The practice and predictors of early mobilization of patients post-acute admission to a specialized stroke center

ABSTRACT

Background: Early mobilization (EM) post-stroke is recommended; however, the ideal timing and nature of EM, and factors that may influence EM practice are unclear.

Objectives: The primary objective was to describe the type and extent of mobilization 0–48 h post-stroke admission to acute hospital care. A secondary objective was to evaluate whether pre-stroke functional level, stroke severity, tissue plasminogen activator (tPA) administration, and level of consciousness (LOC) predicted any passive, any active, and out-of-bed mobilization (i.e. sitting at edge-of-bed, standing, or ambulation) 0–24 h post-admission.

Methods: A quantitative, cross-sectional, retrospective review of health records of patients admitted to a specialized acute stroke center in 2016 was conducted.

Results: Data from 296 eligible health records were abstracted. Median age was 73 years, and 87% of patients had sustained an ischemic stroke. Active, passive, and out-of-bed mobilization occurred in 91.6%, 57.1%, and 24.3% of patients by 12 h post-admission, respectively, and 99.3%, 78.4%, and 77.4% of patients by 48 h post-admission, respectively. Administration of tPA, stroke severity, and impaired LOC, were each associated with any passive mobilization, and no tPA administration, stroke severity, and normal LOC were each associated with out-of-bed mobilization 0–24 h post-admission (p < 0.05).

Conclusions: Almost all patients receive active mobilization by 12 h post-admission whereas out-of-bed mobilization is infrequent. In the first 24 h post-admission, clinicians may prioritize passive over out-of-bed mobilization when patients have received tPA, present with severe stroke, and have impaired LOC. This conservative approach is unsurprising given the lack of clear practice recommendations for these situations.

KEYWORDS:

• Stroke
• acute
• early mobilization
• tPA
• NIHSS
• mRS
• GCS

Disclosure statement

This research was completed in affiliation with the Sunnybrook Health Sciences Centre Bayview Campus and has the potential to lead to site-specific protocols in which SL, JC, and KB may have a clinical interest.

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Additional information

Funding

N. Salbach was supported by a Canadian Institutes of Health Research New Investigator Award to conduct this research. This research was completed by E. Ho, S. Cheung, M. Denton, B. Kim, and F. Stephenson in partial fulfillment of an MScPT degree at the University of Toronto.