Early mobilization in patients with aneurysmal subarachnoid hemorrhage: a prospective observational study

IMPORTANCE: Patients with aneurysmal subarachnoid hemorrhage (aSAH) represent a cohort with limited evidence to guide mobilization practices. OBJECTIVE: The objective was to describe acute mobilization practices, outcomes, and barriers to mobilization in patients following aSAH. DESIGN: The design of the study was a single-center prospective, observational study. SETTING: This study was conducted in the acute ward and intensive care unit of a tertiary neurosurgical referral center. PARTICIPANTS: Participants were adult (≥18 years) patients post-aSAH with secured aneurysms. EXPOSURE: Mobilization practices were delivered during physical therapist sessions up to 14 days post-aneurysm repair. MAIN OUTCOMES AND MEASURES: Severity was classified using the World Federation of Neurological Surgeons scale, dichotomizing into "good" (Grade I to II) and "poor" (Grade III to V) clinical status. Mobilization outcomes were measured using the Mobility Scale for Acute Stroke (MSAS), with independent walking assessed. RESULTS: A total of 102 patients participated with 69 (67.6%) classified as "good" grade and 90 (88.2%) of patients mobilized within the first 14 days. Data were collected from 603 planned mobilization sessions, with barriers to mobilization encountered in 193 (32.0%) of these sessions, primarily due to neurological instability (n = 80, 41.5%) and hemodynamic instability (n = 43, 22.3%). Overall, the highest median MSAS score achieved was 32 (IQR = 10 to 36). By 2 weeks, 65.2% of patients with a "good" clinical status walked independently versus 12.9% in the "poor" group. CONCLUSIONS: While most patients mobilized, physiological instability commonly prevented mobilization activities. Independent walking by 2 weeks was significantly more common in patients with "good" clinical status. These findings underline the importance of careful screening and monitoring during mobilization in the acute period. RELEVANCE: This study underscores the need for further research into optimal mobilization strategies for improving outcomes in patients with aSAH.