Stroke Patients during Rehabilitation—A Pilot Study (2022) · cites this paper as [9]
Cites
Measurements of acute cerebral infarction: a clinical examination scale.
Brott, T. G., Adams, H. P., Olinger, C. P., Marler, J. R., Barsan, W. G., Biller, J., Spilker, J. A., Holleran, R. S., EBERLE, R. W., & Hertzberg, V. (1989) · Stroke · doi:10.1161/01.str.20.7.864 · Cited by 5,918 · see citing works
Classification and natural history of clinically identifiable subtypes of cerebral infarction
Bamford, J., Sandercock, P., Dennis, M., Warlow, C., & Burn, J. (1991) · The Lancet · doi:10.1016/0140-6736(91)93206-o · Cited by 3,294 · see citing works
Banks, J. L., & Marotta, C. A. (2007) · Stroke · doi:10.1161/01.str.0000258355.23810.c6 · Cited by 2,253 · see citing works
Generalized Ordered Logit/Partial Proportional Odds Models for Ordinal Dependent Variables
Williams, R. A. (2006) · The Stata Journal Promoting communications on statistics and Stata · doi:10.1177/1536867x0600600104 · Cited by 2,136 · see citing works
Sedentary Behaviors and Subsequent Health Outcomes in Adults
Thorp, A. A., Owen, N., Neuhaus, M., & Dunstan, D. W. (2011) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2011.05.004 · Cited by 1,455 · see citing works
Organised inpatient (stroke unit) care for stroke
Collaboratio, S. U. T. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000197.pub2 · Cited by 1,315 · see citing works
Bernhardt (2004) · doi:10.1161/01.str.0000120727.40792.40 · Cited by 593 · see citing works
Bed rest: a potentially harmful treatment needing more careful evaluation
Allen, C., Glasziou, P., & Mar, C. D. (1999) · The Lancet · doi:10.1016/s0140-6736(98)10063-6 · Cited by 480 · see citing works
Benefit of a stroke unit: a randomized controlled trial.
Indredavik, B., Bakke, F., Solberg, R., Rokseth, R., Haaheim, L. L., & Holme, I. (1991) · Stroke · doi:10.1161/01.str.22.8.1026 · Cited by 462 · see citing works
Self-citationComparison of Neurological Scales and Scoring Systems for Acute Stroke Prognosis
Muir, K. W., Weir, C. J., Murray, G. D., Povey, C., & Lees, K. R. (1996) · Stroke · doi:10.1161/01.str.27.10.1817 · Cited by 440 · see citing works
What are the components of effective stroke unit care?
Langhorne, P. (2002) · Age and Ageing · doi:10.1093/ageing/31.5.365 · Cited by 380 · see citing works
Treatment in a Combined Acute and Rehabilitation Stroke Unit: Which Aspects Are Most Important?
Indredavik, B., Bakke, F., Slørdahl, S. A., Rokseth, R., & Håheim, L. L. (1999) · Stroke · doi:10.1161/01.str.30.5.917 · Cited by 368 · see citing works
Self-citationMonitoring of Physical Activity after Stroke: A Systematic Review of Accelerometry-Based Measures
Gebruers, N., Vanroy, C., Truijen, S., Engelborghs, S., & De Deyn, P. P. (2010) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2009.10.025 · Cited by 293 · see citing works
Taraldsen, K., Askim, T., Sletvold, O., Einarsen, E. K., Bjåstad, K. G., Indredavik, B., & Helbostad, J. L. (2011) · Physical Therapy · doi:10.2522/ptj.20100159 · Cited by 282 · see citing works
Self-citationCumming, T. B., Thrift, A. G., Collier, J. M., Churilov, L., Dewey, H. M., Donnan, G. A., & Bernhardt, J. (2011) · Stroke · doi:10.1161/strokeaha.110.594598 · Cited by 281 · see citing works
Self-citationSystematic Review of Prognostic Models in Patients with Acute Stroke
Counsell, C. E., & Dennis, M. S. (2001) · Cerebrovascular Diseases · doi:10.1159/000047699 · Cited by 249 · see citing works
