The review found that early mobilisation after acute myocardial infarction (AMI) was associated with a trend towards decreased mortality compared to conventional care. Because the included studies were of relatively poor quality and (as pointed out in the review) pre-dated current AMI treatment strategies, the reliability and applicability of the authors’ conclusions is questionable.

To determine the impact of early mobilisation after acute myocardial infarction (AMI) on mortality and reinfarction rates.

MEDLINE (1966 to 2007), CINAHL (1966 to 2008), HealthStar (1975 to 2008), EMBASE (1966 to 2008) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Search terms were reported. Reference lists of review articles were checked and experts in the field were consulted. The search was not restricted by language or publication status.

Controlled studies that compared any in-hospital early mobilisation following AMI versus prescribed bed rest or conventional care alone were eligible for inclusion. Early mobilisation was defined as programmed changes of position from bed to chair, chair to standing or bed to walking, in addition to conventional care. Outcomes of interest in the review were all-cause mortality and non-fatal reinfarction within one year of AMI.

Most participants in the included studies were patients with uncomplicated AMI in coronary care units or hospital wards. Most were aged 55 to 65 years and 70% to 100% were male. The intervention was similar in all studies (stand up, move to chair and walk). Time of initiation of mobilisation ranged from two to 10 days post-AMI in intervention groups and from after five to 21 days in controls. Duration of follow-up ranged from in-hospital to 19 months. Nearly all the included studies were published in 1982 or earlier.

Two reviewers independently selected the studies. Disagreements were resolved by consensus.

Evaluated features of study quality were: randomisation, allocation concealment, blinding and reporting of withdrawals and dropouts. Studies were categorised as high, intermediate (at least two quality features met) or low quality.

Two reviewers independently conducted the assessment. Disagreements were resolved by consensus.

Relative risks (RRs) and 95% confidence intervals (CIs) were calculated from the numbers of events in the two groups of each study. Data were analysed on an intention-to-treat principle, using all randomised participants as the denominator.

Two reviewers independently extracted data. Disagreements were resolved by consensus.

Studies were displayed in funnel plots. Study data were combined if plots were symmetrical and there were at least 100 events overall. Pooled relative risks and 95% CIs were calculated using a random-effects model. Heterogeneity was checked using the Χ² statistic. Subgroup analyses were conducted by study quality and by timing of the intervention (before or after day five post AMI).

Fourteen studies were included in the review (n=3,148, range 48 to 742): seven randomised controlled trials (RCTs, n=2,019) and seven pseudo-randomised trials (n=1,129). Seven studies were intermediate quality and seven were low quality. Six RCTs described their randomisation method and three were blinded. No study provided reasons for losses to follow up; rates ranged from 5% to 20%.

There was no statistically significant difference between the intervention group and controls in rates of mortality (14 studies) or non-fatal reinfarction (13 studies). Results of subgroup analyses were non-significant. There was a non-significant trend for decreased mortality in the intervention group (RR 0.85, 95% CI 0.68 to 1.05). No statistically significant heterogeneity was detected and funnel plots did not suggest publication bias.

Early mobilisation after AMI was associated with a trend towards decreased mortality.

The objectives and inclusion criteria of the review were clear in most respects. Relevant sources were searched for studies without restriction by language or publication status. However, no time frame was defined for early mobilisation and mobilisation was earlier in the control groups of some studies than in the intervention groups of others. This made it hard to interpret the review findings. Steps were taken to minimise risks of reviewer bias and error by having more than one reviewer independently select studies, undertake validity assessment and extract data. Adequate details were provided about the characteristics and quality of included studies. Statistical techniques used to combine studies and assess for heterogeneity and publication bias appeared appropriate. Because the included studies were of relatively poor quality and (as pointed out in the review) pre-dated current AMI treatment strategies, the reliability and applicability of the authors' conclusions is questionable.

Practice: The authors stated that nurses should provide and promote early mobilisation to AMI patients across their hospital stay. However, the authors also noted that early mobilisation may have some contra-indications (for example, AMI Killip III and IV).

Research: The authors stated that a large RCT was needed to assess the effect of early mobilisation on patients treated for AMI using current standards of therapy.

Authors supported by a Nursing Fellowship and a Doctoral Research Award from the Heart and Stroke Foundation of Canada.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.