Very Early Mobilization in Stroke Patients Treated with Intravenous Recombinant Tissue Plasminogen Activator

Arnold, Scott M.; Dinkins, Maryane; Mooney, Lesia; Freeman, William D.; Rawal, Bhupendra; Heckman, Michael G.; Davis, Olivia

doi:10.1016/j.jstrokecerebrovasdis.2015.01.007

Cited by 24 publications

(52 citation statements)

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“…It thus seems very likely that specific subgroups concerning stroke etiology, severity of stroke symptoms, comorbidities, and acute stroke therapy like hematoma evacuation, IV thrombolysis, or thrombectomy need to be taken into account for an individualized rehabilitation protocol [40]. An overview on worldwide national stroke guidelines was presented 2015 by Bernhardt et al and demonstrated a widely recommended early mobilization regime (22 out of 30 national guidelines, of these eight recommended mobilization within 24 h after stroke onset).…”

Section: Discussionmentioning

confidence: 99%

Access, timing and frequency of very early stroke rehabilitation – insights from the Baden-Wuerttemberg stroke registry

et al. 2016

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BackgroundWhile the precise timing and intensity of very early rehabilitation (VER) after stroke onset is still under discussion, its beneficial effect on functional disability is generally accepted. The recently published randomized controlled AVERT trial indicated that patients with severe stroke might be more susceptible to harmful side effects of VER, which we hypothesized is contrary to current clinical practice. We analyzed the Baden-Wuerttemberg stroke registry to gain insight into the application of VER in acute ischemic stroke (IS) and intracerebral hemorrhage (ICH) in clinical practice.Methods99,753 IS patients and 8824 patients with ICH hospitalized from January 2008 to December 2012 were analyzed. Data on the access to physical therapy (PT), occupational therapy (OT), and speech therapy (ST), the time from admission to first contact with a therapist and the average number of therapy sessions during the first 7 days of admission are reported. Multiple logistic regression models adjusted for patient and treatment characteristics were carried out to investigate the influence of VER on clinical outcome.ResultsPT was applied in 90/87% (IS/ICH), OT in 63/57%, and ST in 70/65% of the study population. Therapy was mostly initiated within 24 h (PT 87/82%) or 48 h after admission (OT 91/89% and ST 93/90%). Percentages of patients under therapy and also the average number of therapy sessions were highest in those with a discharge modified Rankin Scale score of 2 to 5 and lowest in patients with complete recovery or death during hospitalization. The outcome analyses were fundamentally hindered due to biases by individual decision making regarding the application and frequency of VER.ConclusionsWhile most patients had access to PT we noticed an undersupply of OT and ST. Only little differences were observed between patients with IS and ICH. The staff decisions for treatment seem to reflect attempts to optimize resources. Patients with either excellent or very unfavorable prognosis were less frequently assigned to VER and, if treated, received a lower average number of therapy sessions. On the contrary, severely disabled patients received VER at high frequency, although potentially harmful according to recent indications from the randomized controlled AVERT trial.

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Section: Discussionmentioning

confidence: 99%

Access, timing and frequency of very early stroke rehabilitation – insights from the Baden-Wuerttemberg stroke registry

et al. 2016

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“…Bed rest causes a reduction in total blood volume that reduces cardiac stroke volume and maximum cardiac output. Such cardiac atrophy can be detected with as little as 2 weeks of bed rest 13,14) , so the longer bed rest of the patients in the MT group may have had an influence on the prominent changes in blood pressure seen in these patients, even though the portion of blood pressure deviation was lower than a precedent study 15) . The prevalence of Af and the portion of CEI in the MT group was higher than those of the control group, but both of them were not associated with prominent blood pressure changes by a multivariable binary logistic regression.…”

