Early Out-of-Bed Rehabilitation After Endovascular Thrombectomy: A Randomized Controlled Trial.

OBJECTIVES

To determine whether out-of-bed rehabilitation within 48 hours after endovascular thrombectomy (EVT) for large-vessel occlusion improves functional outcomes and motor recovery and to evaluate the safety of neurologic and immobility-related complications.

DESIGN

A randomized controlled trial.

SETTING

A tertiary medical center.

PARTICIPANTS

Forty-two patients (N=42) who underwent EVT for anterior-circulation large-vessel occlusion and were stable within 48 hours after reperfusion were randomly assigned to early out-of-bed mobilization (EM; n=21) or usual care (UC; n=21) groups.

INTERVENTIONS: The EM group initiated progressive out-of-bed activities within 48 hours, and the UC group received conventional rehabilitation within 7 days. Both groups received 20-30-minute sessions twice daily, 5 d/wk.

MAIN OUTCOME MEASURES: The primary outcome was the modified Rankin Scale (mRS) at 3 months. Secondary outcomes included mRS at 1 month, Barthel Index, and Fugl-Meyer Assessment for the upper extremity and lower-extremity at 1 and 3 months. Neurologic and immobility-related adverse events were monitored for 3 months.

RESULTS

At 3 months, no significant between-group difference in mRS was observed. Barthel Index scores were comparable at both follow-up time points. Exploratory analyses suggested greater motor recovery in the EM group. The mean between-group difference in Fugl-Meyer Assessment for the upper extremity was 7.13 points (95% CI, -0.98 to 15.24; P=.083) at 1 month and 12.20 points (95% CI, 1.21-23.19; P=.031) at 3 months, whereas the Fugl-Meyer Assessment for the lower-extremity difference was 5.14 points (95% CI, 1.45-8.84; P=.008) at 1 month and 6.33 points (95% CI, 1.06-11.59; P=.020) at 3 months. Neurologic and immobility-related adverse events were infrequent and comparable.

CONCLUSIONS

EM initiated within 48 hours after EVT was not associated with improved overall functional outcome but was safe and associated with notably greater upper and lower-extremity motor recovery compared with UC.