Early mobilization in patients with aneurysmal subarachnoid haemorrhage may im-prove functional status and reduce cerebral vasospasm rate: a systematic review with meta-analysis
DOI:
https://doi.org/10.2340/jrm.v56.41225Keywords:
critical care, early ambulation, physical therapy modalities, subarachnoid haemorrhage, systematic review, functional status, vasospasmAbstract
Objective: The primary aim of this study was to evaluate the safety and efficacy of early mobilization in patients with aneurysmal subarachnoid haemorrhage.
Design: Systematic review with meta-analysis of randomized controlled studies and observational studies.
Patients: Patients with aneurysmal subarachnoid haemorrhage.
Methods: PubMed, Embase, CINAHL, Web of Science, Pedro, and the Cochrane Library databases were searched. A systematic review and meta-analysis were performed. Screening and data extraction were performed by 2 independent reviewers.
Results: Sixteen studies involving 1,757 patients were included. Meta-analysis of the data estimated that early mobilization improved mRS score at discharge (mean difference –1.39, 95% CI –2.51 to –0.28, I2 = 86%) and at 3 months (mean difference –1.10, 95% CI –1.54 to –0.66, I2 = 7%). Early mobilization was associated with a reduction in cerebral vasospasm rate, both radiological (OR 0.66, 95% CI 0.45 to 0.96, I2 = 7%) and clinical (OR 0.44, 95% CI 0.27 to 0.72, I2 = 8%); 6% of mobilization sessions involved adverse events, mostly haemodynamic changes.
Conclusion: This review found moderate-quality evidence supporting the safety and effectiveness of early mobilization in patients with SAH. Further randomized controlled trials are needed to identify the appropriate mobilization strategy and confirm these results.
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Lovelock CE, Rinkel GJE, Rothwell PM. Time trends in outcome of subarachnoid hemorrhage: popula-tion-based study and systematic review. Neurology 2010; 74: 1494–1501.
https://doi.org/10.1212/WNL.0b013e3181dd42b3 DOI: https://doi.org/10.1212/WNL.0b013e3181dd42b3
Molyneux A, Kerr R. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized trial. J Stroke Cerebrovasc Dis 2002; 11: 304–314.
https://doi.org/10.1053/jscd.2002.130390 DOI: https://doi.org/10.1053/jscd.2002.130390
Kruisheer EM, Huenges Wajer IMC, Visser-Meily JMA, Post MWM. Course of participation after sub-arachnoid hemorrhage. J Stroke Cerebrovasc Dis 2017; 26: 1000–1006.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.11.124 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.11.124
Al-Khindi T, Macdonald RL, Schweizer TA. Cognitive and functional outcome after aneurysmal suba-rachnoid hemorrhage. Stroke 2010; 41: e519–e36.
https://doi.org/10.1161/STROKEAHA.110.581975 DOI: https://doi.org/10.1161/STROKEAHA.110.581975
Seule M, Oswald D, Muroi C, Brandi G, Keller E. Outcome, return to work and health-related costs after aneurysmal subarachnoid hemorrhage. Neurocrit Care 2020; 33: 49–57.
https://doi.org/10.1007/s12028-019-00905-2 DOI: https://doi.org/10.1007/s12028-019-00905-2
Passier PECA, Visser-Meily JMA, Rinkel GJE, Lindeman E, Post MWM. Life satisfaction and return to work after aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2011; 20: 324–329.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.02.001 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.02.001
Tang WK, Wang L, Tsoi KK, Kim JM, Lee S-J, Kim JS. Anxiety after subarachnoid hemorrhage: a systematic review and meta-analysis. J Affect Disord Rep 2021; 3: 100060.
https://doi.org/10.1016/j.jadr.2020.100060 DOI: https://doi.org/10.1016/j.jadr.2020.100060
Hoh BL, Ko NU, Amin-Hanjani S, Hsiang-Yi Chou S, Cruz-Flores S, Dangayach NS, et al. 2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke 2023; 54: e314–e370.
https://doi.org/10.1161/STR.0000000000000436 DOI: https://doi.org/10.1161/STR.0000000000000436
Bernhardt J, Churilov L, Ellery F, Collier J, Chamberlain J, Langhorne P, et al. Prespecified dose–response analysis for A Very Early Rehabilitation Trial (AVERT). Neurology 2016; 86: 2138–2145.
https://doi.org/10.1212/WNL.0000000000002459 DOI: https://doi.org/10.1212/WNL.0000000000002459
Scheffenbichler FT, Teja B, Wongtangman K, Mazwi N, Waak K, Schaller SJ, et al. Effects of the level and duration of mobilization therapy in the surgical ICU on the loss of the ability to live independently: an international prospective cohort study. Crit Care Med 2021; 49: e247–e257.
