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; Benjamin G Chousterman

doi:10.1016/j.wneu.2023.03.073

Impact of Early Out-of-Bed Mobilization on Functional Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Cohort Study

World Neurosurg. 2023 Jul:175:e278-e287. doi: 10.1016/j.wneu.2023.03.073. Epub 2023 Mar 24.

Authors

Adéla Foudhaili¹, Romain Barthélémy², Magalie Collet², Charles de Roquetaillade², Sébastien Kerever³, Damien Vitiello⁴, Alexandre Mebazaa², Benjamin G Chousterman²

Affiliations

¹ 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.
² Université Paris Cité, Inserm, MASCOT, Paris, France; Department of Anesthesiology and Critical Care, CHU Lariboisière, AP-HP, Paris, France.
³ Department of Anesthesiology and Critical Care, CHU Lariboisière, AP-HP, Paris, France; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre de Recherche Epidémiologie et StatistiqueS, Paris, France.
⁴ Université Paris Cité, Institut des Sciences du Sport-Santé de Paris, Paris, France.

PMID: 36966907
DOI: 10.1016/j.wneu.2023.03.073

Abstract

Background: Effects 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.

Methods: A 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.

Results: A 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).

Conclusions: EOM 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.

Keywords: Early ambulation; Early mobilization; Functional status; Intracranial; Intracranial aneurysm; Subarachnoid hemorrhage; Vasospasm.

MeSH terms

Humans
Odds Ratio
Prospective Studies
Retrospective Studies
Subarachnoid Hemorrhage* / complications
Treatment Outcome
Vasospasm, Intracranial* / epidemiology