The Optimising Analysis of Stroke Trials (OAST) Collaboration (2007) · Stroke · doi:10.1161/strokeaha.106.474080 · Cited by 192 · see citing works
Physical Activity in Hospitalised Stroke Patients
West, T., & Bernhardt, J. (2011) · Stroke Research and Treatment · doi:10.1155/2012/813765 · Cited by 187 · see citing works
Self-citationClark, D. E., Lowman, J. D., Griffin, R. L., et al. (2012) · Physical Therapy · doi:10.2522/ptj.20110417 · Cited by 187 · see citing works
Govan, L., Langhorne, P., & Weir, C. J. (2007) · Stroke · doi:10.1161/strokeaha.106.478842 · Cited by 168 · see citing works
Benefit of an Extended Stroke Unit Service With Early Supported Discharge
Indredavik, B., Fjærtoft, H., Ekeberg, G., Løge, A. D., & Mørch, B. (2000) · Stroke · doi:10.1161/01.str.31.12.2989 · Cited by 163 · see citing works
Self-citationHarrell, F. E. (2001) · Springer series in statistics · doi:10.1007/978-1-4757-3462-1_13 · Cited by 153 · see citing works
Very Early Rehabilitation or Intensive Telemetry after Stroke: A Pilot Randomised Trial
Langhorne, P., Stott, D. J., Knight, A., Bernhardt, J. A., Barer, D. H., & Watkins, C. L. (2010) · Cerebrovascular Diseases · doi:10.1159/000278931 · Cited by 148 · see citing works
Self-citationDrolet, A., DeJuilio, P., Harkless, S., Henricks, S., Kamin, E., Leddy, E. A., Lloyd, J., Waters, C., & Williams, S. (2012) · Physical Therapy · doi:10.2522/ptj.20110400 · Cited by 123 · see citing works
Outcome After Mobilization Within 24 Hours of Acute Stroke: A Randomized Controlled Trial
Sundseth, A., Thommessen, B., & Rønning, O. M. (2012) · Stroke · doi:10.1161/strokeaha.111.646687 · Cited by 113 · see citing works
Gender Differences in the Functional Recovery after Acute Stroke
Kim, J. S., Lee, K., Roh, H., Ahn, M., & Hwang, H.-W. (2010) · Journal of Clinical Neurology · doi:10.3988/jcn.2010.6.4.183 · Cited by 109 · see citing works
Kwakkel, G., Veerbeek, J. M., van Wegen, E. E. H., Nijland, R. H. M., der Wel, B. C. H.-V., & Dippel, D. W. J. (2010) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2010.04.004 · Cited by 97 · see citing works
Processes of Care and Medical Complications in Patients With Stroke
Ingeman, A., Andersen, G., Hundborg, H., Svendsen, M., & Johnsen, S. P. (2011) · Stroke · doi:10.1161/strokeaha.110.599738 · Cited by 93 · see citing works
Diserens, K., Moreira, T., Hirt, L., Faouzi, M., Grujic, J., Bieler, G., Vuadens, P., & Michel, P. (2011) · Clinical Rehabilitation · doi:10.1177/0269215511425541 · Cited by 93 · see citing works
Predicting functional outcome after stroke by modelling baseline clinical and CT variables
Reid, J. M., Gubitz, G. J., Dai, D., Kydd, D., Eskes, G. A., Reidy, Y., Christian, C. A., Counsell, C. E., Dennis, M. S., & Phillips, S. J. (2010) · Age and Ageing · doi:10.1093/ageing/afq027 · Cited by 89 · see citing works
Olkowski, B. F., Devine, M. A., Slotnick, L. E., Veznedaroglu, E., Liebman, K. M., Arcaro, M. L., & Binning, M. J. (2012) · Physical Therapy · doi:10.2522/ptj.20110334 · Cited by 88 · see citing works
Lack of regular physical exercise or too much inactivity
Thyfault, J. P., & Booth, F. W. (2011) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0b013e3283468e69 · Cited by 74 · see citing works
Sorbello, D., Dewey, H. M., Churilov, L., Thrift, A. G., Collier, J. M., Donnan, G. A., & Bernhardt, J. A. (2009) · Cerebrovascular Diseases · doi:10.1159/000230712 · Cited by 70 · see citing works
