Early mobilisation for patients following acute myocardiac infarction: A systematic review and meta-analysis of experimental studies

Objective: To determine the impact of early mobilisation (EM) on total mortality and non-fatal re-infarction after acute myocardial infarction (AMI). Design: Systematic review and meta-analysis. Data sources: MEDLINE, CINAHL, HealthStar, EMBASE, the Cochrane Library Controlled Trials Registry and experts. Methods: Target studies included published and unpublished experimental, controlled studies in any language comparing AMI patients allocated to any in-hospital early mobilisation or a control/standard treatment. Two reviewers independently assessed study eligibility and quality and performed data extraction. We calculated relative risks (RRs) and 95% confidence intervals (CIs) using the random-effects model. Outcomes: All-cause mortality or re-infarction up to 1-year post-AMI. Results: Out of 385 potentially relevant studies, 14 met our eligibility criteria (13 published before 1983). There were 149 deaths (9.3% of 1607) and 82 non-fatal re-infarctions (5.2% of 1580) among post-AMI patients receiving EM, compared with 179 deaths (11.6% of 1541) and 80 non-fatal re-infarctions (5.3% of 1518) among AMI patients receiving control treatment (RR = 0.85, 95% CI 0.68, 1.05 and RR = 1.02, 95% CI 0.75, 1.39 respectively). Conclusion: Our meta-analysis demonstrated a trend towards decreased mortality with EM after AMI. However, there is uncertainty about early mobilisation and more research should be developed having into account all kind of differences among patients receiving treatment after AMI worldwide.