Physiotherapists' experiences of early mobilization after stroke thrombolysis in England and Wales: A qualitative study

Introduction Thrombolysis with tissue plasminogen activator is a mainstream treatment for ischemic stroke. Known risks with thrombolysis include intracerebral hemorrhage and bleeding elsewhere in the body. There are no specific recommendations for the timing of commencing mobility rehabilitation after thrombolysis. Research evidence for early mobilization (within 24 hours) after thrombolysis is sparse and little is known about physiotherapy practice in the UK.Purpose: This exploratory study aimed to investigate the experiences, including clinical decision-making of physiotherapists in England and Wales regarding early mobilization after thrombolysis. Methods A qualitative study with interpretative paradigm using a phenomenological methodology. Semi-structured interviews were conducted with a purposive sample. Thematic analysis triangulated by participant and researcher review of resultant themes was supported by NVivo software. A reflexive diary was maintained throughout. Results Data saturation was reached after 14 interviews. All participants reported experience of early mobilization after thrombolysis, with no reported harm or serious incident. Themes included descriptions of practice, perceived benefits and harms, and implementation of risk assessment and management strategies. Conclusions Physiotherapists describe a variety of practices with careful implementation of any early mobilization after thrombolysis. Common factors of risk assessment reported by participants could contribute to guideline development.