Self-citationAskim, T., Rohweder, G., Lydersen, S., & Indredavik, B. (2004) · Clinical Rehabilitation · doi:10.1191/0269215504cr752oa · Cited by 68 · see citing works
Self-citationAskim, T., Bernhardt, J., Churilov, L., Fredriksen, K., & Indredavik, B. (2013) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-1137 · Cited by 64 · see citing works
Self-citationRelative Validity of 3 Accelerometer Models for Estimating Energy Expenditure During Light Activity
Wetten, A. A., Batterham, M. J., Tan, S., & Tapsell, L. C. (2014) · Journal of Physical Activity and Health · doi:10.1123/jpah.2011-0167 · Cited by 64 · see citing works
Comprehensive Stroke Units: A Review of Comparative Evidence and Experience
Chan, D. K. Y., Cordato, D. J., O’Rourke, F., Chan, D. L., Pollack, M. R. P., Middleton, S., & Levi, C. R. (2012) · International Journal of Stroke · doi:10.1111/j.1747-4949.2012.00850.x · Cited by 59 · see citing works
Day-to-Day Variability of Physical Activity of Older Adults Living in the Community
Nicolai, S., Benzinger, P., Skelton, D. A., Aminian, K., Becker, C., & Lindemann, U. (2010) · Journal of Aging and Physical Activity · doi:10.1123/japa.18.1.75 · Cited by 57 · see citing works
van Wijk, R., Cumming, T. B., Churilov, L. P., et al. (2011) · Neurorehabilitation and neural repair · doi:10.1177/1545968311407779 · Cited by 48 · see citing works
Quality of Care and Length of Hospital Stay Among Patients With Stroke
Svendsen, M. L., Ehlers, L. H., Andersen, G., & Johnsen, S. P. (2009) · Medical Care · doi:10.1097/mlr.0b013e318195f852 · Cited by 47 · see citing works
Askim, T., Bernhardt, J. A., Løge, A. D., & Indredavik, B. (2011) · International Journal of Stroke · doi:10.1111/j.1747-4949.2011.00697.x · Cited by 42 · see citing works
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Błaszcz, M., Prucnal, N., Wrześniewski, K., Pasiut, S., Mika, P., Kucia, M., Stach, B., Woźniak, M., & Mirek, E. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11247260 · Cited by 12 · see citing works
Kubo, H., Kanai, M., Nozoe, M., Inamoto, A., Taguchi, A., Mase, K., & Shimada, S. (2022) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2022.107202 · Cited by 8 · see citing works
- Authors
- Askim, T., Bernhardt, J., Salvesen, Ø., & Indredavik, B.
- Affiliations
- Norwegian University of Science and Technology (NO)
- La Trobe University (AU)
- Corresponding author
- Askim, Torunn
- Venue
- Journal of Stroke and Cerebrovascular Diseases
- Publisher
- Elsevier BV
- Published
- 2014-05
- Volume
- 23
- Issue
- 5
- Pages
- e305-e312
- ISSN
- 1052-3057 (ISSN-L)
- OpenAlex
- W2016226591
- Cited by
- 91
- References
- 41
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 8 · 2023: 11 · 2022: 10 · 2021: 8 · 2020: 8 · 2019: 7 · 2018: 12 · 2017: 4 · 2016: 8 · 2015: 5 · 2014: 6
- FWCI
- 7.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Stroke and Cerebrovascular Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Keywords
- stroke, bed rest, early mobilization, functional outcome, modified Rankin Scale, stroke rehabilitation, motor activity, time in bed
- MeSH terms
- Stroke Rehabilitation, Aged, Aged, 80 and over, Bed Rest, Disability Evaluation, Exercise Therapy, Female, Hospitals, University, Humans, Male, Middle Aged, Motor Activity, Norway, Prospective Studies, Risk Factors, Severity of Illness Index, Time Factors, Multivariate Analysis, Logistic Models, Odds Ratio, Treatment Outcome, Recovery of Function, Stroke, Secondary Prevention
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