The effect of mobilization on blood pressure for stroke survivors with moderate or severe injury: a rapid review

Abstract

Purpose: Severe stroke survivors respond to mobilization rehabilitation interventions with more varied outcomes than those with less severe stroke. They may face additional risks for impaired blood pressure regulation and extended vulnerability to blood pressure changes, potentially contributing to poor recovery outcomes. The primary aim of this rapid review was to identify and synthesize current evidence investigating the effects of mobilization on blood pressure, for stroke survivors in the acute and early stage of rehabilitation. The secondary aim was to identify potential risks associated with acute mobilization interventions, to inform clinical decisions and guide future research directions. Materials and methods: A comprehensive search strategy was conducted in five databases supplemented with scrutiny of published stroke guidelines. Inclusion criteria were: severe or moderate stroke injury; acute or early post-stroke (<90 days); mobilization intervention; and reporting blood pressure measures. Data was extracted, tabled, and synthesized using descriptive analysis. Results: Seven hundred and ten articles were identified, of which seven articles were included. Varied mobilization interventions were described including sitting (n = 4), backrest tilt (n = 1), standing (n = 2), tilt table with or without exercises (n = 2), and supine cycling (n = 1). Large blood pressure changes, most frequently hypotension, were found in a small number of participants, with increasing incidence for more vertical and passive mobilization activities. Blood pressure changes stabilized over time. Conclusions: Transient blood pressure changes frequently occurred with mobilization. Concerningly, large blood pressure changes occurred for some participants, increasing with verticality and passive nature of mobilization. Further research is needed, to guide optimal mobilization rehabilitation for acute severe stroke survivors.