##common.pageHeaderLogo.altText##
DOI:
https://doi.org/10.57187/4921

Medical guidelines

Vol. 156 No. 3 (2026)

Recommendations for early mobilisation at Swiss Stroke Centres and Stroke Units: a practice guide and discussion paper

Cite this as:
Swiss Med Wkly. 2026;156:4921
Published
25.03.2026

Summary

 The present recommendation document proposes a non-binding practical guide intended to support the standardised implementation of early mobilisation at Swiss Stroke Centres and Stroke Units, with application planned to begin in January 2026. It was developed by the “Early Mobilisation Working Group”, established in November 2023, to promote a consistent, evidence-based approach to mobilising stroke survivors in the (hyper)acute phase at Swiss Stroke Centres and Stroke Units. The group originated from the “Stroke Therapy Network” committee of the Swiss Stroke Society and developed into a collaboration with the “Stroke Nursing Network” committee of the Swiss Stroke Society.

The current literature does not provide sufficient evidence to define all aspects of the dose and intensity of early mobilisation of stroke survivors. Therefore, this guide also draws upon clinical expertise and considers the structural and organisational conditions specific to Swiss Stroke Centres and Stroke Units.

Some aspects of early mobilisation remain insufficiently defined and require ongoing discussion and research. The authors explicitly invite stakeholders and readers to provide feedback to support the continued development and improvement of this guide. 

