• World Neurosurg · Jul 2023

    Impact of early out-of-bed mobilization on functional outcome in patients with aneurysmal subarachnoid hemorrhage: a retrospective cohort study.

    • Adéla Foudhaili, Romain Barthélémy, Magalie Collet, Charles de Roquetaillade, Sébastien Kerever, Damien Vitiello, Alexandre Mebazaa, and Benjamin G Chousterman.
    • Université Paris Cité, Inserm, MASCOT, Paris, France; Department of Physical Medicine and Rehabilitation, CHU Lariboisière, AP-HP, Paris, France; Université Paris Cité, Institut des Sciences du Sport-Santé de Paris, Paris, France. Electronic address: adela.foudhaili@aphp.fr.
    • World Neurosurg. 2023 Jul 1; 175: e278e287e278-e287.

    BackgroundEffects of early mobilization are not well documented in patients with aneurysmal subarachnoid hemorrhage (aSAH). Only a few studies have investigated it through progressive mobilization protocols and suggested that it is safe and feasible. This study aimed to determine the impact of early out-of-bed mobilization (EOM) on 3-month functional outcome and cerebral vasospasm (CVS) occurrence in patients with aSAH.MethodsA retrospective review of consecutive patients admitted to the intensive care unit with a diagnosis of aSAH was performed. EOM was defined as out-of-bed (OOB) mobilization performed before or on day 4 after aSAH onset. The primary outcome was 3-month functional independence (i.e., a modified Rankin Scale below 3) and the occurrence of CVS.ResultsA total of 179 patients with aSAH met the inclusion criteria. Thirty-one patients constituted the EOM group, and 148 patients were in the delayed out-of-bed mobilization group. Functional independence was more frequent in the EOM group than in the delayed out-of-bed mobilization group (n = 26 [84%] vs. n = 83 [56%], P = 0.004). In a multivariable analysis, EOM was an independent predictor of functional independence (adjusted odds ratio = 3.11; 95% confidence interval, 1.11-10.36; P < 0.05). The delay between bleeding and first OOB mobilization was also identified as an independent risk factor for the occurrence of CVS (adjusted odds ratio = 1.12; 95% confidence interval = 1.06-1.18, P < 0.001).ConclusionsEOM was independently associated with favorable functional outcome after aSAH. The delay between bleeding and OOB mobilization was an independent risk factor for reduced functional independence and CVS occurrence. Prospective randomized trials are necessary to confirm these results and improve clinical practice.Copyright © 2023 Elsevier Inc. All rights reserved.

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