https://doi.org/10.1097/CCM.0000000000004808 DOI: https://doi.org/10.1097/CCM.0000000000004808
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan: a web and mobile app for systematic reviews. Syst Rev 2016; 5: 210.
https://doi.org/10.1186/s13643-016-0384-4 DOI: https://doi.org/10.1186/s13643-016-0384-4
PlotDigitizer [Serial on the Internet]. Available from: https://plotdigitizer.com/
Foudhaili A, Barthélémy R, Collet M, De Roquetaillade C, Kerever S, Vitiello D, et al. Impact of early out-of-bed mobilization on functional outcome in patients with aneurysmal subarachnoid hemorrhage: a retrospective cohort study. World Neurosurg 2023; 175: e278–e287.
https://doi.org/10.1016/j.wneu.2023.03.073 DOI: https://doi.org/10.1016/j.wneu.2023.03.073
Nydahl P, Sricharoenchai T, Chandra S, Kundt FS, Huang M, Fischill M, et al. Safety of patient mobilizat-ion and rehabilitation in the intensive care unit: systematic review with meta-analysis. Ann Am Thorac Soc 2017; 14: 766–777.
https://doi.org/10.1513/AnnalsATS.201611-843SR DOI: https://doi.org/10.1513/AnnalsATS.201611-843SR
Uemura M, Inoue T, Kuwata S, Yoshikawa Y, Matsumoto H, Hirata Y. Taking a sitting position within 13 days of subarachnoid hemorrhage onset prevents decline in the ability to perform activities of daily living and shortens hospitalization duration. Int J Disabil Hum Dev 2018; 17: 517–524.
Takara H, Kohatsu Y, Suzuki S, Satoh S, Abe Y, Miyazato S, et al. Initiating mobilization is not associated with symptomatic cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage: a ret-rospective multicenter case-control study. Phys Ther Res 2022; 25: 134–142.
https://doi.org/10.1298/ptr.E10205 DOI: https://doi.org/10.1298/ptr.E10205
Karic T, Sorteberg A, Haug Nordenmark T, Becker F, Roe C. Early rehabilitation in patients with acute aneurysmal subarachnoid hemorrhage. Disabil Rehabil 2015; 37: 1446–1454.
https://doi.org/10.3109/09638288.2014.966162 DOI: https://doi.org/10.3109/09638288.2014.966162
Karic T, Roe C, Nordenmark T, Becker F, Sorteberg A. Impact of early mobilization and rehabilitation on global functional outcome one year after aneurysmal subarachnoid hemorrhage. J Rehabil Med 2016; 48: 676–682.
https://doi.org/10.2340/16501977-2121 DOI: https://doi.org/10.2340/16501977-2121
Karic T, Røe C, Nordenmark TH, Becker F, Sorteberg W, Sorteberg A. Effect of early mobilization and re-habilitation on complications in aneurysmal subarachnoid hemorrhage. J Neurosurg 2017; 126: 518–526.
https://doi.org/10.3171/2015.12.JNS151744 DOI: https://doi.org/10.3171/2015.12.JNS151744
Olkowski BF, Devine MA, Slotnick LE, Veznedaroglu E, Liebman KM, Arcaro ML, et al. Safety and feasibi-lity of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage. Phys Ther 2013; 93: 208–215.
https://doi.org/10.2522/ptj.20110334 DOI: https://doi.org/10.2522/ptj.20110334
Olkowski BF, Binning MJ, Sanfillippo G, Arcaro ML, Slotnick LE, Veznedaroglu E, et al. Early mobilization in aneurysmal subarachnoid hemorrhage accelerates recovery and reduces length of stay. J Acute Care Phys Ther 2015; 6: 47–55.
https://doi.org/10.1097/JAT.0000000000000008 DOI: https://doi.org/10.1097/JAT.0000000000000008
Moyer M, Young B, Wilensky EM, Borst J, Pino W, Hart M, et al. Implementation of an early mobility pat-hway in neurointensive care unit patients with external ventricular devices. J Neurosci Nurs 2017; 49: 102–107.
https://doi.org/10.1097/JNN.0000000000000258 DOI: https://doi.org/10.1097/JNN.0000000000000258
Young B, Moyer M, Pino W, Kung D, Zager E, Kumar MA. Safety and feasibility of early mobilization in pa-tients with subarachnoid hemorrhage and external ventricular drain. Neurocrit Care 2019; 31: 88–96.
