Impact of Early Mobilization on 90-Day Outcomes in Thrombectomy Patients

Introduction: Early mobilization of ischemic stroke patients receiving IV alteplase (tPA) did not worsen 90-day outcome at two urban stroke centers in a prior study, but there are no studies evaluating outcomes of early mobilization after thrombectomy. The mobility protocol used in the previous study was also utilized to mobilize stroke patients receiving thrombectomy treatment at these two centers, once minimum number of hours for groin precautions was complete and the groin puncture site was stable. The objective of this study was to determine for post-thrombectomy patients mobilized within 24 hours, whether earlier mobilization worsened outcomes. Methods: Medical records of ischemic stroke patients receiving thrombectomy at two urban stroke centers between May 2013 and December 2017 were reviewed for early mobilization (within 24 hours of groin puncture). Patients who did not expire in hospital and had complete data were included in the analysis. Ordinal regression was used to determine if, with each hour delay in time first up, patients’ functional outcomes worsened at 90 days using the modified Rankin scale (mRS), adjusting for pre-symptom onset mRS, admission NIHSS, age, sex, and post-treatment thrombolysis in cerebral infarction (TICI) grade. The mRS at 90 days was categorized as no symptoms or no significant disability (0 - 1), mild or moderate disability (2 - 3), and severe disability or death (4 - 6). Results: Of 147 patients mobilized within 24 hours, 91 patients were included in the analysis. Overall, 51% (n=46) were female, 74% (n=67) had no disability prior to their stroke, mean age was 68.0 (±14.1), mean admission NIHSS was 15.9 (±6.7), and 85% (n=78) had a post treatment TICI score of 2b or greater. Median time first mobilized was 14.1 hours [interquartile range: 9.4, 19.1]. Ordinal regression showed no evidence that earlier mobilization had an effect on patient outcomes at 90 days, patients were neither worse or better by time first mobilized within the first 24 hours (p=.706). Conclusions: Ischemic stroke patients receiving thrombectomy were mobilized within 24 hours of groin puncture by the early mobility protocol. Patients experienced no impact on outcomes at 90 days by time first mobilized. This result may have been limited by small sample size.https://digitalcommons.psjhealth.org/other_pubs/1070/thumbnail.jp