Abstract T P303: Early Mobility after Thrombolysis for Stroke is Safe and Improves Outcomes

Abstract

Purpose: To evaluate safety and outcome of mobilizing patients to their functional ability within 24 hours of receiving thrombolytic therapy (IV tPA) for stroke at two Primary Stroke Centers. Background: Bed rest for 24 hours after tPA for stroke is the national standard of care, though there are no data to support this practice. Additionally, tPA patients are not typically mobilized early due to a perceived risk of increased complication or falls. However, data show that early mobility in other critical care populations improves outcomes and shortens length of stay (LOS). Studies to date among tPA-treated patients suggest favorable outcomes but with small clinical trial data. Methods: A validated Stroke Early Mobility Assessment Protocol was implemented within 24 hours in all patients receiving tPA for stroke and mobilizing them to their highest functionally safe level. Data from pre (Jan 2009-June 2012) and post (July 2012-March 2014) implementation were compared for safety and outcome, including complications, falls, discharge destination, and LOS. Chi square and t-tests were used to determine significant differences in outcomes before and after implementation. Results: Between 2009 and 2014, 331 stroke patients received tPA (177 pre-implementation and 154 post). Among those receiving tPA after implementation, 129 were mobilized per protocol, 16 were not, and 8 were placed on comfort care. There were no falls among tPA patients pre or post implementation. Post implementation patients mobilized early were more likely to be discharged home, 56.5% vs. 40.1%, and less likely to expire or discharge to hospice, 9.6% vs 4.5% (p<0.01). There was no significant change in symptomatic hemorrhagic complications or LOS. Conclusion: Using a validated protocol, early mobilization of patients after tPA does not cause an increase in falls or neurologic or other complications. Early mobilization may improve the likelihood of discharge to home and reduce in-hospital mortality, but does not change LOS. Future analyses will include multivariate models to determine the direct relationship between early mobilization and outcomes among ICU patients receiving tPA.