title: Effect of early mobilization and rehabilitation on complications in aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE Early rehabilitation is effective in an array of acute neurological disorders but it is not established as part of treatment guidelines after aneurysmal subarachnoid hemorrhage (aSAH). This may in part be due to the fear of aggravating the development of cerebral vasospasm, which is the most feared complication of aSAH. The aim of this study was to evaluate the effect of early rehabilitation and mobilization on complications during the acute phase and within 90 days after aSAH. METHODS This was a prospective, interventional study that included patients with aSAH at the neuro-intermediate ward after aneurysm repair. The control group received standard treatment, whereas the early rehab group underwent early rehabilitation and mobilization in addition to standard treatment. Clinical and radiological characteristics of patients with aSAH, progression in mobilization, and treatment variables were registered. The frequency and severity of cerebral vasospasm, cerebral infarction acquired in conjunction with the aSAH, and acute and chronic hydrocephalus, as well as pulmonary and thromboembolic complications, were compared between the 2 groups. RESULTS Clinical and radiological characteristics of patients with aSAH were similar between the groups. The early rehab group was mobilized beginning on the first day after aneurysm repair. The significantly quicker and higher degree of mobilization in the early rehab group did not increase complications. Clinical cerebral vasospasm was not as frequent in the early rehab group and it also tended to be less severe. Each step of mobilization achieved during the first 4 days after aneurysm repair reduced the risk of severe vasospasm by 30%. Acute and chronic hydrocephalus were similar in both groups, but there was a tendency toward earlier shunt implantation among patients in the control group. Pulmonary infections, thromboembolic events, and death before discharge or within 90 days after the ictus were similar between the 2 groups. CONCLUSIONS Early rehabilitation of patients after aSAH is safe and feasible. The earlier and higher degree of mobilization does not increase neurosurgical complications. Rather, the frequency and severity of cerebral vasospasm following aSAH are alleviated and are not aggravated by early rehabilitation. Clinical trial registration no.: NCT01656317 ( www.clinicaltrials.gov ).
authors.affiliation: Departments of 1 Physical Medicine and Rehabilitation and.|Neurosurgery, Oslo University Hospital, Oslo.
authors.forename: Tanja
authors.initials: T
authors.lastname: Karic
authors.affiliation: Departments of 1 Physical Medicine and Rehabilitation and.|Institute of Clinical Medicine, University of Oslo, Norway.
authors.forename: Cecilie
authors.initials: C
authors.lastname: Røe
authors.affiliation: Departments of 1 Physical Medicine and Rehabilitation and.
authors.forename: Tonje Haug
authors.initials: TH
authors.lastname: Nordenmark
authors.affiliation: Sunnaas Rehabilitation Hospital, Nesoddtangen; and.|Institute of Clinical Medicine, University of Oslo, Norway.
authors.forename: Frank
authors.initials: F
authors.lastname: Becker
authors.affiliation: Neurosurgery, Oslo University Hospital, Oslo.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Sorteberg
authors.affiliation: Neurosurgery, Oslo University Hospital, Oslo.|Institute of Clinical Medicine, University of Oslo, Norway.
authors.forename: Angelika
authors.initials: A
authors.lastname: Sorteberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004434:Early Ambulation; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000534:rehabilitation* / Q000601:surgery*; D013997:Time Factors; D020301:Vasospasm, Intracranial / Q000453:epidemiology
keywords: CPP = cerebral perfusion pressure; CTA = CT angiography; DVT = deep venous thrombosis; NIW = neuro-intermediate ward; PE = pulmonary embolism; aSAH = aneurysmal subarachnoid hemorrhage; aneurysmal subarachnoid hemorrhage; cerebral vasospasm; complications; early rehabilitation; mobilization; neurointensive care; vascular disorders