Initiating Mobilization Is Not Associated with Symptomatic Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Multicenter Case-control Study

Abstract

The study aim was to investigate the association between initiating mobilization within 7 days after onset and symptomatic cerebral vasospasm (SCV) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods: This was a retrospective multicenter case-control study in Japan. Patients with a diagnosis of aSAH who underwent physical therapy with/without occupational therapy were included and categorized into 2 groups according to the presence or absence of SCV. Initiating mobilization was defined as sitting on the bed edge (at least once, with/without assist, regardless of duration) within 7 days after aSAH onset. Cox proportional hazards regression analysis was performed to evaluate the association between initiating mobilization within 7 days after onset and SCV. Results: The analysis included 510 patients. Among all included patients, 57 (11.2%) patients had SCV. In the univariate Cox proportional hazards regression analysis, initiating of mobilization was not associated with SCV (hazard ratio [HR] = 0.78; 95% confidence interval [CI] = 0.45-1.32). In the multivariate analysis, only the modified Fisher scale was significantly associated with SCV (HR = 26.23; 95% CI = 1.21-571.0). Conclusion: Initiating mobilization within 7 days after aSAH onset was not associated with SCV in patients with aSAH.

Association Between Early Mobilization and Functional Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Multicenter Retrospective Propensity Score-Matched Study

“…In a randomized controlled study, cerebral ischemia and motor paralysis were increased when early mobilization was initiated within 2-5 days of onset (47). However, other studies have reported a decrease in SCV or no association with early mobilization (30,45). In the present study, the incidence of SCV was lower in the early mobilization group (4.1%) than in the delayed mobilization group (22.1%), which is consistent with previous studies (30,45).…”

“…However, other studies have reported a decrease in SCV or no association with early mobilization (30,45). In the present study, the incidence of SCV was lower in the early mobilization group (4.1%) than in the delayed mobilization group (22.1%), which is consistent with previous studies (30,45). Furthermore, the early mobilization group had lower rates of higher brain dysfunction and lower limb paralysis, potentially because of fewer instances of SCV.…”

“…Regarding complications, the results of the present study suggest that early mobilization is not associated with increased complication rates. Previous studies have also reported no increase in complications, such as SCV (30,45), pneumonia (21,30), deep venous thrombosis (30), and secondary hydrocephalus (21) with early mobilization. Especially, SCV is an unfavorable prognostic factor (46).…”

Early versus delayed mobilization after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of efficacy and safety

“…After duplicate removal (n = 807), 1927 records were screened and 398 were then assessed for eligibility through full-text screening. Finally, 11 studies that met the inclusion and exclusion criteria and reported on 1460 patients were identified and included in the qualitative synthesis, [17][18][19][20][21][22][23][24][25][26][27] with 10 studies analyzing 1292 patients available for inclusion in the quantitative synthesis. [17][18][19][21][22][23][24][25][26][27] The two publications by Karic et al from 2016 and 2017 reported almost exactly the same cohort; quantitative data appropriate for this analysis were, however, exclusively reported in the 2017 publication.…”

“…Finally, 11 studies that met the inclusion and exclusion criteria and reported on 1460 patients were identified and included in the qualitative synthesis, [17][18][19][20][21][22][23][24][25][26][27] with 10 studies analyzing 1292 patients available for inclusion in the quantitative synthesis. [17][18][19][21][22][23][24][25][26][27] The two publications by Karic et al from 2016 and 2017 reported almost exactly the same cohort; quantitative data appropriate for this analysis were, however, exclusively reported in the 2017 publication. 20,22 Sufficient data were available to perform a meta-analysis of mRS score at discharge, 30-day mortality, clinical and radiological vasospasm, length of stay, hydrocephalus, EVD and LD device placement, ventriculoperitoneal shunting, DVT, and pneumonia.…”