title: Effect of an evidence-based mobility intervention on the level of function in acute intracerebral and subarachnoid hemorrhagic stroke patients on a neurointensive care unit.
abstract: OBJECTIVE
  To explore the effect of an evidence-based mobility intervention on the level of function (LOF) achieved by patients with intracerebral hemorrhage (ICH) stroke and subarachnoid hemorrhage (SAH) stroke and to identify clinical characteristics and measures associated with walking distances >15.24m.
  
  
  METHODS
  Retrospective pre- and postintervention study.
  
  
  METHODS
  Regional neurointensive care unit.
  
  
  METHODS
  Adult patients with ICH and SAH (N=361).
  
  
  METHODS
  Daily mobility intervention based on patient's current LOF.
  
  
  METHODS
  Walking >15.24m (LOF 5) by neurointensive care unit discharge.
  
  
  RESULTS
  Electronic health records for 361 patients (52.6% women; mean age, 62.1y; ICH stroke, 63.2%; aphasia, 35%; hemiplegia, 33%) were included. There was a 2.3-fold increase in patients with hemorrhagic stroke achieving a LOF of 5 by neurointensive care unit discharge after introduction of a mobility intervention. In the multivariable logistic regression model including neurointensive care unit length of stay (LOS) as a covariate, the intervention, LOF of 5 at admission, SAH stroke type, third (vs lowest) quartile of neurointensive care unit LOS, and absence of aphasia and/or hemiplegia were associated with higher likelihood of achieving a LOF of 5 (odds ratio [OR]=5.28; 95% confidence interval [CI], 2.52-11.06; OR=6.02; 95% CI, 1.45-24.96; OR=3.78; 95% CI, 1.83-7.80; OR=2.94; 95% CI, 1.16-7.47; OR=17.77; 95% CI, 6.59-47.92, respectively).
  
  
  CONCLUSIONS
  A mobility intervention was strongly associated with increased distance walked by neurointensive care unit patients with acute hemorrhage at discharge and can be applied in any intensive care unit setting to promote stroke recovery. Future studies directed at building predictive models for walking achievement in patients with acute hemorrhagic stroke may provide insight into individualized treatment goal setting and discharge planning.
authors.affiliation: Clinical Education, Practice & Informatics, Kaiser Permanente, Redwood City, CA. Electronic address: maxinerand@mail.fresnostate.edu.
authors.forename: Maxine L
authors.initials: ML
authors.lastname: Rand
authors.affiliation: Biostatistical Consulting Unit, Kaiser Permanente Division of Research, Oakland, CA.
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Darbinian
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000150:complications; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D007362:Intensive Care Units; D020300:Intracranial Hemorrhages / Q000150:complications*; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology*; D000071939:Stroke Rehabilitation; D013345:Subarachnoid Hemorrhage / Q000150:complications; D016138:Walking
keywords: Intensive care; Length of stay; Mobility limitation; Rehabilitation; Stroke; Subarachnoid hemorrhage; Walking