Section: Discussionmentioning

confidence: 98%

Assessment of factors associated with prominent changes in blood pressure during an early mobilization protocol for patients with acute ischemic stroke after mechanical thrombectomy

et al. 2016

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ABSTRACT. Objective: To assess factors associated with changes in blood pressure during early mobilization protocol for patients with acute ischemic stroke who were treated with mechanical thrombectomy. Design: Retrospective observational study. Method: We analyzed patients with acute ischemic stroke who were treated with mechanical thrombectomy (MT group, n=60) and patients who received conservative medical management (control group, n=60) matched by age and National Institute Health of Stroke Score at admission from April 2009 to July 2014. The proportion of patients with prominent blood pressure change during an early mobilization protocol was compared between the MT group and control group. Factors associated with prominent blood pressure change were also analyzed using multivariable logistic regression analysis. Result: The deviation in blood pressure response was much more significant in the MT than control group (13.3 vs. 1.7%, p<0.016). Logistic regression analysis showed the interval from admission to being able to sit in a wheelchair associated with prominent changes in blood pressure (odds ratio, 1.604; 95% confidence interval, 1.196-2.150; p<0.002). Conclusion: Our results showed that prominent changes in blood pressure during an early mobilization protocol can occur easily in patients with acute ischemic stroke after mechanical thrombectomy.

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“…Rehabilitation is considered important for preventing muscle weakness and immobility‐related complications in patients with stroke 4,16–18 . Early rehabilitation has also been reported to promote improved physical function and to be effective in reducing medical expenses 19,20 .…”

Section: Discussionmentioning

confidence: 99%

Effect of early intensive rehabilitation on the clinical outcomes of patients with acute stroke

Oyanagi

Kitai

Yoshimura³

et al. 2021

Geriatrics Gerontology Int

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Aim Intensive rehabilitation effectively improves physical functions in patients with acute stroke, but the frequency of intervention and its cost‐effectiveness are poorly studied. This study aimed to examine the effect of early high‐frequency rehabilitation intervention on inpatient outcomes and medical expenses of patients with stroke. Methods The study retrospectively included 1759 patients with acute stroke admitted to the Kobe City Medical Center General Hospital between 2013 and 2016. Patients with a transient ischemic attack, subarachnoid hemorrhage, and those who underwent urgent surgery were excluded. Patients were divided into two groups according to the frequency of rehabilitation intervention: the high‐frequency intervention group (>2 times/day, n = 1105) and normal‐frequency intervention group (<2 times/day, n = 654). A modified Rankin scale score ≤2 at discharge, immobility‐related complications and medical expenses were compared between the groups. Results The high‐frequency intervention group had a significantly shorter time to first rehabilitation (median [interquartile range], 19.0 h [13.1–38.4] vs. 24.7 h [16.1–49.4], P < 0.001) and time to first mobilization (23.3 h [8.7–47.2] vs. 22.8 h [5.7–62.3], P = 0.65) than the normal‐frequency intervention group. Despite higher disease severity, the high‐frequency intervention group exhibited favorable outcomes at discharge (modified Rankin scale, ≤2; adjusted odds ratio, 1.89; 95% confidence interval, 1.25–2.85; P = 0.002). No significant differences were observed between the two groups concerning the rate of immobility‐related complications and total medical expenses during hospitalization. Conclusions High‐frequency intervention was associated with improved outcomes and decreased medical expenses in patients with stroke. Our results may contribute to reducing medical expenses by increasing the efficiency of care delivery. Geriatr Gerontol Int 2021; 21: 623–628.

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Very Early Mobilization in Stroke Patients Treated with Intravenous Recombinant Tissue Plasminogen Activator

Cited by 24 publications

References 25 publications

Access, timing and frequency of very early stroke rehabilitation – insights from the Baden-Wuerttemberg stroke registry

Access, timing and frequency of very early stroke rehabilitation – insights from the Baden-Wuerttemberg stroke registry

Assessment of factors associated with prominent changes in blood pressure during an early mobilization protocol for patients with acute ischemic stroke after mechanical thrombectomy

Effect of early intensive rehabilitation on the clinical outcomes of patients with acute stroke

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