Archives of physical medicine and rehabilitation · 2015
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.
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Rand Maxine L, Darbinian Jeanne A
Аннотация
OBJECTIVES: 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.
DESIGN: Retrospective pre- and postintervention study.
SETTING: Regional neurointensive care unit.
PARTICIPANTS: Adult patients with ICH and SAH (N=361).
INTERVENTION: Daily mobility intervention based on patient's current LOF.
MAIN OUTCOME MEASURE: 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.
DESIGN: Retrospective pre- and postintervention study.
SETTING: Regional neurointensive care unit.
PARTICIPANTS: Adult patients with ICH and SAH (N=361).
INTERVENTION: Daily mobility intervention based on patient's current LOF.
MAIN OUTCOME MEASURE: 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.
Предметные рубрики MeSH
Activities of Daily LivingAge FactorsAgedAged, 80 and overCerebral HemorrhageComorbidityFemaleHealth StatusHumansIntensive Care UnitsIntracranial HemorrhagesLength of StayMalePatient DischargePhysical Therapy ModalitiesRecovery of FunctionRetrospective StudiesStrokeStroke RehabilitationSubarachnoid HemorrhageWalking