Risk of falling after a stroke: Are patients pushed out of bed too early?

The risk of falling during stroke rehabilitation is an important issue but with little available data. A recent study shows unexpected results on mobilization in the sub-acute phase after strokes.

High risk of falling collides with the benefits of early mobilization

The risk of falling during the rehabilitation phase after a stroke is an important issue on which, unfortunately, there is little data available to date. A small recent study shows unexpected results on mobilization in the sub-acute phase after strokes.

Mobilization is a major topic in many disciplines, especially among older patients. The advantages of early promotion of movement are always offset by the risk of falling and the occurrence of sever adverse events (SAEs). So far there are no consistent results on the risk and benefits of early mobilization measures in the rehabilitation phase after strokes, nor on the ideal time or appropriate fall prevention measures.

There are several studies on mobilization in the acute phase after a stroke. For example, the AVERT study examined the effects of early intervention within the first 24 hours, with the result that the incidence of SAEs is not increased. Another Japanese study also looked at the risk of falls and found that falls occur mainly during the day, in winter and inside buildings on the way to the bathroom. The evaluations showed that 7% of those affected fall within the first week, 37% during the first six months and 73% within the first year. In addition, the risk of further falls increases when an event has already occurred.

Surprising results on fitness training in the rehabilitation phase

The current “PhysStroke” study has now published first results on the effects of mobilization in the sub-acute phase. Two different groups were investigated in this randomized trial. One group received 25 minutes of fitness training five times a week in addition to the standardized post-treatment regimen, while the comparison group received various relaxation techniques instead. The occurrence of SAEs was observed, which were defined as:

The evaluations were compared once after four weeks and once after six months, with the result that in both time intervals significantly more SAEs were observed in the fitness group than in the relaxation group. A more detailed analysis of comorbidities and the occurrence of SAEs showed that patients with diabetes mellitus type 2 or existing atrial fibrillation and additional fitness training were particularly affected by the events.

Important questions remain unanswered

The question remains as to how and by what methods the risk of falling after strokes can best be reduced. In addition to therapeutic fall prophylaxis, a schematic procedure before the start of rehabilitation measures has proven to be a sensible option. This should include a risk assessment, detailed information and advice for patients and relatives, and transparent communication between the medical disciplines involved.

Prof. Dr. med. Dr. phil. Martin Ebinger, Medical Park Berlin Humboldtmühle - Stürze und SAEs nach Schlaganfall (Falls and SAEs after stroke), DGN 2020, 06.11.2020