Purpose: To determine if very early mobilization impacts outcomes at 90 days for ischemic stroke patients receiving intravenous alteplase (tPA).
Background: Early mobilization of critical care patients improves outcome, length of stay, and patient satisfaction. Outcomes data of very early mobilization for stroke patients have been mixed, and data for patients mobilized within 24 hours of receiving tPA is limited. We have presented safety data for a nursing-driven early mobility protocol for stroke patients.
Methods: Medical records of ischemic stroke patients who received tPA between 2012 and 2016 at two urban hospitals were reviewed for timing of earliest mobilization following tPA treatment. Patients who received endovascular treatment, were placed on comfort care day zero or one, were mobilized after the first 24 hours, transferred out or left against medical advice, or for whom there was no 90 day modified Rankin Scale (mRS) reported were excluded from the analysis. Multinomial regression was used to determine if the time first mobilized to highest safe level within 24 hours after tPA treatment impacted mRS at 90 days, adjusting for patients’ disability status prior to stroke, stroke severity using National Institutes of Health Stroke Scale (NIHSS), and age.
Results: Of 193 patients included in the final analysis, 43.0% (n=83) were female, mean age was 70.6 (±13.0), and the median admit NIHSS was 6.0 [Interquartile range (IQR): 3.0, 11.0]. The median time first mobilized after tPA was 9.0 hours [IQR: 5.0, 16.0]. At 90 days, 31.6% (n=61) of patients reported no symptoms (mRS 0), 35.2% (n=68) some symptoms or slight disability (mRS 1-2), 19.2% (37) moderate to severe disability (mRS 3-5), and 14.0% (n=27) had expired (mRS 6). There was no relationship between mobilizing earlier and likelihood of moderate or severe disability (Adjusted Odds Ratio (AOR) = 1.05 per hour increase in mobilization; p=0.183) or death (AOR=1.06 per hour increase in mobilization; p=0.143) compared to no symptoms at 90 days.
Conclusions: This study showed that earlier mobilization within 24 hours after tPA did not worsen functional outcome based on 90 day mRS. Our data support very early mobilization to their highest safe level of stroke patients receiving tPA.