The Effect of Early Mobilization in Mild to Moderate Hemorrhagic Stroke
The Effect of Early Mobilization in Mild to Moderate Hemorrhagic Stroke
This study aims to examine the outcomes of early mobilization and early intervention within
 24-72 hours after the onset of hemorrhagic stroke in patients admitted to an intensive care
 unit within 24 hours after stroke. The patients after hemorrhagic stroke who undergo early
 intervention only will be compared with those who also receive early mobilization in order to
 determine if the early mobilization intervention results in earlier or more effective
 recovery of postural stability, activities of daily living function, or motor capacity.

 The participants will be randomly assigned to the following two groups: (1) the early
 mobilization (+early rehabilitation) group and (2) the early rehabilitation group.The
 measurement parameters will be collected before the intervention (basic parameters), two
 weeks after the stroke, four weeks after the stroke and three months after the stroke. SPSS
 (version 17.0) will be used to carry out repeated measures analysis of variance (repeated
 ANOVA) to compare the differences between the groups at different time points (including
 basic values and follow-up values). For statistical significance, Bonferroni correction will
 be applied for the post-hoc analysis of the groups.
Early intervention has been proven to enhance post-stroke functional recovery. Recent studies
 have proposed that early mobilization (out-of-bed activities) also contributes to an
 individual's functional improvement after stroke. However, studies on early intervention
 after stroke have mainly investigated patients with ischemic stroke, while tending to exclude
 patients with hemorrhagic stroke who were admitted to intensive care units. The main reason
 for this is the difference between hemorrhagic and ischemic strokes in terms of their
 mechanisms and treatment methods. Hemorrhagic stroke is characterized by higher severity and
 fatality rates, and there is a general lack of research on early rehabilitation and
 mobilization after hemorrhagic strokes. To our knowledge, there have been no previous studies
 that have simultaneously compared the impact of early mobilization and early rehabilitation
 starting at the same time on the motor recovery of patients after intracranial hemorrhage.
 Thus, this study aims to examine the outcomes of early mobilization and intervention within
 24-72 hours after the onset of hemorrhagic stroke in patients admitted to an intensive care
 unit within 24 hours after stroke. The patients will be compared to identify differences in
 the recovery of postural stability and functional abilities two weeks, four weeks and three
 months after stroke.

 The participants will be randomly assigned to the following two groups: (1) the early
 mobilization (+early rehabilitation) group and (2) the early rehabilitation group. The early
 mobilization group will receive early mobilization intervention within24-72 hours after
 stroke while being monitored by medical equipment. In early mobilization group, this
 intervention program will most include early out-of-bed activities (that is, rolling and
 sitting at the edge of the bed). The early rehabilitation group will undergo only
 conventional early in-bed activities in the stroke center.

 All the outcome measures will be collected at baseline (pre-intervention), 2 weeks after
 stroke, 4 weeks after stroke and three months after stroke.The results will be analyzed with
 SPSS (IBM SPSS Statistics 17, Chicago, IL, USA). Repeated measures analysis of variance
 (repeated ANOVA) and the Chi-square test for categorical variables will be used for comparing
 the outcome data. If there are significant interactions, a post hoc test with Bonferroni
 correction will be used to examine group differences within a time condition. A p value <
 0.05 will be considered statistically significant.
The inclusion criteria will be as follows:

 1. patients with a first time intracerebral (either cortical or subcortical) hemorrhage
 with unilateral hemiparesis/ hemiplegia confirmed by magnetic resonance imaging or
 computed tomography;

 2. patients with no contraindications to being mobilized (early intervention) within 24
 hours of stroke onset (based on the medical team's clinical judgment: including
 systolic blood pressure (SBP)<160mmHg in resting; resting heart rate (HR)<130 bpm; no
 hydrocephalus; 80< mean arterial pressure (MAP)<110 mmHg before intervention);

 3. patients with National Institutes of Health Stroke Scale (NIHSS) scores at admission
 ranging from 1 to 20;

 4. patients with total activity of living independence pre-stroke; and

 5. patients between 20 and 80 years old.

 The exclusion criteria will be as follows:

 1. patients with mild to moderate deficits as described above (3);

 2. patients who are unable to complete the baseline survey because of serious aphasia,
 language difficulties, or cognitive deficits;

 3. patients with other medical conditions, such as severe heart failure, acute coronary
 syndrome, or lower-limb disorders, that prevent early mobilization; and

 4. patients who are unable to provide informed consent. In addition, we will exclude
 those showing rapid early deterioration of symptoms, as well as those with a
 concurrent diagnosis of rapidly deteriorating disease (e.g., terminal cancer).