Early Out-of-Bed Rehabilitation After Endovascular Thrombectomy: A Randomized Controlled Trial

Shu-Mei Yang; Hsing-Yu Chen; Hsiao-Ting Tsai; Ting-Ju Lai; Chi-Ping Tseng; Yu-Lin Lai; Ya-Wen Cheng; Huey-Wen Liang; Chueh-Hung Wu; Meng-Ting Lin

doi:10.1016/j.apmr.2026.03.015

Early Out-of-Bed Rehabilitation After Endovascular Thrombectomy: A Randomized Controlled Trial

Arch Phys Med Rehabil. 2026 Mar 25:S0003-9993(26)00622-2. doi: 10.1016/j.apmr.2026.03.015. Online ahead of print.

Authors

Affiliations

¹ Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-chu.
² Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-chu.
³ Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu.
⁴ Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-chu, Taiwan.
⁵ Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei.
⁶ Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsin-chu. Electronic address: b96401093@ntu.edu.tw.

PMID: 41895625
DOI: 10.1016/j.apmr.2026.03.015

Abstract

Objectives: To determine whether out-of-bed rehabilitation within 48 hours after endovascular thrombectomy (EVT) for large-vessel occlusion improves functional outcomes and motor recovery and to evaluate the safety of neurologic and immobility-related complications.

Design: A randomized controlled trial.

Setting: A tertiary medical center.

Participants: Forty-two patients (N=42) who underwent EVT for anterior-circulation large-vessel occlusion and were stable within 48 hours after reperfusion were randomly assigned to early out-of-bed mobilization (EM; n=21) or usual care (UC; n=21) groups.

Interventions: The EM group initiated progressive out-of-bed activities within 48 hours, and the UC group received conventional rehabilitation within 7 days. Both groups received 20-30-minute sessions twice daily, 5 d/wk.

Main outcome measures: The primary outcome was the modified Rankin Scale (mRS) at 3 months. Secondary outcomes included mRS at 1 month, Barthel Index, and Fugl-Meyer Assessment for the upper extremity and lower-extremity at 1 and 3 months. Neurologic and immobility-related adverse events were monitored for 3 months.

Results: At 3 months, no significant between-group difference in mRS was observed. Barthel Index scores were comparable at both follow-up time points. Exploratory analyses suggested greater motor recovery in the EM group. The mean between-group difference in Fugl-Meyer Assessment for the upper extremity was 7.13 points (95% CI, -0.98 to 15.24; P=.083) at 1 month and 12.20 points (95% CI, 1.21-23.19; P=.031) at 3 months, whereas the Fugl-Meyer Assessment for the lower-extremity difference was 5.14 points (95% CI, 1.45-8.84; P=.008) at 1 month and 6.33 points (95% CI, 1.06-11.59; P=.020) at 3 months. Neurologic and immobility-related adverse events were infrequent and comparable.

Conclusions: EM initiated within 48 hours after EVT was not associated with improved overall functional outcome but was safe and associated with notably greater upper and lower-extremity motor recovery compared with UC.

Keywords: Early mobilization; Functional recovery; Ischemic stroke; Rehabilitation; Thrombectomy.