Response to Letter by Freeman et al Regarding Article, “Very Early Mobilization After Stroke Fast-Tracks Return to Walking: Further Results From the Phase II AVERT Randomized Controlled Trial”

Abstract

Response: In their letter, Freeman et al1 ask whether early mobilization is safe after thrombolysis. This is an important question. In a recent Australian review, we found that although protocols guided treatment in the majority of cases, only 53% of these specified when mobilization out of bed could begin. Of these, 33% permitted mobilization within 24 hours of treatment with recombinant tissue-type plasminogen activator (rtPA), whereas the remainder allowed mobilization 24 to 48 hours after treatment.2 Protocols to guide rtPA administration and subsequent care draw on evidence from clinical trials, expert opinion, and personal experience. Because safety was a major concern in early trials and intensive monitoring the norm, it is not surprising that bed rest became the dominant approach. Evidence of the risks and benefits of starting out of bed activity within hours of rtPA delivery is needed. Freeman et al reported no safety concerns when they mobilized 10 patients between 12 and 24 hours …