To describe current mobilisation practices, outcomes and barriers that occur in the acute and intensive care settings in people following aSAH.To describe current mobilisation practices, outcomes and barriers that occur in the acute and intensive care settings in people following aSAH.
This prospective, observational study was conducted at a tertiary neurosurgical referral centre. Adult patients aged 18 years or older with a diagnosis of aSAH and following repair of the ruptured aneurysm were included. Mobilisation outcomes were recorded during each physiotherapy session using the Mobility Scale for Acute Stroke (MSAS) and censored at 14 days post aneurysm repair or at discharge. Clinical severity was graded at baseline using The World Federation Scale for Neurological Surgeons (WFNS) scale and individuals were dichotomised into “good” (WNFS I-II) and “poor” (WFNS III-V) grade groups.
Over an 18-month period; data was collected for 102 individuals (mean age 56.7 SD12.3) years, 69 (68%) females, 69 (68%) were graded as “good”). Of 46 (45%) admitted to ICU: 39 (47%) were invasively ventilated at baseline. Mobility data were collected across 410 mobility sessions with those who mobilised with physiotherapy (n=90) engaging in a median of 4 (IQR 2, 6) sessions. For individuals graded “good” versus “poor”, walking first occurred on median day 1 (IQR 0, 2) versus day 3 (IQR 2, 8) (p0.001). The median MSAS scores for individuals classified as “good” and “poor” grade were 36 (IQR 30, 36) and 10 (IQR 6, 20) respectively (p0.001). At two weeks, 65% of individuals graded as “good” achieved independent walking versus 13% of those graded “poor” (p0.001).
There were 193 of 603 (32%) sessions attempted by physiotherapists that did not occur due to barriers preventing mobilisation, including excessive drowsiness (25%), haemodynamic instability (22%), mechanical ventilation (18%) and patient refusal (12%). There were 34 (8%) sessions ceased early due to reported safety concerns, mostly due to increased headache (n=6), hypotension (n=6) and light-headedness (n=6).
Most individuals mobilised during the acute phase post-aSAH. Those classified as “good” grade were more likely to walk independently by two weeks compared to patients with a lower WFNS score. Early mobilisation sessions were commonly prevented by barriers that included drowsiness and physiological instability.
Survivors of aSAH require careful screening and monitoring by physiotherapists when undertaking mobilisation activities in the acute ward and intensive care settings. Further research to establish optimal timing and dosage of early mobilisation following aSAH is warranted.
Mobilisation
Subarachnoid Haemorrhage
