Effects of evidence-based early mobilization on prognostic outcomes in older patients with acute ischemic stroke

Background Early mobilization is a key component of stroke-unit rehabilitation, yet evidence regarding structured, protocolized early mobilization in older adults with acute ischemic stroke remains limited. This study aimed to evaluate whether an evidence-based early mobilization (EBEM) program, added to conventional rehabilitation, is associated with improved short-term outcomes in older patients with acute ischemic stroke. Methods This retrospective cohort study included consecutive patients aged ≥60 years with imaging-confirmed acute ischemic stroke admitted between January 2023 and January 2025. Patients treated during 2023 received conventional rehabilitation (control group), whereas those treated during 2024 received EBEM in addition to conventional rehabilitation (observation group). The primary outcome was favorable functional status at discharge, defined as modified Rankin Scale (mRS) score 0–2. Secondary outcomes included neurological recovery measured by the National Institutes of Health Stroke Scale (NIHSS), functional and motor outcomes, gait performance, length of stay, and in-hospital complications. Multivariable logistic regression, subgroup analyses, and propensity score–based sensitivity analyses were performed. Results A total of 177 patients were analyzed (control n = 86; EBEM n = 91). Favorable functional outcome occurred more frequently in the EBEM group (54.9% vs. 34.9%; p = 0.011). EBEM was independently associated with favorable outcome after adjustment (adjusted odds ratio 3.57, 95% confidence interval 1.61–7.93; p = 0.002). Greater neurological improvement was observed (NIHSS change 4.66 ± 1.27 vs. 3.67 ± 1.31; p < 0.001), along with superior Barthel Index, Fugl–Meyer Assessment motor score, Berg Balance Scale, walking distance, and walking speed (all p < 0.001). EBEM was associated with shorter hospitalization ( p = 0.010), fewer intensive care unit transfers ( p = 0.045), and lower rates of pneumonia (9.9% vs. 20.9%; p = 0.041), venous thromboembolism (2.2% vs. 10.5%; p = 0.023), and pressure injury (1.1% vs. 7.0%; p = 0.045). Sensitivity analyses yielded consistent findings. Conclusion Evidence-based early mobilization added to conventional rehabilitation may be associated with improved short-term functional and neurological outcomes and fewer immobility-related complications in older patients with acute ischemic stroke.