https://doi.org/10.1007/s12028-019-00670-2 DOI: https://doi.org/10.1007/s12028-019-00670-2
Shimamura N, Matsuda N, Satou J, Nakano T, Ohkuma H. Early ambulation produces favorable outcome and nondemential state in aneurysmal subarachnoid hemorrhage patients older than 70 ye-ars of age. World Neurosurg 2014; 81: 330–334.
https://doi.org/10.1016/j.wneu.2012.12.007 DOI: https://doi.org/10.1016/j.wneu.2012.12.007
Riordan MA, Kyle M, Dedeo C, Villwock MR, Bauer M, -Vallano ML, et al. Mild exercise reduces cerebral vasospasm after aneurysm subarachnoid hemorrhage: a retrospective clinical study and correlation with laboratory investigation. Acta Neurochir Suppl 2015; 120: 55–61.
https://doi.org/10.1007/978-3-319-04981-6_10 DOI: https://doi.org/10.1007/978-3-319-04981-6_10
Milovanovic A, Grujicic D, Bogosavljevic V, Jokovic M, Mujovic N, Petronic Markovic I. Efficacy of early rehabilitation after surgical repair of acute aneurysmal subarachnoid hemorrhage: outcomes after verticalization on day 2–5 versus day 12 post-bleeding. Turk Neurosurg 2016; 27: 867–873.
https://doi.org/10.5137/1019-5149.JTN.17711-16.1 DOI: https://doi.org/10.5137/1019-5149.JTN.17711-16.1
Yang X, Cao L, Zhang T, Qu X, Chen W, Cheng W, et al. More is less: effect of ICF-based early progressive -mobilization on severe aneurysmal subarachnoid hemorrhage in the NICU. Front Neurol 2022; 13: 951071.
https://doi.org/10.3389/fneur.2022.951071 DOI: https://doi.org/10.3389/fneur.2022.951071
Yokobatake K, Ohta T, Kitaoka H, Nishimura S, Kashima K, Yasuoka M, et al. Safety of early rehabilitation in patients with aneurysmal subarachnoid hemorrhage: a retrospective cohort study. J Stroke Cere-brovasc Dis 2022; 31: 106751.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106751 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106751
Okamura M, Konishi M, Sagara A, Shimizu Y, Nakamura T. Impact of early mobilization on discharge disposition and functional status in patients with subarachnoid hemorrhage: a retrospective cohort study. Medicine (Baltimore) 2021; 100: e28171.
https://doi.org/10.1097/MD.0000000000028171 DOI: https://doi.org/10.1097/MD.0000000000028171
Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 2018; 46: e825.
https://doi.org/10.1097/CCM.0000000000003299 DOI: https://doi.org/10.1097/CCM.0000000000003299
Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373: 1874–1882.
https://doi.org/10.1016/S0140-6736(09)60658-9 DOI: https://doi.org/10.1016/S0140-6736(09)60658-9
Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, et al. Early, goal-directed mo-bilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 2016; 388: 1377–1388.
https://doi.org/10.1016/S0140-6736(16)31637-3 DOI: https://doi.org/10.1016/S0140-6736(16)31637-3
Patel BK, Wolfe KS, Patel SB, Dugan KC, Esbrook CL, Pawlik AJ, et al. Effect of early mobilisation on long-term cognitive impairment in critical illness in the USA: a randomised controlled trial. Lancet Re-spir Med 2023; 11: 563–572.
https://doi.org/10.1016/S2213-2600(22)00489-1 DOI: https://doi.org/10.1016/S2213-2600(22)00489-1
TEAM Study Investigators and the ANZICS Clinical Trials Group. Early active mobilization during mechanical ventilation in the ICU. N Engl J Med 2022; 387: 1747–1758.
https://doi.org/10.1056/NEJMoa2209083 DOI: https://doi.org/10.1056/NEJMoa2209083
AVERT Trial Collaboration group. Efficacy and safety of very early mobilisation within 24 h of stroke on-set (AVERT): a randomised controlled trial. Lancet 2015; 386: 46–55.
https://doi.org/10.1016/S0140-6736(15)60690-0 DOI: https://doi.org/10.1016/S0140-6736(15)60690-0
Marzolini S, Robertson AD, Oh P, Goodman JM, Corbett D, Du X, et al. Aerobic training and mobilization early post-stroke: cautions and considerations. Front Neurol 2019; 10: 1187.
https://doi.org/10.3389/fneur.2019.01187 DOI: https://doi.org/10.3389/fneur.2019.01187
Hernandez, Sabrina, Thomas P, Udy A, Hodgson C. Early mobilisation of patients in the acute hospital setting following aneurysmal subarachnoid haemorrhage: a survey of current physiotherapy practice. N Z J Physiother 2019; 46: 113–132.
