Background and aims: While stroke guidelines guard against intensive early mobility training, clinicians want further guidance for early mobility training after stroke. Evidence for early mobility training in ischaemic stroke is growing, however, clinical trials evaluating early mobility training in haemorrhagic stroke are lacking. The largest international trial in early mobility training identified people with intracerebral haemorrhage may be more vulnerable to early mobility training. Our international collaboration aims to build guidance for early mobility training after intracerebral haemorrhage.
Method: Twenty-six collaborators including neurologists, nurses, physiotherapists, people with lived experience of stroke and researchers co-produced an evidence and expert informed clinical protocol for early mobility training after intracerebral haemorrhage ready for evaluation. Value focused thinking was used to optimise decision making during a series of iterative workshops run via videoconference across nine countries including low-middle and high income settings.
Results: We identified 10 key parameters required to assess the potential safety and effectiveness of initiating early mobility training after intracerebral haemorrhage; monitoring requirements during early training; and, ranked key outcomes and data points to evaluate the training. All elements have been protocolised into a decision matrix alongside guidance for implementation and patient, family and caregiver engagement.
Conclusion: A one-size-fits-all approach to timing and dosage of early mobility training should not be applied to people after intracerebral haemorrhage. We developed expert and evidence informed training pathways for intracerebral haemorrhage phenotypes with different risk profiles which are ready for evaluation.