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| Reference | Keyword* or bone protection included (level of evidence) | Mobilisation and rehabilitation (level of evidence) | Falls prevention (level of evidence) |
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| American Heart Association Physical activity recommendations for stroke survivors. [43] | Decreased activity after stroke leads to secondary complications including osteoporosis. | Rehab goals include preventing complications of prolonged inactivity. Initiate regimens to regain prestroke level of activity as soon as possible. | Not included |
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| American Heart Association ...Rehabilitation care for stroke survivors [44] | Not included | It is reasonable to provide a comprehensive interdisciplinary assessment of mobility. | Consider all people with stroke as having increased falls risk. Work with patient & carers, to minimise falls. |
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| Beijing Neurological Club [45] (English summary only available) | Not included | Rehab should occur as early as possible: 48 hours after stabilisation of vital signs and symptoms in ischemic strokes. Delay rehab until 10–14 days after haemorrhage. | Not included |
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| Belgian Stroke Council [46, 47] | Not included | Mobilise on stroke unit as soon as possible to prevent complications including aspiration pneumonia, DVT, decubitus ulcers. | Not included |
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| Canadian Stroke Network and the Heart and Stroke Foundation of Canada [48] | Not included | Early consultation with rehab professionals can reduce risk of complications from stroke-related immobility such as joint contracture, falls, aspiration pneumonia, & DVT. | Multifactorial community interventions including individualised exercise programs may prevent or reduce falls number & severity. (Level A) |
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| Chinese Stroke Management Guidelines [49] (English summary only available) | Not included | Recommend stroke unit (I, A). | Not included. |
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| Croatian Stroke Society [50] | Not included | Recommend early mobilisation unless intracerebral hypertension is present, to help prevent complications including aspiration pneumonia, DVT, & ulcers (IV). | Not included |
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| European Stroke Organization [51] | Exercise, calcium supplements, & bisphosphonates improve bone strength & decrease post stroke fracture rates. Bisphosphonates for women with previous fractures (II, B). | Early mobilisation is recommended to prevent complications such as aspiration pneumonia, DVT, and pressure ulcers (IV, GCP). | Assessment of falls risk is recommended for every stroke patient (IV, GCP).Vitamin D/calcium for patients at risk of falls (II, B). |
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| Italian SPREAD Collaboration [52] | Not included | Early mobilisation for acute stroke patients, unless clinically contraindicated (C). | Evaluate falls risk on admission and periodically during hospitalisation (C). |
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| Japan Stroke Guidelines Committee [53] | Not included | Aggressive rehab can reduce incidence of pneumonia & other complications (B). Stroke unit for acute patients, except sub-arachnoid haemorrhage, lacunar infarction, deep coma, or patients with poor premorbid ADL (A). | Not included |
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| National Collaborating Centre for Chronic Conditions (UK) [54] | Not included | People with acute stroke should be mobilised as soon as possible (when their clinical condition permits) on a specialist stroke unit. | Not included |
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| National Stroke Foundation (Australia) [41] | Not included | Patients should be mobilised as early and as frequently as possible (B). Rehab should provide as much practice as possible within the first 6 months after stroke (A), minimum of one hour active practice per day at least five days a week (GCP). | Falls risk assessment should be undertaken using a valid tool on admission to hospital. Management plans should be initiated for people at risk of falls (GCP). Provide multi factorial community interventions, including individually prescribed exercises for people at falls risk (B). |
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| Norwegian Stroke Guidelines [55] | “Fracture” mentioned twice. | Comprehensive stroke unit for all patients. Multidisciplinary team to contribute to patients’ mobilisation out of bed, as early and frequently as possible (B). | Give patients with falls risk multi factorial intervention targeting individual and contextual risk factors, including individually prescribed exercise (C). |
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| Nova Scotia Health [56] | Prevention & management of medical complications including osteoporosis is required in stroke rehabilitation. | All patients with stroke should begin rehab early, once medically stable (1). Patients should be mobilised as early and as frequently as possible (III-3). As much therapy as patients are willing & able to tolerate (A). | All patients should be assessed for fall risk (III-2). Patients at risk of falls should have a management plan formulated and documented in collaboration with the patient and caregiver(s) (III). |
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| Ottawa Panel [57] | Not included | 147 recommendations for 13 rehab treatments including gait & exercise. | Balance training is essential in preventing falls |
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| Royal Dutch Society for Physical Therapy [58] | Not included | Starting rehabilitation as soon as possible (within 72 hours of stroke), preferably in a stroke unit, may accelerate & enhance recovery. If possible, mobilise immediately to reduce DVT risk. | It is plausible that the positive effects on postural symmetry & speed of symmetric standing up & sitting down reduce falls while standing up and sitting down. |
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| Scottish Intercollegiate Guidelines Network (SIGN) [59] | Not included | Where safe, every opportunity to increase the intensity of therapy for improving gait should be pursued (B). | Not included |
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| Scottish National Advisory Committee for Stroke [60] | Risks from exercise include cardiac events, falls and fractures. | Community programs: should be mostly aerobic walking, also functional strength & balance exercises. Frequency: 3x per weekDuration: 1 hour per sessionIntensity: moderate if possible | Individuals’ history of falls, balance, osteoporosis & psychoactive medications need to be considered in tailoring of exercise interventions.. |
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| Singapore Ministry of Health [61] | Not included | Early mobilisation for all stroke patients to reduce DVT & pulmonary embolism (D, 2+) | Long-term anticoagulation is contraindicated in elderly patients at high risk of falls. |
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| South African Stroke Society [62] | Not included | Early mobilisation is recommended to prevent complications: aspiration pneumonia, DVT, & pressure ulcers (IV, GCP). | Recommend assessment of falls risk for every stroke patient (IV, GCP). Patient safety & prevention of falls and injury are of paramount importance. |
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| Stroke Foundation of New Zealand [63] | Not included | Early mobilisation for all acute stroke patients to prevent DVT and PE (IV).Rehab should provide as much practice as possible within 6 months of stroke (A), a minimum of 1 hour active rehab per day (IV). | Falls risk assessment should occur on hospital admission, and a management plan initiated (IV).Multifactorial community intervention, including tailored exercises for people at falls risk (B) |
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| Stroke Society of the Philippines [64] | Not included | Major rehab goals for stroke patients are to (1) prevent complications of prolonged inactivity, (2) decrease recurrent stroke and cardiovascular events and (3) increase aerobic fitness. | Stroke survivors are often deconditioned & predisposed to sedentary lifestyle that limits performance of ADLs, increases falls risk, and may contribute to increased risk for recurrent stroke & cardio-vascular disease. |
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| Swedish Stroke Guidelines [65] | Training of balance, safe transfers, and education are important measures to prevent falls and related fractures. | Stroke units are strongly recommended, and mobilisation from early after stroke is of highest importance. Patients should not have unnecessary heart monitoring if it interferes with early mobilisation. | Some evidence supports assessment and prevention of falls for stroke patients, including balance training, patient/ carer information, home hazard reduction, and discontinuation of psychotropic drugs. |
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| UK National Guidelines [66] | Not included | Mobilise people with stroke as soon as their clinical condition permits, on a specialist stroke unit. | Any patient with significant balance impairment should be given intensive progressive balance training. |
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| Veteran’s Affairs/Department of Defence (U.S.) [67] | Early mobilisation & paretic limb movement reduces fracture risk (II-1, A). Consider medications to reduce bone loss (II-1, B), including vitamin D (I, B). Consider assessing bone density for patients with osteoporosis who have been mobilised (sic) for 4 weeks. | All patients should be mobilised, as soon as possible, for prevention of DVT. | Not included |
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