https://doi.org/10.15619/NZJP/46.3.04 DOI: https://doi.org/10.15619/NZJP/46.3.04
Hossain I, Younsi A, Castaño Leon AM, Lippa L, Tóth P, Terpolilli N, et al. Huge variability in restrictions of mobilization for patients with aneurysmal subarachnoid hemorrhage: a European survey of practice. Brain Spine 2023; 3: 101731.
https://doi.org/10.1016/j.bas.2023.101731 DOI: https://doi.org/10.1016/j.bas.2023.101731
Paton M, Chan S, Serpa Neto A, Tipping CJ, Stratton A, Lane R, et al. Association of active mobilisation variables with adverse events and mortality in patients requiring mechanical ventilation in the inten-sive care unit: a systematic review and meta-analysis. Lancet Respir Med 2024; 12: 386–398.
https://doi.org/10.1016/S2213-2600(24)00011-0 DOI: https://doi.org/10.1016/S2213-2600(24)00011-0
Topp R, Ditmyer M, King K, Doherty K, Hornyak J. The effect of bed rest and potential of prehabilitation on patients in the intensive care unit. AACN Clin Issues 2002; 13: 263–276.
https://doi.org/10.1097/00044067-200205000-00011 DOI: https://doi.org/10.1097/00044067-200205000-00011
Parry SM, Puthucheary ZA. The impact of extended bed rest on the musculoskeletal system in the critical care environment. Extreme Physiol Med 2015; 4: 16.
https://doi.org/10.1186/s13728-015-0036-7 DOI: https://doi.org/10.1186/s13728-015-0036-7
Eggmann S, Nydahl P, Gosselink R, Bissett B. We need to talk about adverse events during physical re-habilitation in critical care trials. eClinicalMedicine 2024; 68: 102439.
https://doi.org/10.1016/j.eclinm.2024.102439 DOI: https://doi.org/10.1016/j.eclinm.2024.102439
Brower RG. Consequences of bed rest. Crit Care Med 2009; 37: S422–S428.
https://doi.org/10.1097/CCM.0b013e3181b6e30a DOI: https://doi.org/10.1097/CCM.0b013e3181b6e30a
Foudhaili A, Vitiello D, Chousterman BG. Early mobilization of patients with subarachnoid haemorr-hage: a national survey of French intensive care units. J Rehabil Med 2024; 56: jrm17734.
https://doi.org/10.2340/jrm.v56.17734 DOI: https://doi.org/10.2340/jrm.v56.17734
Ma Z, Wang Q, Liu M. Early versus delayed mobilisation for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2013: CD008346.
https://doi.org/10.1002/14651858.CD008346.pub2 DOI: https://doi.org/10.1002/14651858.CD008346.pub2
Morello A, Spinello A, Staartjes VE, Bue EL, Garbossa D, Germans MR, et al. Early versus delayed mo-bilization after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of effi-cacy and safety. Neurosurg Focus 2023; 55: E11. DOI: https://doi.org/10.3171/2023.9.FOCUS23548
Clarissa C, Salisbury L, Rodgers S, Kean S. Early mobilisation in mechanically ventilated patients: a sys-tematic -integrative review of definitions and activities. J Intensive Care 2019; 7: 3.
https://doi.org/10.1186/s40560-018-0355-z DOI: https://doi.org/10.1186/s40560-018-0355-z
Bein Th, Bischoff M, Brückner U, Gebhardt K, Henzler D, Hermes C, et al. S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders. Anaesthesist 2015; 64: 1–26.
https://doi.org/10.1007/s00101-015-0071-1 DOI: https://doi.org/10.1007/s00101-015-0071-1
Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care 2014; 18: 658.
https://doi.org/10.1186/s13054-014-0658-y DOI: https://doi.org/10.1186/s13054-014-0658-y
Custal C, Koehn J, Borutta M, Mrochen A, Brandner S, Eyüpoglu IY, et al. Beyond functional impairment: redefining favorable outcome in patients with subarachnoid hemorrhage. Cerebrovasc Dis 2021; 50: 729–737.
https://doi.org/10.1159/000517242 DOI: https://doi.org/10.1159/000517242
Kim DH, Haney CL, Van Ginhoven G. Utility of outcome measures after treatment for intracranial aneu-rysms: a prospective trial involving 520 patients. Stroke 2005; 36: 792–796.
https://doi.org/10.1161/01.STR.0000157594.58180.97 DOI: https://doi.org/10.1161/01.STR.0000157594.58180.97
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