References

  1. 1. Klein KE, Bena JF, Mulkey M, Albert NM. Sustainability of a nurse-driven early progressive mobility protocol and patient clinical and psychological health outcomes in a neurological intensive care unit. Intensive Crit Care Nurs. 2018 Apr;45:11–7. 10.1016/j.iccn.2018.01.005
  2. 2. Klein K, Mulkey M, Bena JF, Albert NM. Clinical and psychological effects of early mobilization in patients treated in a neurologic ICU: a comparative study. Crit Care Med. 2015 Apr;43(4):865–73. 10.1097/CCM.0000000000000787
  3. 3. Wuschke J, Sahli L, van den Keybus Deglon K, Klaiber G, Horn T, Loewer A, Betschart M. Use of mobilisation protocols across Swiss Stroke Centers and Units; a national survey from 2025. forthcoming 2026.
  4. 4. Rethnam V, Hayward KS, Bernhardt J, Churilov L. Early Mobilization After Stroke: Do Clinical Practice Guidelines Support Clinicians’ Decision-Making? Front Neurol. 2021 Feb;12:606525. 10.3389/fneur.2021.606525
  5. 5. Baethge C, Goldbeck-Wood S, Mertens S. SANRA-a scale for the quality assessment of narrative review articles. Res Integr Peer Rev. 2019 Mar;4(1):5. 10.1186/s41073-019-0064-8
  6. 6. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344–418. 10.1161/STR.0000000000000211
  7. 7. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management: NICE guideline Reference number:NG128. April 2022. https://www.nice.org.uk/guidance/ng128. Accessed Juni 2025.
  8. 8. AWMF. S3-Leitlinie Lagerungstherapie und Mobilisation von kritisch Erkrankten auf Intensivstation. 2023-2027. https://register.awmf.org/de/leitlinien/detail/001-015. Accessed June 2025.
  9. 9. Steiner T, Turc G, Dawson J, Sunnerhagen K, Christensen H. SAP-E Essentials of Stroke Care; European Stroke Organisation Action Plan: An overview of evidence-based interventions covering the entire chain of stroke care. https://actionplan.eso-stroke.org/wp-content/uploads/2021/07/Essential-Stroke-Care_final_20210714_CPO.pdf. Accessed April 2025.
  10. 10. Australian and New Zealand LIving Clinical Guidelines for Stroke Managment. New Zealand LIving Clinical Guidelines for Stroke Managment: Chapter 5 of 8: Rehabilitation. 28.07.2023. https://app.magicapp.org/#/guideline/6841. Accessed June 2025.
  11. 11. Veerbeek J, van Wegen E, van Peppen R, Hendriks H, Rietberg MB, van der Wees P, et al. KNGF Clinical Practice Guideline for Physical Therapy in patients with stroke: Practice Guidelines. 2014. https://www.dsnr.nl/wp-content/uploads/2012/03/stroke_practice_guidelines_2014.pdf
  12. 12. Kwakkel G, Stinear C, Essers B, Munoz-Novoa M, Branscheidt M, Cabanas-Valdés R, et al. Motor rehabilitation after stroke: european Stroke Organisation (ESO) consensus-based definition and guiding framework. Eur Stroke J. 2023 Dec;8(4):880–94. 10.1177/23969873231191304
  13. 13. Schaller SJ, Scheffenbichler FT, Bein T, Blobner M, Grunow JJ, Hamsen U, et al. Guideline on positioning and early mobilisation in the critically ill by an expert panel. Intensive Care Med. 2024 Aug;50(8):1211–27. 10.1007/s00134-024-07532-2
  14. 14. Rethnam V, Langhorne P, Churilov L, Hayward KS, Herisson F, Poletto SR, et al. Early mobilisation post-stroke: a systematic review and meta-analysis of individual participant data. Disabil Rehabil. 2022 Apr;44(8):1156–63. 10.1080/09638288.2020.1789229
  15. 15. Mariana de Aquino Miranda J, Mendes Borges V, Bazan R, José Luvizutto G, Sabrysna Morais Shinosaki J. Early mobilization in acute stroke phase: a systematic review. Top Stroke Rehabil. 2023 Mar;30(2):157–68. 10.1080/10749357.2021.2008595
  16. 16. Foley N, Hussein N, Saikaley M, Iruthayarajah J, Wiener J, Speechley M, et al. The Elements of Stroke Rehabilitation: Chapter 6. http://www.ebrsr.com/evidence-review/6-elements-stroke-rehabilitation
  17. 17. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001 Oct;94(10):521–6. 10.1093/qjmed/94.10.521
  18. 18. Bernhardt J, Churilov L, Ellery F, Collier J, Chamberlain J, Langhorne P, et al.; AVERT Collaboration Group. Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT). Neurology. 2016 Jun;86(23):2138–45. 10.1212/WNL.0000000000002459
  19. 19. Norvang OP, Hokstad A, Taraldsen K, Tan X, Lydersen S, Indredavik B, et al. Time spent lying, sitting, and upright during hospitalization after stroke: a prospective observation study. BMC Neurol. 2018 Sep;18(1):138. 10.1186/s12883-018-1134-0
  20. 20. Waziry R, Heshmatollah A, Bos D, Chibnik LB, Ikram MA, Hofman A, et al. Time Trends in Survival Following First Hemorrhagic or Ischemic Stroke Between 1991 and 2015 in the Rotterdam Study. Stroke. 2020 Mar;51(3):STROKEAHA119027198. 10.1161/STROKEAHA.119.027198
  21. 21. Namale G, Kamacooko O, Makhoba A, Mugabi T, Ndagire M, Ssanyu P, et al. Predictors of 30-day and 90-day mortality among hemorrhagic and ischemic stroke patients in urban Uganda: a prospective hospital-based cohort study. BMC Cardiovasc Disord. 2020 Oct;20(1):442. 10.1186/s12872-020-01724-6
  22. 22. Arnold SM, Dinkins M, Mooney LH, Freeman WD, Rawal B, Heckman MG, et al. Very early mobilization in stroke patients treated with intravenous recombinant tissue plasminogen activator. J Stroke Cerebrovasc Dis. 2015 Jun;24(6):1168–73. 10.1016/j.jstrokecerebrovasdis.2015.01.007
  23. 23. Momosaki R, Yasunaga H, Kakuda W, Matsui H, Fushimi K, Abo M. Very Early versus Delayed Rehabilitation for Acute Ischemic Stroke Patients with Intravenous Recombinant Tissue Plasminogen Activator: A Nationwide Retrospective Cohort Study. Cerebrovasc Dis. 2016;42(1-2):41–8. 10.1159/000444720
  24. 24. Silver B, Hamid T, Khan M, Di Napoli M, Behrouz R, Saposnik G, et al. 12 versus 24 h bed rest after acute ischemic stroke thrombolysis: a preliminary experience. J Neurol Sci. 2020 Feb;409:116618. 10.1016/j.jns.2019.116618
  25. 25. Anderson CS, Arima H, Lavados P, Billot L, Hackett ML, Olavarría VV, et al.; HeadPoST Investigators and Coordinators. Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke. N Engl J Med. 2017 Jun;376(25):2437–47. 10.1056/NEJMoa1615715
  26. 26. Alexandrov AW, Tsivgoulis G, Hill MD, Liebeskind DS, Schellinger P, Ovbiagele B, et al. HeadPoST: rightly positioned, or flat out wrong? Neurology. 2018 May;90(19):885–9. 10.1212/WNL.0000000000005481
  27. 27. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81. doi: https://doi.org/10.1249/00005768-198205000-00012
  28. 28. MacKay-Lyons M, Billinger SA, Eng JJ, Dromerick A, Giacomantonio N, Hafer-Macko C, et al. Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update. Phys Ther. 2020 Jan;100(1):149–56. 10.1093/ptj/pzz153

Most read articles by the same author(s)