Study setting

All patients were treated in the same comprehensive SU in 2003 and 2013. The SU emphasized a multidisciplinary approach and mobilization to standing or sitting position out of bed within the first 24 h after onset of symptoms. The multidisciplinary team consisted of a physician, a nurse, a physiotherapist, a speech therapist and a member from the early supported discharge team, including an occupational therapist.

Furthermore the treatment consisted of a standardized acute medical treatment program according to the Norwegian Guidelines [18]. Patients were systematically observed and evaluated during the first 72 h, and all received a CT scan within 24 h, preferably within 6 h, after admission. ECG, oxygen saturation and routine blood tests were performed at admission; other diagnostic procedures were performed when indicated. During the first days in the SU, all patients went through a standardized systematic observation and examination of neurologic deficits, blood pressure level, cardiac and pulmonary disorders, temperature, glucose level and fluid and electrolyte balance. The main differences from 2003 to 2013 were a change from intermittent observation 4 to 6 times a day by the nurses on duty in 2003 to continuous monitoring for all patients during the first 24–48 h in 2013. These changes in monitoring procedures were also present during mobilization.

Another difference was the use of thrombolysis in 2003 versus 2013. Thrombolysis was accepted for use in stroke patients in Norway in 2003 [19]. In the initial phase, it was only given to patients included in studies, and within 3 h after stroke. Later, it has been approved for clinical use, and has since 2008 been accepted for use within 4.5 h after stroke.