Journal of Clinical and Diagnostic Research. 2020 Feb, Vol-14(2): YC01-YC05 1 1 DOI: 10.7860/JCDR/2020/37948.13486 Original Article Physiotherapy Section Effect of Very Early Mobilisation on Symptoms of Depression and Anxiety Following Acute Stroke: A Randomised Controlled Trial INTRODUCTION The depression and anxiety are the most recognised adverse events after a cerebro vascular accident [1,2]. Recent systematic reviews and trails from India states that 33% of all stroke survivors experience symptoms of depression and 18% experience anxiety [3-5]. Stroke survivors with depression and anxiety have decreased functional recovery, psychosocial outcome, quality of life and higher death rates and hence greater the length of hospital stay [6-13]. Early and frequent mobilisation is one of the significant parts of acute stroke care units. ‘Very Early Mobilisation’ is defined as frequent out of bed activities of daily living initiated within the first 24 hours of symptom onset [14]. Recent evidence suggests that early and repetitive out of bed activities after acute stroke are proven to be safe, feasible [15] and cost effective [16]. Further very early mobilisation is effective in improving the functional status [17,18], health-related quality of life [19] and reduce the number and severity of adverse events, length of hospital stay [20]. However, recent trials have shown that, very early mobilisation has no effect on depression further had a negative effect on functional disability [21,22]. So, the aim of present study was to determine the effect of very early mobilisation in addition to standard care compared with standard care alone on symptoms of depression and anxiety following acute stroke. MATERIALS AND METHODS This study was a parallel active-controlled, single blinded randomised controlled trial, Registered with Clinical trial registration of India (CTRI/2016/04/006795). Ethical approval was granted by the central ethical committee of the Nitte deemed to be University (ref: NU/CEC/ Ph.D-52/2012). Informed written consent was obtained from all the participants or their caregivers at the start of the study. Subjects were recruited from the stroke population group satisfying the inclusion criteria from the Department of Medicine and Neurology of KS Hegde Charitable hospital, Deralakatte, Mangaluru, Karnataka, India, from December 2013 to December 2015. An informal pilot randomised controlled study was conducted among 30 subjects prior to the actual study. Between groups mean difference (2.16) and pooled standard deviation (3.98) of HAD- Depression scale change scores (admission-discharge) were obtained. The standardised difference obtained was 0.5427. A total of 53 subjects were needed for each group with a two-sided significance of 0.05 (alpha 5%) and a power of 0.8 (beta 20%) [23]. Inclusion Criteria Stroke patients with age above 18 years and of either gender and who was admitted within 24 hours of onset of symptoms, were able to comprehend and respond verbally, systolic BP between 120 and 180 mm Hg, an O 2 saturation >92% (with or without supplementation), a pulse rate between 40 and 100 beats per minute, and within normal range of body temperature <38.5°C, Subjects were included in the study after attaining concerned medical professional permission [24]. Exclusion Criteria Worsened within the first hour of admission to the hospital and intensive care unit, and altered sensorium. Subjects with premorbid modified Rankin Scale [25] (mRS) Score >3, modified rankin scale is a measure of disability, it is a 6 point rating scale, where ‘0’ indicates No symptoms and ‘5’ indicates Severe disability, transient ischemic attacks, concurrent progressive neurological disorder, unstable coronary condition (e.g., acute myocardial infarction) or other medical condition that would impose hazard to the subjects, or if their physiological variables (blood pressure, oxygen, heart rate, temperature) fall outside set safety limits, severe heart failure, lower limb fracture preventing mobilisation, palliative care subjects. PURUSOTHAM CHIPPALA 1 , RAGHAVA SHARMA 2 Keywords: Acute cerebrovascular accident, Early physical activity, Hospital anxiety and depression rating scale, Mood, Physiotherapy ABSTRACT Introduction: Depression and Anxiety are one of the most commonly experienced problems by stroke survivors. It affects the functional status and quality of life of stroke survivor. Early physical activity may reduce symptoms of depression and anxiety. Aim: To determine the effect of very early mobilisation coupled with standard care compared with the standard care alone on symptoms of depression and anxiety following acute stroke. Materials and Methods: Study design was parallel active controlled, randomised controlled trial from December 2013 to December 2015. The intervention group received very early mobilisation including out of bed activities such as sitting, standing upright, walking begun within 24 hours of stroke onset for 5-30 minutes (Determined by patient tolerance) at least twice a day, for seven days. All the participants received standard physiotherapy care for 45 minutes once a day. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression (HAD) rating scale on admission, at discharge and at three months follow-up. The Mann-Whitney U-test was used to compare the HAD rating scale measures between groups and the p-value <0.05 was considered as significant. Results: A total of 105 individuals with acute stroke (62 male and 43 female) aged 30-81 years were recruited in the study. The intervention group (n=48) demonstrated a significant decrease in symptoms of anxiety and depression at discharge (p<0.05) and at three months follow-up (p<0.05) than the standard care group (n=47). Conclusion: Very early mobilisation may be potential treatment to prevent or reduce symptoms of depression and anxiety following acute stroke.